Using Integrative Therapies At The End of Life:  Connecting Through the Lifespan Case Studies from Pathways Hospice, San F...
Pathways Hospice <ul><li>Located in Mountain View, California, USA </li></ul><ul><li>Branch offices in San Francisco and O...
How Care is Provided <ul><li>Patients home or place of residence </li></ul><ul><li>Patients primary medical doctor supervi...
Initial Offerings Relaxation Skills Massage  &  Caring Touch Aromatherapy Animal Assisted Activities Reiki
Expanded Offerings Creative  Expression Acupressure  &  Acupuncture Music &  Sound Story Telling  & Journaling
<ul><li>“ Although symptom management is the first priority for palliative care, it is not the ultimate goal. True person ...
Developmental Tasks at End of Life (EOL) <ul><li>Sense of completion with worldly affairs </li></ul><ul><li>Sense of compl...
Developmental Tasks at End of Life (EOL) <ul><li>Acceptance of the finality of life -of one's existence as an individual <...
Dr. Ira Byock <ul><li>On the Nature of Dying </li></ul><ul><li>On the Family's Role in Care for the Dying  </li></ul><ul><...
Pediatric Palliative Care
Sophia <ul><li>Gender:  Female  </li></ul><ul><li>Race:  Ashkenazi Jewish </li></ul><ul><li>Major complaints: </li></ul><u...
Treatment Sought <ul><ul><li>Palo Alto Medical Foundation </li></ul></ul><ul><ul><li>Lucile Packard Children’s Hospital at...
Sophia’s Progress W/ TCM <ul><li>After 3 months (10 mos): </li></ul><ul><ul><li>Appetite improved </li></ul></ul><ul><ul><...
Integrative Therapies <ul><li>Music therapy </li></ul><ul><li>Prayer </li></ul><ul><li>Aquatic therapy  </li></ul><ul><li>...
Example of Integrative Medicine:  Sophia’s Healing Circle Allopathic Medicine Traditional Medicine Nutrition Naturopathy M...
Sophia’s Disease Progression <ul><li>Between 12 – 19 months: </li></ul><ul><ul><li>Condition Stabilized </li></ul></ul><ul...
Hospice Care <ul><li>Hospice Team Meeting </li></ul><ul><li>Hospice available 24/7 </li></ul><ul><li>NG tube via pump </li...
Integrative Therapies <ul><li>Body Therapies </li></ul><ul><ul><li>Feldenkrais </li></ul></ul><ul><ul><li>Reiki </li></ul>...
Integrative Therapies <ul><li>Homeopathy </li></ul><ul><li>Naturopathy </li></ul><ul><li>Holistic Nutrition </li></ul><ul>...
Sophia’s Current Condition
Sophia’s World
www.sophiasgarden.org
To create an environment of healing,wholeness and wellness for all, through the practice of   holistic nursing
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Using Integrative Therapies at the End of Life: Connecting through the Lifespan

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As hospice patients approach the end of life there are several valuable life tasks to perform. The use of integrative therapies allows patients and families to perform these tasks and connect the past, present, and future to self, each other and their community. Therapies such as aromatherapy, relaxation skills, massage, Reiki, music, animal assisted activities, or art, provide comfort to patients and families as well as helping them to incorporate important cultural traditions during the end of life. Aromatherapy, massage, Reiki and relaxation skills help to relieve pain, alleviate anxiety, and treat side effects from medication. Through techniques such as music, art, animal assisted activities and guided imagery, patients are able to find meaning in life, share feelings with others and connect to life events.

This workshop will give participants a clear understanding of how integrative therapies may be used at the end of life and the rationale for using specific methods. Case studies of an actual hospice patient, and her use of integrative therapies, will demonstrate the profound effect these techniques can have on patients and families, while on hospice. Case study include a 2 ½ year old pediatric patient with Niemann-Pick Disease, Type A. Finally, a template will be provided to help participants develop and implement their own Integrative Therapies Program.

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Using Integrative Therapies at the End of Life: Connecting through the Lifespan

  1. 2. Using Integrative Therapies At The End of Life: Connecting Through the Lifespan Case Studies from Pathways Hospice, San Francisco Bay Area, California, USA Presented by Esther L. Johnson, RN, BC, BSN, PHN Australian College of Holistic Nurses Inc Sixth Biennial Conference Brisbane, Australia October 2004
  2. 3. Pathways Hospice <ul><li>Located in Mountain View, California, USA </li></ul><ul><li>Branch offices in San Francisco and Oakland, California </li></ul><ul><li>25 years of service to the Bay area communities </li></ul><ul><li>Largest community based not for profit hospice in the area </li></ul><ul><li>Daily census of approximately 350 patients </li></ul>
  3. 4. How Care is Provided <ul><li>Patients home or place of residence </li></ul><ul><li>Patients primary medical doctor supervises care </li></ul><ul><li>Hospice Team </li></ul><ul><li>Other Supportive Services </li></ul><ul><li>Integrative Therapies Program </li></ul>
  4. 5. Initial Offerings Relaxation Skills Massage & Caring Touch Aromatherapy Animal Assisted Activities Reiki
  5. 6. Expanded Offerings Creative Expression Acupressure & Acupuncture Music & Sound Story Telling & Journaling
  6. 7. <ul><li>“ Although symptom management is the first priority for palliative care, it is not the ultimate goal. True person and family-centered care strives not only to ensure comfort, but also to improve quality of life and preserve opportunities for people who are dying and for their families to grow through times of illness, caregiving and grief.” </li></ul><ul><li>~ Dr. Ira Byock </li></ul>
  7. 8. Developmental Tasks at End of Life (EOL) <ul><li>Sense of completion with worldly affairs </li></ul><ul><li>Sense of completion in relationships with community </li></ul><ul><li>Sense of meaning about ones' individual life </li></ul><ul><li>Experienced love of self </li></ul><ul><li>Experienced love of others </li></ul><ul><li>Sense of completion in relationships with family and friends </li></ul>
  8. 9. Developmental Tasks at End of Life (EOL) <ul><li>Acceptance of the finality of life -of one's existence as an individual </li></ul><ul><li>Sense of a new self (personhood) beyond personal loss </li></ul><ul><li>Sense of meaning about life in general </li></ul><ul><li>Surrender to the transcendent, to the unknown - &quot;letting go“ </li></ul><ul><li>Reference:  Byock I., The Nature of Suffering and the Nature of Opportunity at the End of Life Clinics in Geriatric Medicine, Vol.12, No.2, pp 237-251, May 1996. </li></ul>
  9. 10. Dr. Ira Byock <ul><li>On the Nature of Dying </li></ul><ul><li>On the Family's Role in Care for the Dying </li></ul><ul><li>On the Community's Role in Care for the Dying </li></ul><ul><li>Surprising Opportunities at the End of Life </li></ul>
  10. 11. Pediatric Palliative Care
  11. 12. Sophia <ul><li>Gender: Female </li></ul><ul><li>Race: Ashkenazi Jewish </li></ul><ul><li>Major complaints: </li></ul><ul><ul><li>Vomiting, diarrhea </li></ul></ul><ul><ul><li>Crying, sleep difficulties </li></ul></ul><ul><ul><li>Chronic respiratory and ear infections </li></ul></ul><ul><li>Age : 10 months </li></ul><ul><li>Diagnosis: NPD, Type A </li></ul>
  12. 13. Treatment Sought <ul><ul><li>Palo Alto Medical Foundation </li></ul></ul><ul><ul><li>Lucile Packard Children’s Hospital at Stanford Medical Center </li></ul></ul><ul><ul><li>Mount Sinai Medical Center in NYC </li></ul></ul><ul><li>Traditional Chinese Medicine </li></ul><ul><ul><li>Acupuncture </li></ul></ul><ul><ul><li>Herbs </li></ul></ul>Medical treatments and consultations with western allopathic institutions
  13. 14. Sophia’s Progress W/ TCM <ul><li>After 3 months (10 mos): </li></ul><ul><ul><li>Appetite improved </li></ul></ul><ul><ul><li>Sleep increased </li></ul></ul><ul><ul><li>Body weight increased </li></ul></ul><ul><li>After 4 months (11 mos): </li></ul><ul><ul><li>Self-feed, 70% solid foods </li></ul></ul><ul><ul><li>Stool more formed </li></ul></ul><ul><li>After 5 months (1 year): </li></ul><ul><ul><li>Energy level, mental concentration, appetite increased </li></ul></ul><ul><ul><li>Vocalize sounds and able to sit up by herself </li></ul></ul><ul><ul><li>Loss of neurological functions slower than other cases </li></ul></ul>
  14. 15. Integrative Therapies <ul><li>Music therapy </li></ul><ul><li>Prayer </li></ul><ul><li>Aquatic therapy </li></ul><ul><li>Homeopathy </li></ul><ul><li>Western herbs </li></ul>
  15. 16. Example of Integrative Medicine: Sophia’s Healing Circle Allopathic Medicine Traditional Medicine Nutrition Naturopathy Medical Research Physical/ Energy Therapies Spiritual/ Psychological Family & Community Support
  16. 17. Sophia’s Disease Progression <ul><li>Between 12 – 19 months: </li></ul><ul><ul><li>Condition Stabilized </li></ul></ul><ul><ul><li>3 Severe Respiratory infections </li></ul></ul><ul><li>At 19 months old: </li></ul><ul><ul><li>Lost neuromuscular ability to clear her own saliva and swallow food </li></ul></ul><ul><ul><li>Liver and spleen continued to enlarge </li></ul></ul><ul><ul><li>Seizures started </li></ul></ul><ul><ul><li>First hospital stay; projected life expectancy was 1 – 2 days </li></ul></ul><ul><ul><li>Admitted to hospice </li></ul></ul><ul><li>At 24 months: </li></ul><ul><ul><li>Started Gentamycin </li></ul></ul>
  17. 18. Hospice Care <ul><li>Hospice Team Meeting </li></ul><ul><li>Hospice available 24/7 </li></ul><ul><li>NG tube via pump </li></ul><ul><li>Suction machine </li></ul><ul><li>Home Oxygen </li></ul><ul><li>VPAP </li></ul><ul><li>Modified DNR </li></ul>
  18. 19. Integrative Therapies <ul><li>Body Therapies </li></ul><ul><ul><li>Feldenkrais </li></ul></ul><ul><ul><li>Reiki </li></ul></ul><ul><ul><li>Cranial sacral therapy </li></ul></ul><ul><ul><li>Chiropractic care </li></ul></ul><ul><li>Integrative Therapies </li></ul><ul><ul><li>Aromatherapy </li></ul></ul><ul><ul><li>Guided Imagery </li></ul></ul><ul><ul><li>Story Telling </li></ul></ul><ul><ul><li>Animal Assisted Activities </li></ul></ul>
  19. 20. Integrative Therapies <ul><li>Homeopathy </li></ul><ul><li>Naturopathy </li></ul><ul><li>Holistic Nutrition </li></ul><ul><ul><li>Sophia’s Garden </li></ul></ul><ul><li>Antibiotic drugs from latest genetic research </li></ul>
  20. 21. Sophia’s Current Condition
  21. 22. Sophia’s World
  22. 23. www.sophiasgarden.org
  23. 24. To create an environment of healing,wholeness and wellness for all, through the practice of holistic nursing

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