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

Slide 1: Pathways Hospice To care is to make a difference. Jane, Age 45

Slide 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

Slide 3: 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

Slide 4: How Care is Provided • Patients home or place of residence • Patients primary medical doctor supervises care • Hospice Team • Other Supportive Services • Integrative Therapies Program

Slide 5: Initial Offerings Relaxation Skills Reiki Massage & Caring Touch Animal Assisted Activities Aromatherapy

Slide 6: Expanded Offerings Music & Sound Acupressure & Acupuncture Creative Expression Story Telling & Journaling

Slide 7: “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

Slide 8: 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

Slide 9: 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.

Slide 10: 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

Slide 11: Pediatric Palliative Care

Slide 12: 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

Slide 13: Treatment Sought 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

Slide 14: 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

Slide 15: Integrative Therapies • Aquatic therapy • Homeopathy • Western herbs • Music therapy • Prayer

Slide 16: Example of Integrative Medicine: Sophia’s Healing Circle Allopathic Medicine Traditional Nutrition Medicine Family & Community Spiritual/ Naturopathy Support Psychological Physical/ Medical Energy Research Therapies

Slide 17: 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

Slide 18: Hospice Care • Hospice Team Meeting • Hospice available 24/7 • NG tube via pump • Suction machine • Home Oxygen • VPAP • Modified DNR

Slide 19: Integrative Therapies • Body Therapies – Feldenkrais – Reiki – Cranial sacral therapy – Chiropractic care • Integrative Therapies – Aromatherapy – Guided Imagery – Story Telling – Animal Assisted Activities

Slide 20: Integrative Therapies • Homeopathy • Naturopathy • Holistic Nutrition – Sophia’s Garden • Antibiotic drugs from latest genetic research

Slide 21: Sophia’s Current Condition

Slide 22: Sophia’s World

Slide 23: www.sophiasgarden.org

Slide 24: To create an environment of healing,wholeness and wellness for all, through the practice of holistic nursing