Book Review

 End of Life, 

 Nursing Solutions for Death with Dignity 

Lynn Keegan and Carole Ann Drick (2011).
New York: Springer Publishing

Summary: Watson Caring Science Institute, Springer Publication Caring Science Library Series,
addresses the need for expanded attention to the dying process, proposing an innovative solution:
"Golden Rooms" offering personalized, peaceful, dignified and loving care at the end of life. 

It received the 2011 AJN Book of the Year Award in Hospice/Palliative Care and Gerontology.

Nurses should devote individualized attention to the transition from this life. Parallel to the moments of our birth, the process of death and dying should be approached as a sacred passing.
 

The authors observe that death has moved from the home and its surrounding support from loved ones. The new ‘death’ occurs in hospitals and intensive care units where  patients die after needless suffering, at times alone.

Part 1 Part 1 discusses end-of-life, costs of care, legal and ethical quandaries. Statistics related to deaths add interest and perspective.
Part 2 is an overview of primary and supportive theories guiding practice.
Part 3 focus’ on implementation of the “Golden Room”.

Nurse educators will find case examples and ethical highlights promote opportunities for reflection and meaningful discussion.

Detailed tables of holistic nursing communication and skills provide description of neuropsychological and physical signs approaching death. Dialogue on “releasing and letting go” lead readers to discover personal attitudes and direction for preparation in their dying process. Explanations of legal documents; advanced directives, living wills, and durable powers of attorney (DPOA) are clarified.

This book is an abundant resource for
Nurses and caregivers who desire to provide
a supportive atmosphere through death & dying.

                  Beginnings                         

______________________________________________________________________ Magazine - February 2019____________________
 

Focused in topics of Holistic advanced care,
the following articles discuss
caregiving, end-of life nursing, and aging-in-place.
 

Donna M. Adams, RN, OCN, CHPN,  HTCP/I and Melinda H. Chichester,  HTCP/I, EOL Doula. Integrating Healing Touch for Advanced Illness and End of Life Nursing Care.pdf Beginnings, 2019.


Gale Lyman, BSN, RN, HNB-BC, Forgotten Family Caregivers 


Rita K. Chow, EdD, RN, AHN-BC(ret). Holistic Nurses Champion Aging In Place.

Karen Radtke, MSN, APN, HWNC-BC, AHN-BC. Advanced Nurse Coaching for Patients with Complex Needs.

 Dementia & Long Term Care 

a holistic approach to behaviors

Self-Awareness is a cornerstone for Holistic Nursing.

In an environment of chronic confusion or dementia, this quality is essential for maintaining the comfort and safety of the residents. A holistic approach encourages nurses to leave stressors, distractors, and tension causing energies outside the patients' 'healing environment'.
For this to occur a nurse must be Centered. 

 CENTERING 

This brief pause connects us to our own thoughts and feelings, and brings awareness to situations which could otherwise continue in a 'reactionary' manner. To be fully attentive with another human beings needs is to leave chaos at the door. 

 "Be Calm to Create Calm"  

"Feeling safe, calm and happy has more to do with who people are with, rather than their physical surroundings. There is a lot that each of us can do to shift the energy of a place from scary to safe, stressful to calm, and frustrating to happy. Research, and probably your own experience, indicates that the mood, attitudes, appearance, behavior and energy of a caregiver impacts one in their care. Contemporary nursing theorists consider the caregiver as part of the patient’s environment..." excerpt from: Helping LTC Residents with Dementia feel Calm Safe & Happy

Often those suffering from dementia or memory loss experience many of the neurotransmitter fluctuations present in mental health disorders. It is reasonable then that remedying their anxieties, loneliness or emotional lability correlates to enhancing the residents' feelings of security, safety, and love. The simplest way to ease an environment of disorder, is to provide an energy of calm.
In mental health nursing this is referred to as 'controlling the milieu'.

 In Search of 
 Independence  

 Resources to support abilities...

HEARING IMPEDIMENT

Advisement for the Hearing impaired:

Use appropriate hearing aids and assistive technology. Get closer or go where the talker is. Take listening breaks- we focus better when rested. Don’t be afraid to disclose your impairment and how to best facilitate communication-  speakers want you to hear what they are trying to say!

Support Persons or Caregivers:

Speak clearly and in a normal tone of voice. DO NOT SHOUT. The person with conductive hearing loss will have more difficulty interpreting the sounds of your speech. Be patient and gain their attention before speaking, often they cannot hear you if you are not facing them! Choose quieter, less ambient noise places for real conversation. Take breaks- it is more work for the brain trying to hear, and then still need to interpret, sound patterns. 

Helpful Resource: www.hearingloss.org

VISUAL IMPAIRMENT

"According to centers for disease control and prevention, approximately 12 million people 40 years and over in the us have vision impairment. 1 million are blind, 3 million have vision impairment after correction, and 8 million have vision impairment due to uncorrected refractive error."
Visioncenter.org is an informational research based guide written and edited by licensed optometrists and medical writers. information is updated from scholarly articles, textbooks, government agencies, and medical journals. 

 color vision deficiency

https://www.visioncenter.org/eye-conditions/color-blindness/ -

Coalition of Organizations for Accessible Technology — COAT advocates for accessibility and usability of technology for people with disabilities. Enacting the 21st Century Communications and Video Accessibility Act (21st CVAA) was a huge step forward and we are working to implement this new law. COAT’s overall aim is to ensure accessibility, usability, and affordability of all broadband, wireless, and Internet technologies for people with disabilities.

MOBILITY

Movement from a recliner to the mailbox, circulating about a kitchen to use appliances, or being able to reach upper cabinets are mobility practices most of us take for granted. Limited mobility often comes with age or debilitating disorders like arthritis and osteoporosis or neurological diseases. No long ago limited mobility felt like a jail sentence to many seniors, but mobility devices ranging from canes, to  walkers and rollators or electric wheelchairs and scooters are restoring independence.
Good news for caregivers: Medicare usually pays up to 80% of the cost of a mobility device with a physicians order!

Screenings to Test Mobility: 

1. Get Up and Go test 

2. Performance-Oriented Mobility Assessment.

Helpful Tips from www.parentgiving.com

How to Spend Time with Your Family While You Care for (and Live With) a Family Member

12 comfort aides for Senior Guests

   Eldercare Nurses & Caregivers   

  Free Online Resources 

Try This®: Best Practices in Nursing Care to Older Adults from The Hartford Institute for Geriatric Nursing, New York University, College of Nursing. 

The goal of the "Try This: Assessment Tools" is to provide best practices in care of older adults and to encourage the use of these best practices by all direct care nurses. These Assessment Tools are designed to be:  Easily accessible, Easily understood, Easily implemented 
The content is designed to help nurses understand the special needs of older adults and use the highest standards of practice in caring for them. Each “Try This” issue includes a 2-page document with a description of why the topic is important and an assessment tool that can be administered in 20 minutes or less. The series is accessible online through the link above. “Try This” instruments are designed to be used as screening tools, not for diagnosis, and include a General Assessment Series, • Specialty Practice Series, Dementia Series, Quality Improvement Series

TLC -The Lyman Center for Caregivers:  A resource center developed by a holistic nurse and experienced family caregiver. Provides insight in caregiver stress managment, burn out prevention, eldercare options, and suggestions for the Aging In Place journey.

• Calm & Centered - TLC   blog 

• Mini "Me Time" for Family Caregivers

• Guided Meditation for Adults & their Caregivers

• Away With You; Respite Travel for Family Caregivers

  Breathe Love Pray     Meditation for Inner Peace

Do You Know Enough About Advance Directives and Older Adults? 

All people have the right to decide what will be done with their body, and all patients who can participate in a conversation, either verbally or through an alternate means of communication, should be approached to discuss and record their treatment preferences and wishes. To learn more about Advance Directives, visit the National Hospice and Palliative Care Organization's Program at the link above.
 

Do You Know Enough about Healthcare Decision Making in Older Adults? 

Capable persons have a well-established right, grounded in law and Western bioethics, to determine what is done to their bodies. In any healthcare setting, the exercise of self-determination (autonomy) is seen in the process of informed consent to and refusal of treatment and/or care planning. 

Determination of decision-making capacity is a compelling clinical issue because treatment and diagnostic interventions have the potential for significant benefit, burden, and/or risk. Honoring the decisions of a capable patient demonstrates respect for the person; honoring the decisions of a patient without capacity is an act of abandonment. 

Rosalynn Carter Institute for Caregiving establishes local, state, national, and international partnerships committed to building quality, long-term, home and community-based services. They believe this begins with providing caregivers with effective supports to promote caregiver health, skills and resilience. They also believe strongly in the need to provide greater recognition for professional and family caregivers. They focus on helping caregivers coping with chronic illness and disability across the lifespan. The RCI overall goal is to support caregivers – both family and professional – through efforts of advocacy, education, research, and service.

 

Non-profit or Free resource sharing may be sent to practice@ahna.org

Please submit all for-profit advertisements to office@ahna.org 

  Movement   

Gentle, mind-body exercises combining slow-flowing intentional movements with breathing, awareness and visualization are rooted in the Asian traditions of martial arts, Chinese medicine and philosophy. Moving the body can help prevent and treat dozens of diseases, such as diabetes, high blood pressure and obesity. While some increase stamina, others improve strength, mobility, balance, or flexibility. Tai chi, Qi Gong, and Yoga enhance relaxation, vitality, focus, posture, balance, strength, flexibility, and mood.  

Click the text to connect with a safe, evidence supported, senior movement activity.

Chair Yoga

Lower Body- Chair Exercise

Upper Body - Chair Exercise

Qi- Gong 20 minute Daily routine

Qi Gong Hand & Face / self-massage  

Qi-Gong Body & Limbs / self massage

Joint Mobility 

Tai Chi for Beginners- 56 min

      Care Angel   

 Free Application for Caregivers   

Care Angel Free Assistance for Caregivers provides remote monitoring, welfare check-ins, and proactive medication and appointment reminders. 

The app is personalized; the user programs it to call and respond as appropriate to manage ongoing health conditions- empowering the families and friends that help with caregiving.

"We specialize in programs that are designed to target your members by conditions, post-discharge procedure treatment plans or as a compliance tool for intentional, non-intentional or non-conforming medication adherence."

Recommended by AHNA member and family care-giver- it is not sponsored and is a free service.