Norway Tragedy - reflections

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

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

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

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

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

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

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