Join me at the Texas NASW - National Association Of Social Workers on Oct. 8

Join me at the Texas NASW - National Association Of Social Workers on Oct. 8. I will be speaking at 2:15. http://www.naswtx.org

Founded in 1957 the National Association of Social Workers (NASW) is the largest organization of professional social workers in the world, with over 155,000 members in 55 chapters. The Texas Chapter, with about 5,700 members, is the major professional social work organization in the state. NASW is committed to advancing professional social work practice and the profession; and to promoting human rights, social and economic justice, and unimpeded access to services for everyone. Its members work in a broad range of settings including hospitals and other health care settings, community agencies, government, academia, business, nursing homes, schools, and private practice.

The Chapter office is located at 810 W. 11th Street, Austin, Texas 78701-2010. The staff is available to respond to member inquiries regarding social work practice, legislative and social policy issues, continuing education, licensing issues, and other informational requests.

The Chapter has numerous branches, committees and other leadership opportunities that involve members throughout the state, and better serve the social work community. These entities work on professional, social policy, and legislative issues, sponsor conferences, and provide a source of networking for members.

NASW’s goals include improving the quality of life and ensuring that the same rights and opportunities
are enjoyed by all. In addition, NASW strives to:
• Advance the quality of social work practice, improve the knowledge base required for
practice, and promote professional development.
• Promote the strength, unity, and recognition of the social work profession and the use of
standards to protect the consumer.
• Propose and promote sound public policies and programs aimed at meeting human needs
and improving quality of life.

Have a kind and respectful day.

Improving the Medical Experience of the Person struggling with Alzheimer’s or other memory loss

When a person with Alzheimer’s or dementia is going to have a medical test or procedure, how can we help the person to feel less frightened and to minimize any suffering? If the patient is struggling to understand what will be happening to them, do a practice run-through and show the person the room where the test will happen. Or find a book with pictures that will help him understand what you are talking about. If the person with diminished capacity is afraid of being alone, you may want to introduce him to the nurses who will be working that day. For my dad, we tape-recorded the doctor’s explanations so he could listen to the information over and over again until he felt more comfortable.

Another thing to keep in mind is that the patient may be experiencing symptoms that affect his or her participation. These symptoms could be pain, side effects of medications, loss of hearing or sight, lack of sleep, an undiagnosed illness and grief, to name a few. Find out what can be done to relieve these symptoms to make it easier for the individual to participate in the process. Ultimately, our goal is to think about the quality-of-life questions from the person’s perspective as he or she will experience the consequences of our decisions.

Have a kind and respectful day.

Free - Thinking Ahead Workbook and Videos available for those with Developmental Disabilities and other Cognitive Impairments

Good news. The California Coalition for Compassionate Care has created a workbook and set of videos for documenting the wishes of those with developmental delays. (It would also work well for those with other cognitive impairments.) You can get free copies of the workbook sent to you or you can download it directly. It is called “Thinking Ahead.”

Here is the website: http://www.coalitionccc.org/thinking-ahead.php

Thinking Ahead: My Life at the End - Enables people with developmental disabilities to advocate for themselves and stay in control of their lives through the very end.

Thinking Ahead: My Life at the End contains words, symbols and pictures that facilitate discussion with and decision-making by persons with developmental disabilities regarding their values, goals and treatment preferences at the end of life. The DVD serves as an instruction manual, containing vignettes that illustrate in simple, graphic format the purpose and use of the materials.

Thinking Ahead was made possible through a Wellness grant awarded to Alta California Regional Center by the California Department of Developmental Services and reflects a collaboration among Alta California, Golden Gate and Eastern Los Angeles Regional Centers, Board Resource Center and the Coalition for Compassionate Care of California.

* Thinking Ahead English
* Thinking Ahead Spanish
* Thinking Ahead Chinese

To order a free hard-copy of the Thinking Ahead workbook and DVD, send an email to
info@finalchoices.org.

Additional Resources

Providing Hospice Care to Residents of Intermediate Care Facilities for the Developmentally Disabled - A guide to facilitate access to hospice services by persons who live in intermediate care facilities for the developmentally disabled.

Have a kind and respectful day.

Drowning but can’t reach for a life vest: families, caregivers, doctors, nurses and many others helping professionals

I had such a sad experience recently. I was speaking to a group of doctors and presenting them some techniques to make their lives easier. (This was at a county hospital which deals with the most underprivileged of our community.) I was surprised by how many of the doctors in the room were so resistant to accepting help. I sensed from their comments how burnt out they were and how hopeless they had become. The system they are working under is so broken that they couldn’t imagine that anything could change or be made better. It was painful to witness their suffering.

I realized that what I was seeing was classic caregiver burnout aka compassion fatigue. Caregivers, both family and professional, get so overwhelmed, they can’t ask for help. Lifeguards see this all the time when the person becomes so fatigued that the person can’t grab hold of the life vest right in front of them. The lifeguard has to swim out to the person and literally carry them to shore.

It is so easy for those of those of those who help caregivers to just say, “Grab on and I will help you,” but it may be too late. Ideally, we should reach the person before they are that far gone, but often times, the burnout doesn’t reveal itself until it has become extreme.

I understand this. When I was caregiving for my fourth and final relative, I became so overwhelmed that I laid down on the sidewalk in front of my house, and couldn’t get up. The only reason I finally did get up was because I didn’t want someone driving by to panic and call an ambulance. (Typical caregiver behavior, I was more worried about everyone else, before myself.) I went in the house and cried for days. I was lucky because my husband was my life saver and helped me reach out for support. For so many caregivers, they are drowning and don’t know help is available or where to turn.

For healthcare professionals, there is pride in being strong and capable, and to be weak is professionally unacceptable. And because their colleagues rarely express their own suffering, these professional caregivers think they are all alone. This leads to even more isolation and inability to ask for help.

I would encourage those of you who work as a professional healer to make sure your organization develops programs and support groups for you. You deserve the same care that family caregivers are receiving in the community. I need all of you to be okay because a lot of people are depending on you. But I don’t expect you to be super-human, I understand you are very human and have the same needs as all the rest of us. Please realize you are not alone and there are people ready to help. A great organization that can help is http://www.compassionfatigue.org/.

Have a kind and respectful day.

Stop! The plan isn’t working as expected.

Sometimes, in spite of our best efforts, the plan we designed for the person in our care, doesn’t work or stops working. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

We may also need to help patients/families modify their expectations when things don’t work. Sometimes people are so desperate for the plan to work that they can’t bear to see the truth when the plan fails. You are not helping your your patient by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering.

One thing you may want to try more often is a time-limited trial of a proposed treatment option. Explain to the family, “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option because it helps the patient/family feel like you are trying but it also gives them a reality check when it doesn’t work. You will want to give them specific symptoms to look for, (that they can understand), so they can see with their own eyes that the plan has failed.

After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your patients in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

Patient’s Rights - Where do they start and where to they end?

What are our obligations to the patient? Keep in mind that autonomy only works with people who have the capacity to make their own decisions.

Here are some of the patients’ rights that come with using autonomy:
• Patients have the right to receive all the information they need to make a good decision.
• Patients have the right to make their own decisions.
• Patients have the right to refuse treatments they do not want.
• Patients do not have the right to demand treatments that will be medically ineffective or are medically inappropriate for their condition.

It is important to realize that there are limits to a patient’s rights. A patient is limited to asking only for treatments that will benefit her. This limitation makes sense. It would be pointless, and potentially harmful, to provide a treatment or medication that would not improve the patient’s condition. So, as a physician, you are able to say no to practicing bad medicine. If what the patient or decision maker is requesting would be inappropriate or non-beneficial you can say no and protect the patient. But if it is a medically valid option, even when you disagree with what the person wants because you think they are being foolish or it isn’t the best option to choose, we have to respect that it is the patient’s body and life.

I know this can be difficult as you watch people making foolish choices. But that is autonomy. All of us, including you, are allowed to make the decisions that make sense in the context of one’s own life. (Of course, there are different boundaries in pediatrics.)

One technique I use with patients is to say, “Here is the ideal plan. Now let’s talk about your plan.” That allows the two of you to partner together to build a plan, although it might not be ideal, it is something the patient is willing to consider and to try. And then perhaps in the future, the patient will be willing to consider the other options you would like him or her to try.

Have a kind and respectful day.

Helping our patients get the help they need when their senses fail

The American Speech-Language-Hearing Association (ASHA) http://www.asha.org

It is so important to make sure that your senior patients get check ups for both hearing and seeing. Don’t assume that the mental changes you are seeing mean there is a brain or psychological issue. Sometimes it is a senses issue. And your patient may or may not know it is happening since it changes happen slowly over time. I didn’t realize that my dad had such poor vision until I sat with him during his eye appointment. Then I understood how much he was missing and how I needed to make sure we modified his space to help him with his visual limitations. I wish the doctor had taken a more proactive approach to helping me with my dad. Instead, he just documented what was happening and moved on to the next patient. I sure could have used his advice and guidance about what this vision loss meant to my dad and how I could help.

Language barriers also create an obstacle to getting what one needs. Unfortunately, I see healthcare professionals discount or ignore someone with speech limitations and turn to the family member instead. I know we are all rushed in medicine but we have to take a stand and say no, I am not going to rush this person through because my patient needs me. It also happens in our day-to-day life when we want someone in front of us in line to hurry up but they can’t because it takes them longer to speak.

Just because people can’t speak well or speak fast, doesn’t mean they shouldn’t have a voice in their lives. There are other ways to communicate. People can write, type, point to words or pictures on a board or sign. Many times it is just about having patience. Having the patience to sit still while the other person finds the words. And what I have found with my hospice work is that people communicate even when they can’t say a word. So, sit still and listen. You make a difference when you do.

Have a kind and respectful day.

Speaker phone, conference call or webcam your patient’s condition to their family.

Are you frustrated when the patient goes home and doesn’t follow your instructions or when the family member calls you and wants you to repeat everything you said to the patient?

A great way to solve this is to use technology. And I don’t mean fancy technology, but using either the speaker function and/or conference call feature on everybody’s cell phone. Then the loved ones can give you more information, ask questions and can listen to your update about the patient’s health and treatment plan. This is also an opportunity for you to build a relationship with the family in case the patient can’t speak for him- or herself in the future.

Using technology can be especially important in the hospital. For those who can not travel, use a laptop with a webcam to help the family see how their loved one is doing. There is nothing like seeing the person with their own eyes to help them picture what you are talking about. An image, either by webcam or cell phone picture can give the family understanding of the condition of the patient and how his or her health has changed.

Have a kind and respectful day.

Improving the Medical Experience of the Person struggling with Alzheimer’s or other memory loss

When a person with Alzheimer’s or dementia is going to have a medical test or procedure, how can we help the person to feel less frightened and to minimize any suffering? If the patient is struggling to understand what will be happening to them, do a practice run-through and show the person the room where the test will happen. Or find a book with pictures that will help him understand what you are talking about. If the person with diminished capacity is afraid of being alone, you may want to introduce him to the nurses who will be working that day. For my dad, we tape-recorded the doctor’s explanations so he could listen to the information over and over again until he felt more comfortable.

Another thing to keep in mind is that the patient may be experiencing symptoms that affect his or her participation. These symptoms could be pain, side effects of medications, loss of hearing or sight, lack of sleep, an undiagnosed illness and grief, to name a few. Find out what can be done to relieve these symptoms to make it easier for the individual to participate in the process. Ultimately, our goal is to think about the quality-of-life questions from the person’s perspective as he or she will experience the consequences of our decisions.

Have a kind and respectful day.

Teaching your Patients How to be Good Patients

Time is limited and the patient keeps talking and talking. What can you do? I realize that patients aren’t taught how to be good patients. So it is up to us to teach them. I have three recommendations for you.

Recommendation #1 Have them write out what they want to talk about before their appointment. Now I am sure you have heard this before, but the part that most doctors miss is to get them to prioritize their questions. I tell them to circle the most important 2 questions they want to discuss with you. Otherwise you just get a long list of random questions without any sense of what they truly want you to focus on. Patients understand that you can’t answer all of their questions but they will be satisfied if you take care of the most urgent issues. I have a questionnaire form, Viki Kind’s Office Form that you can download to help you help the patient. I encourage you to give copies to your patients to keep at home so they can fill them out before their appointment. If they haven’t filled one out before they arrive, then have them work on it while they are in your waiting room. In the medical practice I used to manage, we had a clipboard and form all ready for the patient when they checked. This is an easy way to be more efficient and to increase patient satisfaction.

Now some of you might be thinking, “Good, I don’t have to spend time listening, I can just read their list.” Well, you can if you want but your patient will be angry and non-compliant. If your patient doesn’t trust you or trust that you care about them, they won’t heal as fast or follow your instructions.

Here is Recommendation #2. It is up to you to build a caring relationship with them and you do that through compassionate dialogue, not a monologue. The act of listening has its own healing properties.

Recommendation #3 The other thing you need to educate patients about is to stop asking you the, “Oh by the way…” question as you are about to walk out the door. You need to tell them up front to ask you the most important questions at the beginning of the appointment or else you won’t have to time to address their concerns. Of course, this is a hard habit to break for patients and you will have to give them time to learn to be more direct with you.

Bonus Information: Unfortunately, some of these techniques will not work with certain cultures as they use a form of indirect communication which dances around the topic and takes longer as the only way they know how to communicate. But for most of your patients, these techniques will help you manage your time while caring for your patients.

Have a kind and respectful day.

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