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

Pathways Hospice Located in Mountain View, California, USA Branch offices in San Francisco and Oakland, California 25 years of service to the Bay area communities Largest community based not for profit hospice in the area Daily census of approximately 350 patients

Located in Mountain View, California, USA

Branch offices in San Francisco and Oakland, California

25 years of service to the Bay area communities

Largest community based not for profit hospice in the area

Daily census of approximately 350 patients

How Care is Provided Patients home or place of residence Patients primary medical doctor supervises care Hospice Team Other Supportive Services Integrative Therapies Program

Patients home or place of residence

Patients primary medical doctor supervises care

Hospice Team

Other Supportive Services

Integrative Therapies Program

Initial Offerings Relaxation Skills Massage & Caring Touch Aromatherapy Animal Assisted Activities Reiki

Expanded Offerings Creative Expression Acupressure & Acupuncture Music & Sound Story Telling & Journaling

“ 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.” ~ Dr. Ira Byock

“ 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.”

~ Dr. Ira Byock

Developmental Tasks at End of Life (EOL) Sense of completion with worldly affairs Sense of completion in relationships with community Sense of meaning about ones' individual life Experienced love of self Experienced love of others Sense of completion in relationships with family and friends

Sense of completion with worldly affairs

Sense of completion in relationships with community

Sense of meaning about ones' individual life

Experienced love of self

Experienced love of others

Sense of completion in relationships with family and friends

Developmental Tasks at End of Life (EOL) Acceptance of the finality of life -of one's existence as an individual Sense of a new self (personhood) beyond personal loss Sense of meaning about life in general Surrender to the transcendent, to the unknown - "letting go“ 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.

Acceptance of the finality of life -of one's existence as an individual

Sense of a new self (personhood) beyond personal loss

Sense of meaning about life in general

Surrender to the transcendent, to the unknown - "letting go“

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.

Dr. Ira Byock On the Nature of Dying On the Family's Role in Care for the Dying On the Community's Role in Care for the Dying Surprising Opportunities at the End of Life

On the Nature of Dying

On the Family's Role in Care for the Dying

On the Community's Role in Care for the Dying

Surprising Opportunities at the End of Life

Pediatric Palliative Care

Sophia Gender: Female Race: Ashkenazi Jewish Major complaints: Vomiting, diarrhea Crying, sleep difficulties Chronic respiratory and ear infections Age : 10 months Diagnosis: NPD, Type A

Gender: Female

Race: Ashkenazi Jewish

Major complaints:

Vomiting, diarrhea

Crying, sleep difficulties

Chronic respiratory and ear infections

Age : 10 months

Diagnosis: NPD, Type A

Treatment Sought Palo Alto Medical Foundation Lucile Packard Children’s Hospital at Stanford Medical Center Mount Sinai Medical Center in NYC Traditional Chinese Medicine Acupuncture Herbs Medical treatments and consultations with western allopathic institutions

Palo Alto Medical Foundation

Lucile Packard Children’s Hospital at Stanford Medical Center

Mount Sinai Medical Center in NYC

Traditional Chinese Medicine

Acupuncture

Herbs

Sophia’s Progress W/ TCM After 3 months (10 mos): Appetite improved Sleep increased Body weight increased After 4 months (11 mos): Self-feed, 70% solid foods Stool more formed After 5 months (1 year): Energy level, mental concentration, appetite increased Vocalize sounds and able to sit up by herself Loss of neurological functions slower than other cases

After 3 months (10 mos):

Appetite improved

Sleep increased

Body weight increased

After 4 months (11 mos):

Self-feed, 70% solid foods

Stool more formed

After 5 months (1 year):

Energy level, mental concentration, appetite increased

Vocalize sounds and able to sit up by herself

Loss of neurological functions slower than other cases

Integrative Therapies Music therapy Prayer Aquatic therapy Homeopathy Western herbs

Music therapy

Prayer

Aquatic therapy

Homeopathy

Western herbs

Example of Integrative Medicine: Sophia’s Healing Circle Allopathic Medicine Traditional Medicine Nutrition Naturopathy Medical Research Physical/ Energy Therapies Spiritual/ Psychological Family & Community Support

Sophia’s Disease Progression Between 12 – 19 months: Condition Stabilized 3 Severe Respiratory infections At 19 months old: Lost neuromuscular ability to clear her own saliva and swallow food Liver and spleen continued to enlarge Seizures started First hospital stay; projected life expectancy was 1 – 2 days Admitted to hospice At 24 months: Started Gentamycin

Between 12 – 19 months:

Condition Stabilized

3 Severe Respiratory infections

At 19 months old:

Lost neuromuscular ability to clear her own saliva and swallow food

Liver and spleen continued to enlarge

Seizures started

First hospital stay; projected life expectancy was 1 – 2 days

Admitted to hospice

At 24 months:

Started Gentamycin

Hospice Care Hospice Team Meeting Hospice available 24/7 NG tube via pump Suction machine Home Oxygen VPAP Modified DNR

Hospice Team Meeting

Hospice available 24/7

NG tube via pump

Suction machine

Home Oxygen

VPAP

Modified DNR

Integrative Therapies Body Therapies Feldenkrais Reiki Cranial sacral therapy Chiropractic care Integrative Therapies Aromatherapy Guided Imagery Story Telling Animal Assisted Activities

Body Therapies

Feldenkrais

Reiki

Cranial sacral therapy

Chiropractic care

Integrative Therapies

Aromatherapy

Guided Imagery

Story Telling

Animal Assisted Activities

Integrative Therapies Homeopathy Naturopathy Holistic Nutrition Sophia’s Garden Antibiotic drugs from latest genetic research

Homeopathy

Naturopathy

Holistic Nutrition

Sophia’s Garden

Antibiotic drugs from latest genetic research

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