Friday, August 26, 2011

A Nursing Home is Like a School: Person-Centered Culture Change (Video 3:06)

I started hospice volunteering in Detroit nursing homes while I was a public school principal. It didn’t take long before I observed that nursing homes and schools have several important similarities. Both have cultures that impact people in institutions. A paradigm shift in how some of these institutions are often perceived, not only by the public, but also by those who work in them, is long overdue. This needed transformation is often referred to as person- centered culture change, a movement that focuses on values and practices that respect the input of everyone involved with the institution. Through the eyes of an educator, I will mainly address culture change regarding residents.

In order for a person-centered climate to fully enhance quality of life in nursing homes and other residential institutions for older adults, residents must have experiences similar to what students should have in schools. Like students, residents must first know that the nursing home is a real “home” where they are welcomed and cherished at all times. They must feel that their environments are safe, that trustworthy employees care about them and listen to them with their hearts. Residents must know that their progress as individuals with specialized needs is the primary motivation for everything that goes on. Those with dementia should be challenged to learn new skills in non-threatening ways.

Residents must know that the personal histories they bring matter. These life stories help create who they are, not labels used to judge them and put them in stereotypical categories during their later years. They need ongoing encouragement to use their strengths in productive ways to improve their self-esteem and enhance lives of others. Their talents and accomplishments should be shared with the larger group so they can be appreciated and praised. Finally, their “graduations” (deaths) should be recognized as revered events.

For many institutions, person-centered culture change may seem overwhelming. But the rewards are immense when sincere efforts begin with everyone’s ongoing commitment to succeed. 

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Friday, August 19, 2011

Ten Steps to Being a Great Hospice Volunteer

Ten Steps to Being a Great Hospice Volunteer
By Frances Shani Parker, Author

1)   Remember why you serve.

There’s a reason you feel compelled to enhance lives of the terminally ill. Cherish that inspiration. Move forward committed to an amazing and rewarding healthcare adventure.

2)   Believe it’s all win-win.

Providing end-of-life service is a privilege, not a calling to be a savior. You and those you support come together in relationships of mutual healing and growth. Honor your win-win journey.

3)   Be present.

By all means, show up. But be present with patients after you arrive. Evaluate appearances, behaviors, surroundings, and interactions with others. Listen with your heart. Even silence speaks. Really try to understand living from their perspectives. Focus on advocacy for improving their quality of life.

4)   Try other doors.

Patients will have challenges such as dementia that may not respond to your usual front-door communication. Try other doors and even windows. Obstacles are enrichment opportunities in your partnerships with patients. Touch, music, pictures, stories, and fantasies are a few entry points. Let patients help you navigate your way into their world.

5)   Know your piece in the puzzle.
Adherence to rules of protocol and professional ethics should be routine. Be aware of boundaries such as confidentiality regarding yourself, your patients, and their loved ones. Follow guidelines of your hospice organization, and seek help when needed.

6)   Untie your knots.

There may be times of doubt, confusion, sadness, and guilt. These are normal knots of the caregiving process. Untie them by seeking support for your total well-being. Maintain proper rest, nutrition, exercise, and balance in your life. Do your best. Don’t be surprised when you discover reasons to kiss yourself.

7)   Spread the word.

Be knowledgeable about hospice and palliative care. Share information so others can benefit from these specialized areas of healthcare. Encourage involvement in hospice and palliative care career and service activities.

8)   Pick up a turtle.
If you see a turtle sitting on a fence post, you know somebody helped to put it there. Be on the lookout for turtles aiming for fence posts. Be a role model for other volunteers. Participate in organizations, conferences, workshops, and discussion groups where you can share best practices while learning new ideas.
       9)   Write death sentences.

Death will come no matter how often you avoid it or wrestle it to the ground. Have your advance directives, finances, and property in legal order. Urge others to do the same. Don’t burden loved ones later with important decisions you can record now. As you unfasten yourself from this life, be satisfied knowing your death sentences will be carried out according to your wishes.
    10)  Expect rainbow smiles.
Rainbow smiles hug you so tightly you can feel ribs of joy press against your essence. Hospice volunteering provides ongoing experiences for you to positively impact lives. When you do, rainbow smiles will come.

© Frances Shani Parker

You can read about my personal journey in becoming a hospice volunteer without realizing I was one here:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Thursday, August 11, 2011

Should Loved Ones Watch CPR (Cardiopulmonary Resuscitation)? (Research, Video 2:13)

Your loved one is in the throes of cardiac arrest. Tension engulfs the air as medical personnel proceed to perform CPR. Should you be allowed to watch? Do you even want to? Many will say you shouldn’t watch because of possible anguish and confusion involved. Some medical personnel may be concerned about liability and possible interference by you or family members witnessing this traumatic event.

But research supports having family members present. Witnessing CPR of a loved one helps observers understand the severity of the situation, appreciate the care being given, and even supports healthy grieving by confirming that everything was done.  With the development of appropriate policies and proper training of staff, the presence of family members during CPR can be a fulfilling experience.

This video shares positive views on this topic from Dr. Tammie Quest, Director of Education in Palliative and End-of-Life Care - Emergency Medicine Project, Associate Professor, Department of Emergency Medicine, Emory University School of Medicine:

Contact your local American Red Cross for CPR training.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Friday, August 5, 2011

Hospice and Hispanics: Doctor-Patient Communication (Research, Video 2:52)

Cultural values play an important role in how racial-ethnic populations make decisions regarding terminal illness, caregiving, end-of-life experiences, and hospice participation. Communication is a critical factor in delivering information that can be understood in the context of these values. Doctors and their background training must reflect general cultural knowledge of racial-ethnic groups in order to communicate well with them, always keeping in mind that there are differences within populations.

With a focus on Hispanics, researchers at the University of South Florida School of Social Work studied factors that doctors use to communicate with patients. Communication involved revealing a terminally ill diagnosis and a hospice referral. Interviews conducted in Spanish and/or English with ten doctors in Central Florida reported these results relating to communication and related themes:

1)   Role of family members and end-of-life decisions
2)   Language barriers and limited knowledge of culture and beliefs relating to end-of-life decisions
3)   Gaps in training and education of doctors

Hispanics and other racial-ethnic populations that continue to be under-represented in hospice care must be included in the entitlement to death with dignity that the hospice philosophy supports. In order to improve representation, barriers such as language communication, knowledge of family roles, and cultural beliefs related to end-of-life decisions must be addressed. Better education and training of doctors and other healthcare workers can greatly improve their communication skills with various cultures.

This video from the Hospice Foundation of America Cares video series shares important information about Hispanic concerns that can help healthcare workers meet patients’ needs. Dorotea Gonzalez, nurse at Capital Hospice in Virginia, shares her perspectives on some of the philosophies at the foundation of Hispanic culture.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.