Kath's Blog

Norway Tragedy - reflections

2011-07-25T08:30:00.001-07:00

I am not sure where I was when the tragedy occurred in Norway on June 22nd, but I know where I was when I heard about it.

Moments etched in my mind - Moments and hours in the dark of the night -

a sense of unreality that fellow human beings have the ability to be so cruel and to cause such pain.

sharing the sorrow of individuals, families, friends and communities.

pondering the mothers and fathers of the dead and injured.

pondering the trauma of those who survived.

knowing that there is a mother out there somewhere anguishing... asking HOW and WHEN and WHY her son would or could do such evil.

thinking of the police and rescue team members.

thinking of those who planned and led this camp where youth met to consider a better world.

and thinking of adventures, hikes, conferences, and experiences with our kids, and with our community of kids...

a moment of silence to share globally such sorrow.

Kath

Norway Tragedy - responding to kids

2011-07-25T07:10:00.000-07:00

We are in the midst of teaching the course "Walking and Talking with Kids about Death and Dying". In preparation for the course Wendy (Kurchak) found a short Youtube video interview with Dr. Bob Hilt from from Seattle Children's Hospital addressing "how to talk to kids about global disasters". Dr. Hilt provides some key points and a role play to highlight his points. This video is timely, and guidelines would be helpful for all parents! http://www.youtube.com/watch?v=V5zaS_2Fnd0

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Thomas Attig - The Heart of Grief

2011-07-13T20:39:00.000-07:00

Victoria BC is fortunate to be the new home of Dr. Thomas Attig. Today I had the privilege of visiting with Tom as we sat by the Victoria breakwater at the Ogden Point Cafe. We talked about one of my favorite books which Tom actually wrote - "The Heart of Grief". I still remember the day that I found this book, read the opening quote, "Death ends a life it does not end a relationship". Tom was the first author I found who adequately addressed the desire for an ongoing "relationship" with the deceased, pointed out that people do not want to stop hurting if they feel that they are supposed to "sever" the relationship with their deceased loved one, and identified the many many ways that people continue to be influenced by their loved one even after death.

In The Heart of Grief, Tom recounts "dozens of stories of people who have struggled with deaths in their lives, he describes grieving as a transition from loving in presence to loving in separation.... He tells stories, for instance, of a young girl taking some of her dead sister's practical advice as she enters high school, a widower realizing how much intimate life with his wife has colored his character, and an athlete drawing inspiration from his dead brother and achieving what they had dreamed of together. Far from forgetting our loved ones, Attig urges us to explore ways in which our memories of the departed can be sustained, our understanding of them enhanced, and their legacies embraced, so they continue to play active roles in our everyday and inner lives." http://www.griefsheart.com/heartofgrief.html

For those who want to hear Tom speak, you can listen to him in the "Life and Death Matters Podcast Library"

Thanks Tom for a great visit, and THANKS Tom, for a GREAT BOOK!!

Kath

Are we preparing our health care professionals to provide excellent care for the dying?s

2011-07-11T22:01:00.000-07:00

I used to think that all dying people should be registered with a hospice organization, receive Cadillac services, and die supported by the specialty care team.

Over the past few years I have been intrigued by the work of Palliative Care Australia (PCA). PCA suggests that the majority of the dying can and will be cared for and have their needs met by their primary care teams, and not by the specialty hospice palliative care services. This means that rather than working to increase referrals to hospice programs that we need to educate all members of the health care team to provide care for the dying, across all settings.

What is happening across Canada to prepare the health care team during their core curriculum to provide excellent care for the dying?

Registered Nurses - In 2009 the Canadian Association of Schools of Nursing (CASN) announced “a new educational resource developed by the CASN Task Force on Palliative and end-of-life care to assist educators in curriculum development. See http://casn.ca/en/Whats_new_at_CASN_108/items/81.html In March 2011 CASN Task Force met in Ottawa and with input from Stakeholders revised this list. For more information and updated resource contact the CASN office.

Practical Nurses –The National Blueprint for 2012-2016 is now available. My limited understanding is that the Blueprint only outlines knowledge that can be tested on a multiple choice exam. The Blueprint does not contain competencies or indicators. Does anyone have information on national or provincial projects to address the development of Palliative End of Life Competencies within core curriculum for Practical Nurses?

Health Care Workers (HCW) A national committee is currently developing competencies for “unregulated caregivers” to help standardize education and increase job mobility. Considering that HCWs are often the eyes, the ears and the hands of the health care team, and they provide care that is critical to the implementation of any Care Plan, it is my great hope that the committee will address competencies related to Hospice Palliative End of Life.

Physicians Competencies have been developed for educating Medical Students (Educating Future Physicians in End of Life Care EFPEC) and similarly competencies are currently being developed for Social Workers. I am not sure what is being done for educating pharmacists and other members of the health care team.

If anyone has further updates or information, please add to the discussion! Go to

http://www.facebook.com/pages/Life-and-Death-Matters/154744847924194

Thanks

Kath

Hospice Africa, Hospice Africa Uganda

2011-07-11T20:52:00.000-07:00

We are thrilled to have students in our current online course, "Walking and Talking with Kids about Death and Dying" from Nepal, Kenya, Tanzania, and Uganda. One of the participants who wanted to sign up, but is unable to at this point, asked for information on Hospice Africa, and asked that I link her with the site. As with other good links, I am including some links here, and a book that addresses volunteering with Hospice Africa, as well as describing, chronicalling, and discussing the development and work of hospcie in Africa!

The website for Hospice Africa is http://hospice-africa.merseyside.org/index.html

The website for "All Africa" is http://allafrica.com/stories/201106060201.html This site seems to link with a number of ads, as well as links for information about hospice in Africa.

Find more about Hospice Uganda at http://hospiceafrica.ie/hospice-africa-uganda. Hospice Africa Uganda is linked closely with Hospice Africa, and to Ireland to Dr Anne Merriman. Dr Merriman's book is the "Audacity to Love - The Story of Hospice Africa".

Ateduobie, and others, if you would like to direct us to a specific site or resource, please send that information, or comment on our facebook page.

Integrating Hospice Palliative Care Education in Core Curriculum

2011-07-06T16:41:00.000-07:00

To integrate or not to integrate - that is the question: Hospice Palliative Education in core curriculum.
My preference is a combined approach! It is important to set aside a place where the focus is on Hospice Palliative Care philosophy, principles and practices. A separate course helps to ensure that the message is not diluted and lost in the context of an entire program. On the other hand, how can you discuss respiratory illnesses and not discuss the process of dying at end stage with COPD? How can you teach about the kidney without teaching about dying with renal disease?
The reality is that illnesses need to be followed from diagnosis through to death.
Body systems should likewise be followed from healthy function through to dysfunction and death.
Human development should follow conception through birth, ages and stages and follow through to death.
So my vote is a "combination" of methods for teaching Hospice Palliative Care, whether you are educating Health Care Workers, Practical Nurses or Registered Nurses.
What do you think?
Please go to facebook to comment! http://www.facebook.com/note.php?created&&note_id=188486651205552
Kath

Bridging the apparent gap between the Hospice and the Gerontology worlds

2011-06-30T07:20:00.001-07:00

Good morning!

I received an email this morning from a dear colleague from Hood College whose goal is to help bridge the apparent gap between the hospice palliative care world and the gerontology world.
Kim asked for the names of a few articles, a few leaders who have helped to develop my understanding of gerontology, as a hospice palliative care nurse.

Mercedes Bern Klug, wrote an article titled "The Ambiguous Dying Syndrome". Published in the Journal of Social Work in 2004, Mercedes does an incredible job of addressing the challenge of dying with chronic illness over a long, unknown period of time.

Ladislav Volicer, M.D., Ph.D wrote a paper Alzheimers Association titled, "End-of-life Care for People with Dementia in Residential Care Settings" which is the most thorough article on the topic that I have seen. His references will lead you to many other articles.

A few of my favorite books:

Joanne Lynn wrote a great book on dying with chronic illness, titled: "Sick to Death and Not Going to Take is Anymore!: Reforming Health Care for the Last Years of Life." Her stats are American based, but reflect Canadian trends regarding dying with chronic illness, unknowns, etc..

There are a few good texts on Palliative Care and Dementia, including one by Volicer and Hurley, another by Morrison and Meier.

The Hospice Foundation of America has a series of books, with a new book published each year. They have a few books that address the topic of losses associated with aging, and dying with dementia.

I posted an entry to facebook on this topic today. Please feel free to add your favorites to this list!

Kath

Comedy in the midst of loss - Carol Scibelli

2011-06-27T08:35:00.000-07:00

Carol Scibelli is a comedian whose husband died in 2006. Seeing humour provided her with solace, or as she calls it "grief relief". She is wired to be funny, she presents humor that is honest and knows that laughter can be healing.

Her book "Poor Widow Me" may provide some laughter for those looking for moments of relief. Sample: "There I was, his wife, his widow, sitting between our children in the first row, reserved for the closest of family; probably the only time in life that people don't want the best seats in the house."

Her blog, "Last Spouse Standing" provides lots of great laughs! http://poorwidowme.blogspot.com/

My only regret of the conference is that we did not get a chance to "do dinner together" - It would have been great fun!

Thanks Carol!

Kath

Ken Doka on Disenfranchised Grief

2011-06-27T07:54:00.000-07:00

One of the highlights of the ADEC conference was a half day session with Ken Doka on Disenfranchised Grief.

Ken started the session by trying to set us all at ease, encouraged us not to worry about what we have said or done in the past and mentioned an interesting article, “On doing everything right, a case study in failure” that sounds interesting.

It was interesting to hear his "ah ha" moment which gave seed to the development of this theory of "Disenfranchised Grief". Ken coined the term to describe the grief that occurs when the loss is not socially sanctioned, openly acknowledged or publicly mourned for the following reasons:

The relationship is not recognized,
The loss is not acknowledged, or
The griever is not recognized.

Ken highlighted ways the theory has been applied and how it has grown in the years since he first wrote about it.

He also wove the idea of grieving styles, Instrumental vs Intuitive, into the discussion. He suggested that disenfranchised styles include:

Males who are intuitive grievers (a mans' tears may be perceived as weak)
Females who are instrumental grievers (a woman may be perceived as being unfeeling)
People who are instrumental grievers early in the loss (we may expect people to express feelings rather then focus energy on the work/tasks that need to be accomplished)
People who are intuitive grievers later in the loss experience (we become impatient with people who continue to express grief over time)
Counsellor disenfranchisement of instrumental grievers who do not want to talk feelings (this hopefully has/is changing with the concept of instrumental vs intuitive grieving styles)

Ken introduced me to "empty arm syndrome" associated with perinatal loss. Following the death of a baby, mothers have sometimes developed pain in the heart, breasts, lower abdomen and upper arms. The location of the pains symbolizing the connection of mother and babe.

Ken also discussed his adaptation to Bill Worden's Tasks of Grief:

Acknowledge the loss
Express manifest and latent emotions (express those emotions that are both obvious and those that are present but not easily visible or actualized)
Adjust to a changed life
Relocate the loss
Reconstitute faith and philosophic systems challenged by the loss.

Ken identified interventions for each of the "tasks" and provided some stories to anchor the learning.

After years of hearing about Ken from our mutual colleagues, Terry Martin and Dana Cable, reading his books, seeing his name in much of the current grief literature, and having him interviewed for the Life and Death Matters Podcast Library, it was a great pleasure to hear/see him present.

Kath

Death Education - an argument for death education presented by Kathy Kortes-Miller

2011-06-27T07:30:00.001-07:00

Kathy Kortes-Miller from Lakehead University in Thunder Bay presented "Situating Death in Education". Kathy provides a strong argument for the question "Why include death education in the schools?"

Kathy kept the group spell bound and I think she had us all wanting MORE! I was proud to be Canadian just to listen to her. She articulated ideas that many of us are familiar with, but she added updates, included great quotes, thoughts and perspectives, and then touched on a few challenges. Her visual presentation was excellent, and the companion handout summarized the presentation.

Kathy articulated well the vehicle of education as a "force for change... the medium by which information is communicated and understanding enhanced.... Education directly influences attitudes and values and can assist in defining, strengthening or modifying them."

Kathy said, "We are not free to choose whether anyone will learn about death, though we have some choice about how they will learn." She suggests that death education specifically "will not prevent death as a normative life event but rather it will work to prevent some of the negative side effects of not understanding dying and death.... Perceiving death education as primary prevention allows for opportunities to begin engaging in the important discussions around the meaning of death and the quality of life which guide our living until we die."

Kathy also discussed another one of my passions - the need to provide better support to the PSWs who provide 80% of patient/resident care in long term care in Ontario!

Thanks and Great Work Kathy!

Kath

Conference: "Association for Death Education and Counseling" and the "International Conference on Grief and Bereavement in Contemporary Society"

2011-06-26T19:34:00.000-07:00

Our GREAT ONLINE FACILITATOR Jen Wortham enticed me to attend the ADEC and ICGBCS conference in Miami this past week. I am delighted that I followed her lead and attended!

The combined conference brought participants from around the globe. My greatest grief was in having to choose between several interesting and exciting workshops for each concurrent session, and the frustration of only being able to be in one place at a time.

For those who are not familiar with ADEC, it is the only group that I know of whose mission includes "Death Education". Postings for the next while will include reflections from the ADEC conference, links to resources/sources.

Interview with Stephanie Staples

2011-06-26T19:09:00.000-07:00

Stephanie Staples from "Your Life Unlimited" provided an upbeat, inspiring and practical keynote address titled "Life Support for Nurses – Burnout Prevention that Works!"

After the conference Stephanie interviewed the Katherine Williams who spoke on "Bullying in the Workplace" and myself. If you would like to see the video go to: http://www.youtube.com/watch?v=cHw8IDczq5

Kath

CLPNBC conference - Living Excellence in Practice

2011-06-18T23:03:00.000-07:00

The CLPNBC conference was held at the Vancouver Italian Cultural Center. The Cultural Center was built on the site of an old dump, built with vision, collaboration, volunteer labour, and lots of determination.... it is an incredible site, providing great place for celebration and education. Fitting to meet there with the LPNs who are growing in leaps and bounds in their full scope practice, and meeting new challenges head on.

I was asked to speak about Living Excellence in Practice. The quotes I especially enjoyed include: Excellence, the state or quality of being exceptionally good.
Excellence is not a skill it is an attitude. Ralph Marston
We are what we repeatedly do. Excellence then is not an act, but a habit. Aristotle
"To strive for excellence is to do the best that you can do" Betty Davies, RN, PhD

We discussed the idea that if excellence is an attitude, a habit, and a striving... then we can be excellent whether we are new grads, have a few years experience, or have been working for thirty years in nursing.

We talked about what excellence in practice and excellence in education feels like, tastes like, and looks like. We then talked about the LPN not only as a learner, but also as a teacher!

Being a hospice nurse, I could not talk without discussing death and dying, and ways that excellence might be included when caring for the dying and their families.

For example, excellence might include using the "D" word when touring a family through a residential care facility prior to the admission of their loved one, or talking about decreasing intake with family when they are concerned about their loved one not eating enough.

The energy and the input from the LPNs was inspiring.

Thank you CLPNBC for the invitation to speak, and thanks to all who contributed to the discussion and helped make it a great learning experience.

Regards,
Kath

D

College of LPNs of BC conference in Vancouver

2011-06-07T23:39:00.000-07:00

The College of LPNs of BC is sponsoring a one day conference on Friday June 10, 2011 at the Italian Cultural Center in Vancouver.

Stephanie Staples is the keynote speaker, she will speak on "Life Support for Nurses" and help participants develop a personal wellness plan.

Katherine Williams will speak about "Workplace Bullying: Causes, Targets & Solutions". She speaks from a personal and professional perspective.

I am honoured to be invited to speak on "Living Excellence in Practice".

We look forward to meeting people at our Life and Death Matters exhibit. Please do drop by and say hi!

For more information go to: http://clpnbcconference.org/

Kath

Makoto Takahashi - Leader in Death Education in Japan's ADEC

2011-05-17T18:19:00.000-07:00

On Saturday morning I had the distinct honour of welcoming Makoto Takahashi and his family to our home! Makoto (Mac) is a leader in death education in Japan. He is very active in the Association of Death Education and Counselling (ADEC) in Japan.

Before he retired Mac taught at a very old prestigious private school that has educated many leaders. Mac taught students between 15 and 18 years old. He taught at least 800 students a year! Classes were one hour long, twice a week, and went for ten weeks. Approximately 20 hours of study. Students often came back to him in the years following the course when they experienced a death in their lives. Apparently there were 10-15 deaths of parents each year in this very large school. For those who would like more information on the curriculum, please feel free to email me and I can connect you with Mac.

As I listened to Mac talk, I thought that perhaps the owl who visited us the night before was simply a foreshadowing of the wisdom that Mac would bring the next morning!

Thanks Mac!

BCHPCA, Charmaine Crooks, Glenda Standeven, Elizabeth Causton, Alan Wolfelt and one more surprise!

2011-05-14T09:24:00.000-07:00

Highligts of the BCHPCA conference...

Charmaine Crooks, Olympian, was the MC for the awards banquet! Charmaine blessed us with her grace, generousity of spirit, and stories of her family's experiences with palliative care. To be in her presence was to feel of greatness and humility simultaneously. To be greeted by her was to feel loved. I would expect this from a great spiritual leader, but had not expected to feel this from a great athlete. Thanks Charmaine for sharing yourself with us!
Glenda Standeven, author of "Choosing to Smile" shared stories and laughter from her life, including the irony of having a leg amputated and carrying the name "STANDEVEN". Her stories were hilarious and inspiring. Thanks Glenda!
My dear teacher colleague Elizabeth Causton did not surprise me, she delivered yet another FABULOUS presentation titled "Changing the way we care: Self First" and reminded us of the importance of "putting our own oxygen on before helping someone with theirs" and suggested that the lesson from flying can be applied to our lives.
Day two of the conference was actually a day sponsored by Kearney's funeral home - and Dr Alan Wolfelt spoke to us. He is a fabulous speaker, and brings the theory of loss and grief and mourning from theory to practicality with humour and warmth.
And.... perhaps the best part of all.... this focus of this conference was on the Hospice Societies,... and I so enjoyed meeting people from hospices located throughout the province... . What a great group of individuals! Kay Johnson received the Award of Excellence, and her acceptance speech acknolwedged the role of many of the earlier leaders of HPC in BC - who paved the way for what is being enjoyed and built upon today.

After the ferry home to Victoria, we wrapped up in blankets, sat on the deck, and watched the sky get dark, the stars shine, and the moon move across the sky. I lit some candles by the edge of the deck that gave enough light so we could see each other. We shared some great discussion with our daughter Krystal and her hubby Jared... and gently and suddenly a big beautiful BARRED OWL landed on the railing just ten feet from us! S/He sat and looked at us, looked around, and after a few minutes swooped down to the garden and up to the corner of the roof. It was a most unique and cherished moment. One we will always remember. (For those who read the story "I heard the owl call my name", ... he did not call our names, just looked at us!)
WOW.
Kath

Great news from Niagara Falls....

2011-05-05T19:50:00.000-07:00

The NACC has just updated their Personal Support Worker Program with the launch of a revised module on caring for the dying!

Last year the "Essentials in Hospice Palliative Care" manual and companion resources were approved by the National Association of Career Colleges for their Personal Support Worker education program. Earlier this year I was invited by NACC to rewrite the curriculum about caring for the dying person.

I was thrilled to develop this module, now titled "Care of the Dying Person and Their Family: Essentials in Hospice Palliative Care".

Thanks to Linda Von Tettenborn for your consulting support, and thanks to the NACC Advisory Committee for your expertise.

Today the presentation to launch the materials was well received. We look so forward to hearing how the implementation goes for the colleges and welcome any feedback!

Early this morning Ted and I walked along by Niagara Falls. What an amazing site, all the more amazing because we were alone in the early morning hours. As I contemplated the "Seven Wonders of the World" I reflected on caregivers, the incredible contribution they make and suggest that caregivers are also one of the great wonders of the world!

Kath

Loss Grief and Growth Education Resource launched in Alberta!

2011-05-02T13:49:00.000-07:00

On Friday April 29, 2011 at the Alberta Funeral Service Association (AFSA) annual conference, the "Loss Grief and Growth Education Resource (LGG) was launched.(For further information about LGG go to: http://kathmurray.blogspot.com/2010/06/loss-grief-and-growth-education-project.html)

The AFSA committee, led by SHeila Van Alstyne, presented the work that they have done to facilitate the implementation by both the Funeral Directors and the Schools. They have compiled "KITS" with the LGG resource, supporting materials, and copies of the "essential" books that each school would do well to have on hand. With kits in hand, the Funeral Directors can approach the schools, provide the resources, and offer education/support/resources. With kits already compiled, the teachers will not have to fund or find funding to purchase basic resources to have on hand.

It was great to be among the Funeral Directors again. I continue to be surprised by the commitment of so many to their communities and their clients. In the future, I will write more about this.

Kath

Time to celebrate! BCHPCA Awards deadline has been extended!

2011-04-26T21:43:00.000-07:00

IT IS TIME TO CELEBRATE!

Nominate a colleague for The BCHPCA Award of Excellence or apply for The BCHPCA Research Award.

For further information go to: http://www.hospicebc.org/news-events/awards

Hospice Palliative Care Ontario - Annual Conference and BIG NEWS!

2011-04-12T15:08:00.000-07:00

The Hospice Association of Ontario and the Ontario Palliative Care Association have merged to form Hospice Palliative Care Ontario! The annual conference provided the opportunity to formalize this union. Rituals of union were integrated with the Gala Dinner.

The new charter is available at http://www.ontariopalliativecare.org/pdfs/2011/HAO-OPCA_Integration_Update_Feb_22_2011.pdf

The energy of the membership was infectious. The commitment of their leaders to the process, is/was evident. And people were delighted that their fearless leader Chris Sherwood was able to attend and celebrate with them!

Way to go Ontario! Good work.

Ted and I enjoyed meeting new people and reestablishing relationships with people we have met before. Thank you so much to the people who dropped by the booth to meet us, get more information about the 'Essentials" resources and/or the online program, and those who shared your stories and experiences with both the materials and the online courses!

Congrats to Marge Dennis who won the "Essentials in Hospice Palliative Care" manual and workbook. Glad that you can share it with your local hospice group.
Congrats to Laura Bean who won the online course! We look forward to meeting you!

Thanks to the planning committee for arranging such an outstanding conference with great speakers, workshops, food, and networking!

Warm regards,

Kath

PS Thanks Brenda from Canadian Virtual Hospice for the special memory of hot chocolate shared with Bev from Room 217 and the vivacious "Hot Chocolate Lady"!
Same time same place next year!?

Senator Sharon Carstairs - committed to excellent end of life care!

2011-04-12T13:00:00.000-07:00

Senator Carstairs is a legend! She has advocated tirelessly for HPC in Canada for years. She spoke at the Hospice Palliative Care Ontario conference yesterday. It was a privilege to hear her speak.

I thought that those who were not there, might like to hear a few of her comments. Here are a few of my notes:

10% of Canadians die suddenly. 90% of Canadians can use HPC services. Less than 30% receive support from a specialty HPC team. The majority of those who receive the services die from cancer. People dying from non-traditional hospice diagnoses (including chronic illnesses), those living in rural and First Nation communities have greater difficulty accessing resources. We have a long way to go!

Euthanasia,... the debate is coming forward again. We should NOT discuss this in a vacuum. We need to first ensure that every Canadian has access to Hospice Palliative Care - and only then have the debate! When people have access to good HPC their perspective on euthanasia changes.

According to stats, in Canada 2011 - 13% are over 65. In 2031 - 25% will be over 65. That is nearly double the current number in just twenty years!

HPC needs to be a core service in health care, not an optional piece that each area of health care can put aside.

She quoted Harvey Chochinov's great statement regarding HPC not having a vocal constituency:
"The dead are not here to speak, the dying are too weak to speak, and the bereaved are too overcome by their grief to speak."

Senator Carstairs said, "I believe HPC is an art. It is the essence of our humanity."

Personally, I enjoyed hearing the story of how she came to politics. At 15 years old, she graduated from high school. She applied to nursing. Apparently her mother switched her application from nursing to pre-medicine. Then in second year she took an elective in Political Science - and the rest is history!

How fortunate we are that she followed her love of politics!

All the best Senator Carstairs. Thanks for staying on as a "champion" even when you retire from the Senate!

Kath

Photo of Louise Cadrin and Senator Carstairs. Retrieved April 12th from:
http://www.counterweights.ca/2010/05/three-strikes-and-you%E2%80%99re-out-harper-government-not-really-driving-canadian-senate-reform-agenda-now/
Louise Cadrin is director of palliative care services for the Regina Qu'Appelle Health Region in Regina, Saskatchewan,

Advance Care Planning Day

2011-04-12T06:00:00.000-07:00

Preparedness takes on new meanings depending, among other things, on our daily lives, family circumstances, and global issues…

During childrearing years an apparently simple but forever difficult planning decision was “what am I going to cook for dinner”. Before going on an annual “honeymoon” the practical question was “who is going to take care of the kids while we are away?” The bigger question was, “Who will take care and love the kids if anything happens to us?”

Living on Vancouver Island there is always a possibility of an earthquake which means that in addition to figuring out what to cook for dinner, I am supposed to have a 72 hour kit. Like cooking dinner, it sounds relatively simple. Get a list of what is needed to survive for 72 hours, pull together and/or purchase the items, put them in a bag, store them in an accessible location and update the contents as needed. The reality, like planning dinner, or writing a will, is that it takes longer to worry about it, than to do it! And, like cooking dinner, or writing a will, when it is done, it feels SOOOO good!

Today April 12^th is Advance Care Planning Day in Canada! The Canadian Hospice Palliative Care Association (CHPCA) has launched a new website - "Speaking Up". The site was developed to "raise awareness of the importance of advance care planning, as well as the issues related to an aging population, a strained health care system and end of life care. The "Speak Up" campaign reminds Canadians to think about and talk about their end of life wishes.” (retrieved from website April 12, 2011) In addition there is information to help get you started. http://www.advancecareplanning.ca/home.aspx

The best part of ACP is the conversation around the dinner table. I told my gang that I figured that when I was ready I would like to follow an old tradition of going for a long walk in the ice, perhaps out on an ice flow. My darling son in law, who I am sure adores me (?!) has kindly offered to push the iceflow away when I am ready. He reminded me though that with global warming I may not want to wait too long. How good to have loved ones to help make your wishes come true.

My darling colleague Dr Deb Braithwaite talks of visiting families after the death, and debriefing, touching base, etc... I told her that she would know my house,... it would be the one with all the balloons in the driveway, and she would hear the old Wizard of Oz song playing, "Ding Dong the Witch is Dead". My daughter used to groan when she heard me say that, but now she says, "We are going to have to get that song when you die, just so we can laugh and play it. In reality, I think they will play my two favorite songs... "What a wonderful world" and "I love to laugh".

As for the care before death... we have had a few serious conversations about that. The legal papers are all signed appointing a person to speak for me should I not be able to speak for myself. And, so far, I have not needed that help. The good thing, like my preparedness kit, it is done!

Now I just have to figure out what to cook for dinner!

For those who are doing fine in the meal planning department, perhaps instead of gifting someone with a recipe book, you can consider sending the link to help them with Advance Care Planning!

Have a great day!

Kath

Loss Grief and Growth - a resource for teachers supporting students

2011-04-09T19:12:00.000-07:00

If you are a Funeral Director (FD) in Ontario, you are required to attend two days of Continuing Education every five years to maintain your license. This year I had the privilege of attending the education sponsored by the Ontario Board of Funeral Services to present the “Loss Grief and Growth” (LGG) education resource. This resource was developed to support teachers who are preparing and/or supporting kids experiencing loss and grief. (see post 26/2010)

Throughout the two days, Suzanne Scott from Funeral Services of Canada and I met some great people who are very interested in helping to carry the LGG resource into the schools.

The FDs shared stories of incredible work they are doing with kids, in schools, and in community.

One of the stories that touched me:

A Funeral Director (FD) from a small town near the Quebec border spoke of his children, and how they welcome children who are visiting the Funeral Home. Apparently, he purchased suits for his two young boys. When they see kids come with parents to the Funeral Home to make arrangements, his children often go home, get their suits on, come back to the funeral home, and start to visit with the kids. They show the kids a room with toys, and then sometimes take the kids to show them the chapel, the caskets, the waiting room etc.. This has been a great gift for the visiting kids who might otherwise have been uncomfortable. I am confident that the children are provided some direction and support.

Once again I had the opportunity to hear Yves Berthiume speak about his tours for the Grade 7’s and 8’s to his funeral home. The teachers and kids LOVE the tours. They enter the building, sign in, and then go through as though they were adults on tour. When the time comes for questions they are full of them! The questions last until they are pulled away to return to school.

A FD told of a child who toured the funeral home, and whose father died unexpectedly months later. The mother was lost. The child said, “Don’t worry mom, now we go to the Funeral Home, and this is what happens.” The child was not afraid, the child knew what to expect.

Another child toured the funeral home, and later when he was dying of cancer, returned to choose a casket, and plan his funeral.

Sometimes I hear hospice workers say, “Oh, we don’t work with kids” forgetting that most of their clients/patients, have children or grandchildren within their circle of loved ones. We need to remember these short people, and attend to their needs as well.

The teachers in our communities are in an amazing position to support, mentor, and guide our youth. The LGG resource is one resource to help them do so.

LGG can be downloaded free of charge from www.curriculum.org listed under supplementary resources. Or go to www.fsac.ca

Kath

BC Hospice Palliative Care Association Conference

2011-04-01T08:53:00.000-07:00

Hi all,

The annual BCHPCA conference is May 12th and 13th adjacent to the Vancouver airport. (Fly in and take a free shuttle to the hotel!)

This is a great opportunity to come together, share, laugh, learn and replenish.

Day one

Keynote addresses by two phenomenal presenters....

Elizabeth Causton: Changing the way we work - Self First

Glenda Standeven: Choosing to Smile

See Glenda's website and read her story at; http://www.glendastandeven.com/

Workshops:

Paul Holmes: SocialNetworking
Cari Hoffman: Advanced Care Planning
Elizabeth Causton: Final Gifts

Networking sessions in the afternoon!

Awards dinner and dance to top off a good day.

Day two

Participate in a full day session with Dr. Alan Wolfelt (sponsored by Kearney's Funeral home)

· Exploring Spiritual Aspects of Death, Grief and Mourning: A Workshop for Caregivers

· Helping Children and Teens Cope With Grief: A “Companioning” Philosophy of Caregiving

Early bird registration cut off is April 15^th . Register at the following link:

http://www.hospicebc.org/news-events/bc-hospice-palliative-care-association-conference

If you have any questions, do not hesitate to email me for more information! or Contact the BCHPCA office.

Kath

The Japanese - symbol of strength and resilience

2011-03-22T20:26:00.000-07:00

As we look to Japan many of us wonder how we can help. I wonder if we might better ask what we can learn from this dignified and resilient people?

Stephen Lewis in his keynote address at the Association of Death Education and Counseling conference in Montreal a few years ago, spoke of the grief in war torn countries. He encouraged the bereavement counsellors in the audience to continue in the important work that they do internationally, or to start providing help internationally. He talked of the value of their work.

As I listened to him, I reflected on my dear colleague Andrea Warnick who went Indonesia following the massive earthquake, worked in an orphanage with grieving children, returned home and using their art made calendars to raise money for that orphanage. Though she had worried about being “an extra mouth” I think she made a valuable contribution.

I think about Stephen Lewis encouraging people to volunteer, I think of Andrea and her contribution… but I still reflect on the fact that every person who goes to Japan to “help” is also one more mouth to feed.

I read the papers and listen to the news, and hear of the remarkable resilience of the Japanese people.

And I wonder if we need to worry less about what they can learn from us, and more about what we need to learn from them!

According to John Bradfield "In Japanese culture the Bamboo plant symbolizes strength and resilience and luck and success because of its ability to grow quickly"

I think I will plant bamboo this spring.

Kath

Photo: Arun Kumar Sinhar on Flickr
Photo and quote about the bamboo retrieved March 22,2011 from
http://johnlbradfield.com/environment/japanese-tsunami-and-the-amazing-resilience-of-japanese-people/

Japan - holding a space for caring across the miles

2011-03-15T14:34:00.000-07:00

A place of silence,
a place to hold the sorrow and tragedy of the earthquakes/tsunami in Japan,
a place to consider the many who suffer.

It is fitting to look for Haiku that might speak of the sorrow, and with someone's words that are more eloquent than mine, send prayers and thoughts across the miles.

Atsujin

Earth and metal...
although my breathing ceases
time and tide go on.

Tsuchi kane ya
iki wa taete mo
tsukihi ari

Haiku retrieved from: http://www.ancientworlds.net/aw/Article/778048

Photo courtesy of Virginia Hayes, Gabriola Island, BC

Person Centered Care - the essence of good dementia care

2011-03-15T14:27:00.000-07:00

Dementia Care: “Knowing our life and emotional history is for others the key to unlocking who we are, why we feel the way we do and what influences our actions.” (Christene Gordon, Director of Services, Alzheimers Society of Alberta and NWTs.)

So simple, but the root of what person centered care is about. Considering that most people with dementia die in a facility, how important for the care team to come to “know a resident” before determining plan of care!

Dr. Thomas Hadjistavropoulos and the PACSLAC!

2011-03-12T11:58:00.000-08:00

Louis Armstrongs singing "What a wonderful world" is truly one of my "favorite things".
Attending a conference and hearing about good tools, validated by good research, and presented in a manner that makes me want to go home and integrate the work in my practice is another one of my "favorite things".

At the Alzheimer Society of Manitoba annual conference this week I was privileged to hear Dr. Thomas Hadjistavropoulos from the University of Regina Department of Psychology and Centre on Aging and Health speak about pain assessment in the elderly. He presented a pain assessment tool called the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). You can access the tool at: http://www.rgpc.ca/best/PAIN%20Best%20Practices%20-%20ML%20Vanderhorst%20%28June%2007%29/PACSLAC.pdf
If you want to use the tool, you simply write Dr. Thomas at the email provided for permission and guidelines.

Kath

Harmony: Dementia Care and Hospice Palliative Care

2011-03-12T10:57:00.000-08:00

In June of 2006 Fiona Sudbury the Director of Care at Broadmead Lodge in Victoria asked me to help them prepare a course on "Dying with Dementia". I remember well saying to Fiona that the gerontology community, the hospice palliative care community, and I personally were not ready to write that course. After a few months, another phone call with Fiona, and a day in my favorite library at Hood College.... I started to research the topic.
Imagine my surprise when I discovered that best practice in dementia care was in harmony with best practice in hospice palliative care! We started working the next month!

It was my privilege to work with Janice Robinson, Al Vandergoot and the incredible team at Broadmead, to develop their education program "The Dementia Difference: A palliative approach for people dying with late stage dementia." (See references below for two articles published in Journal of Palliative Care reviewing the program and the preliminary outcomes.)

Working with the caregivers and staff at Broadmead Lodge was significant in my professional growth. I was blessed by the cross-pollination of ideas. I was inspired by the expertise of caregivers who were highly skilled and extremely dedicated to excellent care for people with dementia.

Since that time, I have taught a few sessions titled "Dying with Dementia", highlighting the research on best practice in caring for people with late stage dementia. This past week I was honoured to present at the annual conference of the Alzheimer Society of Manitoba. Once again I was impressed by the excellence and committment of individuals involved in dementia care and education.

Caregivers who attended the workshop were thrilled to learn more about a palliative approach in caregiving.
One theme that seems to emerge routinely, "We provide excellent care following admission, we give great care in the last hours, but it is in the weeks before death, when we are less able to determine when death will occur, that we struggle to provide the best care."

It is clear that people desire more information, and desire practical information.

Two favorite resources include Bern Klug on the "Ambiguous Dying Syndrome" and Volicer's artcile which he did for the Alzheimer's Association of Florida. BernKlug does a great job of identifying how difficult it is to die with chronic disease when death is certain, but at an uncertain time. Volicer does an incredible job of pulling together research on best practice in end stage dementia. After all the hunting I did for research, his one article seemed to summarize everything else that I found.

When I wrote the text "Essentials in Hospice Palliative Care" it was my desire to provide a section linking HPC and Dementia Care. I appreciate input on this topic, please feel free to write.

All the best to you in caregiving!
Kath

Bern-Klug, M., (2004), The Ambiguous Dying Syndrome, Health & Social Work, (29:1/2004; 55-65).

Volicer, L., (2005), End-of-life care for people with dementia in residential care settings, Alzheimer’s Association.

And....of course, the articles about the "Dementia Difference" course at Broadmead Lodge:

Gnaedinger, Nancy, Murray, Katherine, Robinson, Janice, “Preliminary Outcomes of “The Dementia Difference” workshop at The Lodge at Broadmead, Victoria BC”, Journal of Palliative Care, (26:2/2010; 130-133).

Gnaedinger, Nancy, Murray, Katherine, Robinson, Janice, The dementia difference: A palliative approach for people dying with late-stage dementia. Journal of Palliative Care, (24:4/2008; 274-276).

LDMonline - participants from communities across the globe!

2011-03-04T22:22:00.000-08:00

I just reviewed the lists of registrants from the online courses that were offered by LDMonline in the past few months. At this moment in time, most course participants live in relatively isolated and small communities across Canada! The other participants live in NEPAL, Australia, USA and Denmark. The nurses from Nepal work with hospice organizations that are "twinning" with a hospice in Canada. (See www.onehospice.com).

I love education, I love learning, and there is something quite wonderful about seeing people access "online" education who might be less likely to attend "onsite" education.

Kath

Advance Care Planning - less about tubes and more about talk

2011-02-28T07:19:00.000-08:00

Have you seen the cartoon of a couple watching TV and talking about "life supports". The man says "If I am ever dependent on a machine I want it to be unplugged". At which point the woman gets up and unplugs the TV!

When people discuss living wills and preferences at end of life, the conversation seems to quickly move to discussing life supporting technology. It seems to me that these discussions are less about tubes and technology, and more about talking and exploration.

This morning the newsletter from the Canadian Hospice Palliative Care Association announced:

"On April 12^th, 2011 CHPCA will launch the National Advance Care Planning Day, a day for Canadians to reflect on decisions made at the end of life.

The Speak Up - Start the conversation about end-of-life care campaign will seek to encourage Canadians to have conversations about planning for end of life care by providing access to shared tools and terminology for Canadians, making it easier for them to share their preferences with family, friends and health professionals, no matter where they live. Watch for more information (www.chpca.net)."

Live longer with palliative care?

2011-02-23T07:25:00.000-08:00

A study published last summer in the New England Journal of Medicine showed that patients with non-small-cell lung cancer who received palliative care early after diagnosis had a better quality of life and lived longer than those who received standard care. These patients also received less aggressive care. This research has received much publicity in the American newspapers in the past month. Link for the journal article: http://www.nejm.org/doi/full/10.1056/NEJMoa1000678

This may help to clarify the goals of palliative care for people who are concerned that palliative care shortens life.

Kath

Canadian Virtual Hospice has done it again....

2011-02-22T08:11:00.000-08:00

Last week a colleague showed me a most excellent article by Dr. Mike Harlos about DEHYDRATION. The thorough but easy to read article addresses: what it is, causes, sorting out the symptoms, managing dehydration, what you can do, and what your team can do.
Link: http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Topics/Topics/Symptoms/Dehydration.aspx

Kath

Palliative Social Work - new book

2011-02-21T14:56:00.000-08:00

I just got home from the annual assembly of the American Academy of Hospice Palliative Medicine and the Hospice Palliative Nurses Association in Vancouver BC. The Americans received a warm and wet/rainy welcome from the BCHPCA, CHPCA and the Canadian Society of Palliative Care Physicians. Dr. Fraser Black (Victoria Hospice Medical Director) and Wendy Wainwright (President of CHPCA) presented a lunchtime forum titled "Showcasing Canada". They highlighted major initiatives in HPC in Canada - and even the Canadians who attended learned a few things!

I was excited to see the strength of Social Work manifest at the conference. Oxford University Press has just published the Oxford Textbook of Palliative Social Work, Edited by Terry Altilio and Shirley Otis-Green. Betty Ferrell's foreword articulates the vital contribution of Social Workers to palliative care practice and to the effective functioning of team. The chapters help to address the breadth and depth of SW in Palliative Care. It looks to be an excellent resource.

For further information go to: http://www.oup.com/us/catalog/general/subject/Medicine/PalliativeMedicine/?view=usa&ci=9780199739110#

As well as the new text, several conference sessions presented research and best practice in palliative social work.

Sessions were recorded and can be ordered.

Kath

"It's not what you do it is how you do it...." Lessons from the Flag Lady

2011-02-09T15:20:00.000-08:00

On route to the post office. Road constructions. Stop sign.
I pull over to the side, now is as good a time as any to check for messages.
A knock on my window, "Love, can you move over further? Cars and trucks are having to swerve to get past you."
"Really? Oh, sorry, I didn't realize"
"No problem love, just pull on up there and pull over further, .... there you go, that is perfect."
When I finished with my emails, she directed me forward and into the line up, waved, smiled, gave me a thumbs up and wished me a wonderful day.

Don't you love it when you meet people that remind you of how to live?

Yesterday Christina Foerster and Deb Starck and I were recording podcasts. As we talked about caring for the body after death, Christina said, "It is not what you do so much as how you do it".

Whether we are flag persons, surgeons, nurses or undertakers - it is less about what we do, and more about how we do it!

Have a great day.

Kath

Making Cemeteries Relevant, Part 5: Lees + Associates

2011-01-24T13:57:00.000-08:00

The Daily Undertaker is a fascinating e-newsletter with sections that include: Natural and Sustainable Options, Art and Death, Inspiring Services, Memorialization Ideas, Grieving and links to further newsletters, journals, sites, related to death, cemetaries, funerals, rituals etc.

In the newsletter Pat McNally writes a series titled :"Making Cemeteries Relevant". Pat articulates his view of art and ritual on his blog: "There is perhaps nothing more important than art and ritual, because they help us to make sense of our world. When we experience a good work of art, or engage in a meaningful ritual, we see the world, and our place in it, in a different and richer way." (http://www.blogger.com/profile/16264369363269384639 )

For Part 5 of the series he interviewed Erik Lees, from Lees and Associates. Pat starts the interview with Erik: "Your work is different. In the nature of the projects your firm has been involved in, and the responsiveness of your designs to the stories behind the grounds, and the people who will visit there, I find something very compelling. "

Their work is compelling!

Pat's interview with Erik includes a discussion of key sites that Lees and Associates designed, tells a piece of the story of those whose lives are being honoured at the site, and provides a photo of each site. To read the interview and to see the photos go to:
http://www.dailyundertaker.com/2011/01/making-cemeteries-relevant-part-5-lees.html

Erik discusses the "Woodlands" site. Woodlands in BC, housed many people who were developmentally and mentally challenged for many years.

Erik says, "There were so many challenges with this project, but great projects are rarely simple!

The headstones from this 2 acre cemetery had been removed over 40 years ago, some of which were just dumped in a ravine, some were used for patio stones and a retaining wall – as sacrilegious as this may seem. Our task was to repatriate those stones to the cemetery site, but in the absence of accurate records, we were not able to definitively say where each headstone belonged, hence our decision to incorporate them in to a series of walls. The other challenge was that we only found 900 of the 3200 headstones, so we had to devise a system to acknowledge and remember all those that were buried there, not just those whose names were on the headstones we found. As with all our projects we undertook thorough research and during that process found inspiration in the history of the institution and even more so: the stories of those who lived there. One of

the most compelling stories was how many of the children were housed in dormitories with windows too high to see out of. We decided to create a “window too high” and although it is far more literal than we might otherwise choose, it proved to be a very powerful icon in the garden and one around which visitors had their picture taken."

As this site was being built, I cared for the mother of a woman who had lived at Woodlands. I told her that a memorial was being created. She told me about the building, and about the windows which were too high.

This work also intrigues me as Erik Lees happens to be my very talented older brother! Way to go Lees and Associates! http://www.elac.bc.ca/

Kath

Noah's Comfort Basket

2011-01-13T12:32:00.000-08:00

I have been sick with the flu for the past few days and luckily for me, our five year old grandson Noah decided to be my personal caregiver!

Noah brought me water, a cold cloth, bowl of sliced pears, basket with drawing paper, book, warm winter hat, paintings, and hot pads. He rearranged my blankets, washed my arm, checked in regularly, and blew me a few kisses. In a very loud voice he instructed his little brother to speak to me nicely.

Over the years I have taught about the "Comfort Basket" or the "Basket of Comfort Measures" to nurses, health care workers, family caregivers, and kids in the school communities. I have always enjoyed the concept, but I sure enjoyed being a recipient.

I was impressed by the intuitive wisdom of this kind and loving child. I think I have a new teaching partner!

Kath

Jennifer Wortham and Wendy Kurchak.... are Certified Thanatologists!

2011-01-04T22:47:00.001-08:00

Hello WORLD!

Announcing that Wendy (former student with LDMonline) and Jennifer (LDMonline facilitator) are now CERTIFIED THANATOLOGISTS! They passed the exam that they wrote with the Association for Death Education and Counseling! Wendy says she is going to frame hers and put it in the front entrance way to her home, along with a brief (10,000 words or less) explanation of what Thanatology IS! Jennifer is dancing up and down the streets in New York City, and has not been reachable since getting the big news!

Congratulations Jen and Wendy!

For those who do not know, the Association for Death Education and Counseling® (ADEC) is "an international, professional organization dedicated to promoting excellence and recognizing diversity in death education, care of the dying, grief counseling and research in thanatology. Based on quality research, theory and practice, the association provides information, support and resources to its international, multicultural, multidisciplinary membership and to the public." ( retrieved January 4,2011, from http;//www.adec.org/Mission_Statement/2022.htm )

HPNA and AAHPM Conference - Feb 16-19, 2011 in VANCOUVER!

2011-01-03T13:12:00.000-08:00

I am delighted to announce that the Hospice and Palliative Nurses Association (HPNA) and the American Academy of Hospice and Palliative Medicine (AAHPM) are having their annual assembly/conference in Vancouver BC!!! My home town! (I grew up at the base of the mountains in their brochure!))

BCHPCA and the Canadian Society of Palliative Care Physicians (CSPCP) are supporting partners of this conference. Members of these supporting organizations will receive the same discount as members of the AAHPM and HPNA.

The brochure outlines an exciting conference with a strong clinical focus, and many great speakers and sessions.

To download the brochure go to:
http://digital.ipcprintservices.com/publication/?i=46109

Meanwhile, the BC Hospice Palliative Care Association is planning their annual conference for May, 2011, also in Vancouver. This conference will focus on the needs of volunteers, hospice directors, board members etc.. More information to follow!

Kath

"What is life?"

2010-12-30T19:34:00.000-08:00

Tonight I read a note from a dear young friend Lindsay Kigueta Borrows. Lindsay is one of those individuals whose intelligence, generousity of spirit, strength and agility, gift for languages (English, Ojibway, Spanish....), beauty and kindness are blanketed and glued together by her compassion, empathy, and willingness to reach out.

In her letter Lindsay quoted Chief Crowfoot,

"What is life?

It is the flash of a firefly in the night.

The breath of a buffalo in the winter.

The little shadow that runs across the grass then loses itself in the sunset".

Thanks Lindsay for reminding me.

Kath

Lost emails!... and my committment to responding to emails

2010-12-10T08:12:00.000-08:00

I try to respond to emails within a day or two of receiving them.... This got difficult a few months ago when my computer upgrade resulted in a dozen lost emails, specifically a few emails from people I did not know.

Then yesterday, as I was learning a new "smart phone", I managed to delete another dozen emails! UGH!

So, if you have emailed me in the past, or if you email me in the future, and I do not respond in a timely manner, please resend your email....

Perhaps I should take up painting, it looks more fun!
Kath

Hospice for Animals.... What education is available?

2010-12-10T08:06:00.000-08:00

I received an email the other day asking if I knew of education for people providing hospice care for animals. What an incredible question!

I know resources exist for pet loss, pet bereavement, pet therapy... but I have not heard of courses/programs addressing hospice for animals.

Does anyone have any resources? Any ideas?

And would the person sending that request, please email me again! Thanks!
kath at lifeanddeathmatters.ca

Kath

Living with Death - lessons on grief

2010-11-23T19:51:00.000-08:00

While looking for Pam Fitzgerald on the web, I came across a brilliant short video about grief, living with death, and our ongoing connections with our loved ones. Clips of two movies, Last Orders (2001) and The Three Burials of Melquiades Estrada (2005) highlight the wishes of the departed and the desire of the living to meet those requests.

Pam Fitzgerald and Lysa Toye, both grief counsellors discuss the grief of the men involved in the two films, comment on their styles of grieving, the work of caring for the body. Film critic Peter Howell provides insights into the movies, and into coming to terms with life. It is simple, and beautifully woven together!

I recommend this as a nice introduction to grief.... have a look....

http://www.tvo.org/TVO/WebObjects/TVO.woa?videoid?75546064001

Kath

Winter, time for dormancy and reflection?

2010-11-23T13:07:00.000-08:00

Last week I received an e-newsletter from someone I knew 30+ years ago. It was interesting to read a message that I have shared in different words,(not nearly as poetic! :))about the need for dormancy in our lives.
Excerpts from David’s email:
“Pushed by ceaseless demands from all directions, it's easy to deny the significance of the winters in our life, especially in a world that measures progress and worth by external success, growth, and productivity. Yet after every autumn, there's a winter. After every harvest, there is a need for rest. After opportunity comes dormancy. After expansion comes retraction.
For those of us who live in northern climates, winter can cast a multitude of responses. There are winters of sadness and loss, winters of contemplation, winters of personal and economic recession, winters of rest, winters of disappointment, winters of darkness, winters of boredom, and, of course, if you are a skier, there are winters of celebration.
Whether short or long, I'm learning to flow with winter instead of fight it. Before I understood the vital importance of winter in the cycles of life, when winter was here I would wish that it was summer. When things were difficult, I wished they were easy. Since then, I have learned that wishing for it to be different was actually creating the problem. Now, instead of wishing it were easier, if I just stay present to what is here, then I somehow find value in what the difficulties and dormancy are bringing me. In this way, the dormancy is transformed into a gift.” (© 2010 by David Irvine david@davidirvine.com)

His writing reminded me of one of my favorite books given to me by a nursing colleague, “Sabbath, Restoring the Sacred Rhythm of Rest”, written by Wayne Muller. Muller explores the tradition of ‘sabbath’ across world religions, and suggests that not only can we look at Sabbath as a day, but as a moment, as a breath in time, set apart to rest.
In Victoria we have had an unusual cold spell, and the snow has lasted at least four days! Yesterday the wind was howling, and the snow was flying. It was beautiful. It was especially beautiful as we have a lovely wood fireplace, and it does a great job of heating our home. It was so beautiful that we were unable to leave it at bedtime and decided to camp in front of the fire to sleep last night. The glow from the fire was beautiful. It was a great end to a day of retreat, dormancy, and reflection.
Happy Winter,
Kath

“Give so Victoria Hospice can keep giving” Hospice is in need of funds....

2010-11-19T12:47:00.000-08:00

In my late twenties we moved to Victoria and I was hired to work with Victoria Hospice. It was at Victoria Hospice that I learned about disease management, symptom management, and the dying process. I learned about being with the dying, about listening and silence, about loss and grief. I learned that some of the suffering that I had witnessed in both friends and patients throughout their dying could have been prevented with adequate education, skills and resources.

I enjoy caring for the dying, I am passionate about this work. However, I much prefer to provide this care with the knowledge, skills and resources that I have learned from Victoria Hospice. Victoria Hospice has led this work nationally and internationally. Much of the work occuring across Canada can be traced back to work initiated by Victoria Hospice. As owner and director of Life and Death Matters and LDMonline, I am concerned as I hear of the financial struggles facing Victoria Hospice. To see announcement, check this site:
http://www.atv.ca/victoria/4994_74424.aspx

Victoria Hospice in their infancy and first decade/s developed a strong foundation of excellence in patient/family care. Over the past twenty years, their knowledge and expertise has been translated into the classic texts "Medical Care of the Dying" and "Transitions in Dying and Bereavement". The education department provides the "Medical Intensive" and the "Psychosocial Care" courses on a semiannual basis. The research department collaborates with researchers from across the country to ensure and/or discover "best practice". This is an incredible team of people and they do incredible work!

Sponsoring Victoria Hospice will help people in Victoria and will help those further afield to provide excellent care. If you have contemplated donating money, donating to the thrift store, purchasing a text, or attending one of their courses... now is a good time to take action.
victoriahospice.org

Kath

A few highlights from the CHPCA conference

2010-11-11T19:58:00.000-08:00

A few highlights of the CHPCA conference in Ottawa.....

1. Rubbing shoulders with colleagues from across the country..

2. Co-presenting "Food the Four letter "F" Word in End of Life Care" with Dr. Josh Shadd! It was so much more fun to do this presentation after another editing and deleting of slides, and having Josh address all the pathophysiology slides! (See last months blog!)

3. Attending the challenge panel ""Wounded healers" - Exploring Self Care in HPC". Eunice Gorman, Fred Nelson, David Kuhl each addressed the three questions, Am I taking care of myself well enough to do this kind of work? Do I offer myself the same kind of compassion that I offer those in need? When do I slow down to just sit with the reality of my own vulnerability?

Eunice introduced me to a new term, "vicarious resilience". This term is used to describe the positive effect of witnessing how people cope constructively with adversity. This term describes for me the inspiration I feel when I witness people adapt to loss, overcome significant challenges, and move forward with their lives in a way that they initially thought impossible. Because of these people, I have more faith in myself, knowing that others have walked this road, and that perhaps I too can walk this road successfully. Each time Eunice has presented, or each time I have heard her present, she has identified the joys of the work we do, while still acknowledging the challenges. I appreciate this positive acknowledgement of all that we "get" from working in HPC.

Fred Nelson, who had just won the CHPCA Award of Excellence, spoke from a very personal perspective in addressing each question. Sitting in this big room of people, in what was not an intimate setting at all, we were richly blessed by his generousity of spirit in allowing us into his heart, his world. And, as he told of the challenges of work, the need for exercise, the need for quiet time, time to stop/pull over, and the need for awareness.... he also provided great humour and opportunity for us to laugh!

David Kuhl works with the Center for Professional Renewal, with Providence Health in Vancouver BC. a few of his choice quotes...

"We work in public but we hurt in private."
"The air must be clean between and among us".
"Expert, the person who has experienced every problem possible and made every mistake possible". (I love that definition!)

4. "Developing quality palliative care in long term care homes" with Dr Mary Lou Kelley, Alesha Gaudet... In their studies they have identified that 80% of the care is provided by Health Care Workers. They tributed Health Care Workers, and the work that they do!!!! Music to my ears! I look forward to watching this participatory action research over the coming years.

5. "T3:Not for Me" - Bruce Kennedy, pharmacist gave a riveting presentation providing insights into why codeine and codeine with acetaminophen products are poor choices for pain control, despite being the most popular Canadian prescription analgesic. He also presented another session on tips for palliative medications. Once again, great to have a palliative pharmacist ready to share their knowledge in a way that is easily understood!

6. "Improving EoL Care in First Nations communities", with Holly Prince. Holly has repeatedly been involved in interesting work in the First Nation communities. "Living on the edge: working with dying cancer patients in northern remote communities". And finally, "The significant work life experiences of community based palliative care registered nurses". One comment that impressed me was that many nurses working outside of the hospital setting, no matter how remote the community, may feel isolated by virtue of working alone, with few resources available to them.

7. I brought home Room 217's new cd titled Country Roads... which I listened to as I drove up island the other day... GREAT CD if you want some nice gentle bedside music and like some of the old country songs. Bev and her team are gifted at putting together fabulous music. (See http://www.room217.ca )

Unfortunately I missed a few of the keynote speeches, and was not able to attend all sessions.
Next year the conference is Sept 8-11, 2011 in St John's, Newfoundland, and promises to be an incredible experience! Book your tickets, use your air miles, arrange your holiday and education leave.... See you there!

Kath

Teaching: the art of connecting. Lesson from the front line

2010-10-20T13:35:00.000-07:00

Teaching is an art. Teaching is a pleasure.... when it goes well.

Last month I had the opportunity to do one of those "didn't go so well presentations". The topic was a favorite. The group was fabulous. What went wrong?

Parker Palmer writes in his book "The Courage to Teach" that good teachers having the capacity to help students weave connections (with content, with personal experiences, with other students, and with the teacher.)

I was reminded that before we can help people connect with the content, we need to connect with the content ourselves!

I had recently updated my presentation with an esteemed colleague in preparation for a team teaching opportunity. With his permission I included "his slides". I thought I knew his slides - we had talked through them and worked with them several times over the phone. But when it came to presenting the material and to answering questions, the words to explain the slides were not there and a few slides did not seem to make sense!

In this incident, I thought I was prepared.... after all, we had worked with the presentation several times. But in the end, I realized that I had not really connected with his slides, with the words to talk about the slides, and with the science behind the slides.

For dinner that night I ate a lovely piece of humble pie, and was grateful for kind participants and honest feedback - both of which helped me remember CONNECT CONNECT CONNECT.

When Pharmacists show up to play! Announcing the new Canadian Palliative Care Formulary

2010-09-24T06:35:00.000-07:00

Hospice Palliative Care is all about team - and team is all about who shows up to play. Over the years I have noticed the difference when a strong, committed and talented pharmacist shows up to play.

Bruce Kennedy is a pharmacist in Fraser Health. His kids, he says, figure he is “just a pharmacist”. And yet in BC his dedication to HPC, desire to translate his knowledge of medication into language that can be understood by the rest of the team, and his desire to play on the “team” has contributed to the development of the Fraser Health Symptom Management Guidelines http://www.fraserhealth.ca/professionals/hospice_palliative_care. These guidelines provide a strong foundation for the delivery of symptom management. I tribute Bruce and the FH team for these guidelines.

More recently Bruce’s commitment to education and resource development has resulted in the writing of a Canadian version of the Palliative Care Formulary, adapted from the parent edition produced in the UK by Twycross and Wilcock. This book links with the international www.palliativedrugs.com (a website dedicated to disseminate information and stimulate international dialogue about the use of medications in HPC). This book looks to be a fabulous resource and can be ordered in Canada from the CHPCA website http://www.chpca.net/home.html .

A great pharmacist may be a nurses best friend and a most effective advocate for patient comfort. In Dawson Creek in north eastern BC, Nicole Dahlen is one of those pharmacists! Nikki's support is felt locally and her leadership influences care regionally across the north as she helps to integrate and teach the FH clinical guidelines in practice.

Way to go Bruce! Good work Nikki! And way to go pharmacists who show up to play!