Hospice & Palliative Care Nursing

Nurses' Perceptions of End-of-Life Care Before and After Interventions in Intensive Care Units

by Teresa Goodell

The Value of Loss

by Author Sam Oliver

Loss has values our world needs.

The Value of Loss

    We live in an age of efficiency and time constraints. Everything we do... more The Value of Loss

    We live in an age of efficiency and time constraints. Everything we do has to be fast and with incredible accuracy. There doesn’t seem to be any room for mistakes or a person who slows down in maturity. It seems as though we live in a society that wants to treasure the young and devalue the elderly.
    The ability to live in such a fast paced world demands so much out of us as we age. We attempt to run with the pack like a ban of wolves until we can no longer take another step. A world that no longer values maturity is a world that is heading towards a life filled with no meaning. Experience brings to life the role of a teacher. A person able to express and bring into being the reasons why we do what we do.
    Hospice has taught me a great deal about loss over the years. Dying people slow my pace down a lot in the course of a day. Much of my mind is on meeting deadlines and schedules my company demands of me so I can visit all who need me in a given week. At the same time, my Hospice patients demand me to slow down and be attentive to even the smallest of needs. Here are just a few of them.

1. Listen to their story.
Even if you hear the same old story day after day after day, or a story is told with memory lapses. Your ability to hold your attention on what brings meaning to a dying patient is a way of caring. It is an incredible opportunity for two hearts to be engaged in unconditional love. This movement into unconditional love engages a purposeful attempt on your part to expand your heart and give space to someone others may be devaluing because he or she is no longer a productive member of society. Here, you become a bridge of communication between the divine and human qualities of attention that brings healing into a world that no longer values attentive awareness.

2. Give space to the Creative Imagination.

Giving space for the creative imagination to emerge in a relationship is like opening a door into the heavens. The creative imagination is the inner vision of a person’s mind and heart. When your mind and heart join to create a path, your soul is engaged.  Soul Care is the essence of why each of us is here. We all want to be known as we are truly known in this world. Such vulnerability is not as helpless as the world has made it out to be. To be known for whom you are without judgment by you or others is a pathway into courage. The ability to share a part of this level of who you are indicates a person’s capacity to trust the world in ways known to us as a child. It was the time in your life when you engaged the world in play and not stress.

3. Appreciate Silence.

Your ability to calm down the mind and heart, so you can match the pace of a dying loved one is a gift. It opens your reflective nature and creates a path into a place your soul calls home. The ability to hold your attention on the needs of another over your own opens the gateway into your empathic nature. All of us have the ability to be “in tune” with another person when we realize the needs of another are important. The heart begins to open and a channel of expression beings to emerge. Your feelings begin to appreciate the needs of another in a moment of silence where the feelings of awareness unite you in peace.

4. Letting Go.

Letting go of your needs and a dying patient’s needs to hold on to a world that no longer values loss opens a pathway into divine qualities of existence only your soul can embrace. This passageway into a sense of meaning beyond this life gives hope to those who are aging and faith to the dying. Those of us who care for the dying find meaning in the loss of life through a constant remembering the value our patient’s instill upon us as they become more soul than body at the end of their life.

5. Grieving.

Loss opens up a place inside us that guides our hearts and minds into a place where we remember who we really are. We realize that our life will someday come to an end. It challenges us to grow into a reflective lifestyle whereby we do good things for goodness sake and no longer do things to build our egos up. Knowing your life will someday come to an end brings life to your soul and a new beginning for most people to discover for the first time in their life what is really important.

    This journey into realizing that the things in life that really matter are the things in life that isn’t matter is a place of awareness where we understand the meaning of loss. Valuing loss in our society gives appreciation to and for what has gone before us and who made our lives possible. Giving attention to the value loss brings allows us to balance our lives in ways we may not attempt apart from a reason to do so.
    Loss creates space in our world giving homage to the value our history brings to the present moment. Without such honor bestowed on these moments of time our life has brought into being is a life lived without appreciation for what brought each of us together we call the human race. Such a devaluing of human expression leaves no real hope for those creating our future as well. For a life lived without remembering what has sustained its life is a life no longer infused by the spirit that brings all life into being. A life without spirit inspires nothing. Having nothing to live for is a sad place to be inside yourself and the purpose of living no longer remains alive and well. Without a reason to live, all life ceases to be.

Sam Oliver, author of “Mondays with Mary” is a Hospice Chaplain for Amedisys Hospice Care in Londonderry, NH.

Two Kinds of Grief

by Author Sam Oliver

Grief

Over the last 22 years, I have noticed Hospice families deal with the loss of their loved one in a couple of ways.... more Over the last 22 years, I have noticed Hospice families deal with the loss of their loved one in a couple of ways. There are those who mourn deeply their loss. And, there are those who grieve with hope. Both will lead you to the same place inside your being. Therefore, I do not want to imply that one way of grieving is better than the other.

As a loved one passes or is close to the end of their physical life, families begin to find themselves at a loss. The ability to talk to their loved one diminishes. The ability to take a walk with him or her falls away. The ability to share a meal, a memory, and countless other experiences fade into past memories. These past memories become alive inside those who can no longer create new experiences with their loved one who is dying.

This regression into one’s imagination and one’s heart reveals experiences that come alive inside one’s soul. Here, souls join one another on a journey that has no beginning or an end. This part of a relationship is eternal and sacred. They are the inspirational moments allowing a story to be formed and shared. As such, a sacred memory becomes a living presence inside those who have shared them.

I have noticed two kinds of grief in dealing with Hospice families dealing with the loss of their loved ones. One is mourning. The other is grieving with hope.

Mourning is a deep heartfelt experience of loss. This is a kind of grief that expresses itself in the body on an emotional level. The body may become flushed, weakened, very tearful, and much more.

It is good to allow space for deep seeded grief to express itself. This cleanses toxic emotions needing to express themselves through the body. As a person finds expression for their grief, a feeling of relief relaxes the body over a period of time.

Grieving with Hope is faith based. This usually means that a person believes he or she will meet their loved one in heaven again someday. This kind of hope can be comforting in the moment. Later, a person may feel his or her loss when their loved one doesn’t come home with them at their death.

Although a faith based grief has its strength, it does not make everything ok. There is still a feeling of loss on an emotional level. The heart knows something is different and nothing will be the same again.

Our bodies were created to express themselves “even” in grief. In Sacred Texts of many kinds, we find the encouragement to find “peace in the midst of despair” or “blessed are they who mourn for they shall be comforted.” Both of these statements reveal a connection to our faith in a higher being who will give us healing through the path of loss, and into, a sacred journey into the soul where our relationships are eternal.

This journey is taken through and inside the body. It is the journey into the same breath that gives us life and leads us home at the moment our body releases that breath in death. It is a sacred path leading us into who we really are.

Medical error in the hospice setting: Exploring the perspectives of management staff

by Reema Sirriyeh

Medical error in the hospice setting: Exploring the perspectives of management staff

by Reema Sirriyeh

Words for Dying, Death, and Living

by Daniel Keeran MSW

by Daniel Keeran, MSW

Much of the content of this paper is from the chapter on Grief Counseling Skills in more Much of the content of this paper is from the chapter on Grief Counseling Skills in http://www.amazon.com/Effective-Counseling-Skills-therapeutic-statements/dp/1442177993

Areas of conversation between the living and the dying are listed and described in practical detail designed for sharing with family and friends.

The most common reaction to the subject of death and dying is to feel afraid and to avoid the discussion altogether, yet being able to talk openly about the end of life, is one of the most important conversations. For the living, unresolved grief is a major cause of poor mental health often resulting in chronic depression, relationship breakdown, addiction, physical illness, and sometimes suicide.

Three Lives, Three Deaths, Three Journeys: Explorations on Dying Well

by Linda MacDonald Glenn

" The Grandest Badge of His Art": Three Victorian Doctors, Pain Relief, and the Art of Medicine

by Martha Stoddard Holmes

Staff-led interventions for improving oral hygiene in patients following stroke. Cochrane Database of Systematic Reviews (update)

by Marian Brady

Brady MC, Furlanetto D, Hunter RV, Lewis S, Milne V.

Background:
For people with limitations due to neurological conditions such as stroke, the routine practice of... more Background:
For people with limitations due to neurological conditions such as stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group.


Objectives:
To compare the effectiveness of staff-led OHC interventions with standard care for ensuring oral hygiene for individuals after a stroke.


Search strategy:
We searched the trials registers of the Cochrane Stroke Group (last searched April 2010) and Cochrane Oral Health Group (last searched May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library May 2010), MEDLINE (1966 to May 2010), CINAHL (1982 to May 2010), Research Findings Electronic Register (February 2006), National Research Register (Issue 1, 2006), ISI Science and Technology Proceedings (July 2010), Dissertation Abstracts and Conference Papers Index (August 2005), Zetoc (2000 to July 2010) and Proquest Dissertations and Theses (2000 to July 2010). We scanned reference lists from relevant papers and contacted authors and researchers in the field.


Selection criteria:
Randomised controlled trials that evaluated one or more interventions designed to improve oral hygiene. We included trials with a mixed population provided we could extract the stroke-specific data.


Data collection and analysis:
Two review authors independently classified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. We sought clarification from study authors when required.


Main results:
We included three studies involving 470 participants. These trials were of limited comparability evaluating an OHC education training programme, a decontamination gel and a ventilator-associated pneumonia bundle of care augmented with an OHC component by comparing them to a deferred intervention, a placebo gel or standard care respectively. The OHC educational intervention demonstrated a significant reduction in denture plaque scores up to six months (P < 0.00001) after the intervention but not dental plaque. Staff knowledge (P = 0.0008) and attitudes (P = 0.0001) towards oral care also improved. The decontamination gel reduced the incidence of pneumonia amongst the intervention group (P = 0.03).


Authors' conclusions:
Based on two trials involving a small number of stroke survivors, OHC interventions can improve staff knowledge and attitudes, the cleanliness of patients' dentures and reduce the incidence of pneumonia. Improvements in the cleanliness of patients teeth were not observed. Further evidence relating to staff-led oral care interventions is severely lacking.


This record should be cited as:


Brady MC, Furlanetto D, Hunter R, Lewis SC, Milne V. Staff-led interventions for improving oral hygiene in patients following stroke. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003864. DOI: 10.1002/14651858.CD003864.pub2

Healing the Pain of Grief

by Daniel Keeran MSW

by Daniel Keeran, MSW, RMHC-S

GRIEF COUNSELING THEORY AND SKILLS COURSE ONLINE

In this practical online course you will learn what to say to help someone who is grieving and needs healing to move forward in life. The course text and assignments are included in tuition and are sent to you immediately as a PDF attached email file with a hard copy sent by regular mail. To Register visit http://www.counseling-skills.com

This article is an excerpt from the chapter entitled “Grief Counseling Skills” in Effective Counseling Skills: the... more This article is an excerpt from the chapter entitled “Grief Counseling Skills” in Effective Counseling Skills: the practical wording of therapeutic statements and processes. More practical skills are found in the following press release http://prlog.org/11645786

Daniel Keeran, MSW, has been a professional counselor and therapist for over 30 years. He has provided counseling and training to thousands of professionals and the public through his private practice, seminars, and online training courses.

To order the best-selling training manual "Effective Counseling Skills" go to http://www.amazon.com/Effective-Counseling-Skills-therapeutic-statements/dp/1442177993

The importance of religious orientation in dying well: Evidence from three case studies

by Monika Ardelt

Ardelt, Monika; Koenig, Cynthia S.
Journal of Religion, Spirituality & Aging, Vol 19(4), 2007, 61-79.

As older adults approach the ends of their lives, it is not uncommon to find a decrease in subjective well-being.... more As older adults approach the ends of their lives, it is not uncommon to find a decrease in subjective well-being. However, a number of studies have indicated that elders with an intrinsic rather than extrinsic religious orientation often are able to keep a high level of subjective well-being even if they are close to death. In a previous quantitative study, only intrinsic religiosity was indirectly and positively related to subjective well-being in a sample of 103 relatively healthy older adults and 19 hospice patients (age 61+), mediated by shared spiritual activities and purpose in life. Extrinsic religiosity, by contrast, was indirectly and negatively related to subjective well-being. To explore in greater depth how religious orientation might influence subjective well-being at the end of life, we used the method of objective hermeneutics to examine semi-structured qualitative interviews with three older male hospice patients (ages 79, 80, and 98) on religion/spirituality and attitudes about death and dying. Results of the analyses revealed that the intrinsically religious respondent maintained his sense of cosmic purpose in life, which continued to be a source of satisfaction for him, unaffected by his terminal illness. The two extrinsically religious respondents, however, did not find solace in their religion and, hence, were unable to cope with their physical and emotional dependence and vulnerability. The findings suggest that an intrinsic religious orientation is most likely to be related to a cosmic sense of purpose in life, which facilitates subjective well-being even in the face of death.

The role of religion for hospice patients and relatively healthy older adults

by Monika Ardelt

Ardelt, Monika; Koenig, Cynthia S.
Research on Aging, Vol 28(2), Mar 2006, 184-215.

As older adults approach the end of life, they frequently experience death anxiety and a decline in subjective... more As older adults approach the end of life, they frequently experience death anxiety and a decline in subjective well-being that is not always alleviated by increased religious participation. One possible explanation is the differential influences of intrinsic and extrinsic religiosity. The present study examined the effects of religious orientation and spiritual activities on subjective well-being and death attitudes among 103 relatively healthy older adults and 19 hospice patients (age 61+). Results of path analyses showed that a sense of purpose in life rather than religiosity had a direct positive effect on subjective well-being and a direct negative effect on death fear after controlling for physical health and demographic characteristics. Intrinsic religiosity had an indirect positive effect on subjective well-being and a strong direct positive effect on approach acceptance of death. Extrinsic religiosity, however, was positively related to death anxiety and, for hospice patients, negatively related to approach acceptance of death.

The Anticipatory Corpse: Medicine, Power, and the Care of the Dying

by Jeffrey Bishop

The Practice of Cultivating Bodhichitta and Maranasati

by Jennifer R. Stevens

My purpose in researching this subject was multi-faceted.  I wanted to explore the Tibetan Buddhist perspective... more My purpose in researching this subject was multi-faceted.  I wanted to explore the Tibetan Buddhist perspective regarding the process of actual dying and the transfer of consciousness (Phowa), that is believed to occur following the death and I planned to investigate the rituals and meditations associated with their understanding of death.  I, also, hoped to discover how Buddhist thought can help supplement Western practices of end-of-life care, including the methods of training, the use of rituals, and the ways of offering support to those who companion the dying.  I hope to understand ways to implement Buddhist wisdom to deepen and enrich our lives and our dying in the West, especially if a patient is open to supplementing their own spiritual path with conscious dying.  Finally, I intended to suggest some areas where further inquiry might be of benefit to the field of psychology and to the practice of working with death and dying.

How Much Compassion Have I Left? An Exploration of Occupational Stress Among Children's Palliative Care Nurses.

by Laurence Taggart

Sharon McCloskey, Laurence Taggart
International Journal of Palliative Nursing 16(5): 233 - 240 (May 2010)

Nursing is a stressful occupation. While children's palliative care nurses encounter many of the stressors in common... more Nursing is a stressful occupation. While children's palliative care nurses encounter many of the stressors in common with other nurses, this unique context of care generates specific aspects of stress that warrant further examination. This qualitative study explores the experiences of stress in nurses providing children's palliative care in one region of the UK. In total, four focus groups took place with children's hospice nurses, community children's nurses and children's nurse specialists based in the regional children's hospital. The focus groups were taped, transcribed and analysed through the application of Newell and Burnard's thematic content analysis methodology. Four core themes emerged: work demands; relationships, maintaining control, and support and roles. Of particular note were stressors associated with the sub-themes of relationships, emotional demands and ethical conflicts. Conclusions illustrating how individuals and organizations may reduce the impact of stress in nurses contributing to the palliative care of children and their families are made.

“The very environment militates against denial”: Negotiating Place Through Material Culture

by Ian Brodie

Ethnologies, Volume 27, numéro 2, 2005, p. 189-217

In this article the author reflects on the objects brought into his father’s hospice room in the last eight weeks of... more In this article the author reflects on the objects brought into his father’s hospice room in the last eight weeks of his life. Objects and their placement were continually renegotiated as he moved through various stages of his disease — greater and lesser pain, appetite, freedom of movement, and lucidity, and shifting timeframes for his imminent passing. The author’s father had no direct control over the presence or absence of objects, and little control over their placement, so that the room became a site of polite contestation among the various parties helping him in his final days.