As I contemplate retiring in a few short months, it is time to say goodbye and turn this blog over to new writer(s). In many ways, one kind of goodbye has a lot in common with other goodbyes. There is the anticipation of the actual change, which begins the internal reorientation. William Bridges developed a model he called Transitions.
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My sons are conversant with Artificial Intelligence (AI), my older son works with “machine learning” and AI every day. Most people have watched the AI headlines grow at an explosive rate, applied to more and more contexts.
Students of counseling study themselves as part of the strategy to keep their personal issues out of the way of their clients. Countertransference is often unconscious and occurs when the clinician lets their own feelings shape the way they interact with or react to their client. Students of nursing or medicine or pharmacy do not usually learn this same principle or develop the ability to note how their own reactions are evoked by the client. Patients may hook the clinician’s life experiences.
At some point in our lives, we will care for a family member or friend who is ill and vulnerable, and some of us will also experience illness and vulnerability at a level that requires care from others. Most of us prefer helping over being helped.
Fatigue might be the symptom that is assessed the least, but a recent Clinical Care article posted by the Center for the Advancement of Palliative Care (CAPC) writes that fatigue is the most common symptom of serious illness, affecting “more than 80 percent of patients-regardless of their diagnosis.” The article also asserts that fatigue is “one of the most underreported and undertreated” symptoms.
Reminiscence therapy helps people with dementia tap into memories without testing their recall. Questions like “how many siblings do you have?’ can lead to embarrassment if the person living with dementia cannot recall. Instead, using objects to spur naturally arising stories, or music or other methods can create a positive and pleasant experience.
Adapted from https://www.aplaceformom.com/caregiver-resources/articles/reminiscence-therapy
People who live rural, and particularly those outside of town limits, have a unique relationship to place. For many their roots in a particular place run deep, across more than one generation. The people who live on the land in this way have watched the turn of the seasons all their lives and have developed a deep affinity for that specific place.
A person with a serious illness can tell you that the fragmentation of the healthcare system is a barrier in many practical ways. Every specialist asks you to fill out their history form, and then does not seem to read it. Every specialty as well as primary care has a patient portal. Each portal can look and function differently, and one might need a spreadsheet to track all the different logins and passwords. The Electronic Health Records have not yet, except in rare instances, created a single patient-centered data warehouse.
At a time when civic responsibility is a controversial issue, how do we collectively look out for those who are alone and living with serious illness? In the United States, 27% of adults 60 and older live alone.
Think about one of the biggest losses you have suffered.
Risk factors for burnout can be sorted into three groups:
• Risk factors related to the organizational culture and practices.
• Risk factors from exposure to suffering.
• Risk factors related to personality and temperament.
Helping professions are by nature, asymmetrical where the clinical team does the giving, ideally without expectation of any particular response from the patient and family. Christina Maslach , one of the original researchers on burnout observed key symptoms; overwhelming emotional exhaustion, cynicism and detachment from the job, and a sense of ineffectiveness and failure. Another dynamic has been described as depersonalization, where patients are reduced to objects and in the view of the burnt-out clinician, therefore robbed of their full humanity.
The three W’s are a wish, a worry and a wonder. This skill can be combined with other communication skills, such as asking permission, expressing alignment, and reassuring that care will not stop. Vital Talk communication skills and tools offer an evidence-based communication skill set.
Covid-19 has irretrievably changed our world. One of the harshest consequences has been the way patients are separated from other people. Electronic devices can offer a possible and sometimes powerful way for a patient to connect with others outside the hospital. Yet even the care team is separate, minimizing contact and wearing space age apparel.
There is no question that all kinds of people become ill, and some are more pleasant to care for than others. Yet when we use labels like “difficult” or “manipulative” or “demanding” it may weaken our ability to be a healer. We may think we can mask our feelings but we have as many as 4,100 to 10,000 facial expressions and we are fooling ourselves if we think we can truly mask what we feel. For when we label a patient and family, it does evoke feelings, like frustration, or irritation.
In a Harvard Business Review article entitled, Managing the Hopes of Seriously Ill Patients, Brad Stuart describes a toolkit for managing hope.
(Comments and elaborations interwoven with directly quoted material.)
• “Relieving pain and other symptoms. Unrelieved pain triggers hopelessness, whereas controlling pain allows intrinsic hope to emerge. Hospice and palliative care providers are trained to do this.”
How do you hope when you cannot “get your life back?” Does one have to give up hope to receive palliative care?