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

Comedy in the midst of loss - Carol Scibelli

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

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:

1. The relationship is not recognized,
2. The loss is not acknowledged, or
   
3. 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:

1. Males who are intuitive grievers (a mans' tears may be perceived as weak)
   
2. Females who are instrumental grievers (a woman may be perceived as being unfeeling)
   
3. 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)
   
4. People who are intuitive grievers later in the loss experience (we become impatient with people who continue to express grief over time)
   
5. 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:

1. Acknowledge the loss
2. Express manifest and latent emotions (express those emotions that are both obvious and those that are present but not easily visible or actualized)
3. Adjust to a changed life
4. Relocate the loss
5. 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

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"

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

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

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

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