“The Young Child Suffering Grief after a Loss” Interview with Shari Moore, August 26th, at 10AM pacific

“The Young Child Suffering Grief after a Loss” Interview with Shari Moore, August 26th, at 10AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Shari Moore is the Youth Program Director at the Hospice of the Conejo. She has worked with bereaved children, ages 4-13, for 8 years. Her background is in Clinical Psychology. Shari is in her third and final year of coursework for a Ph.D. in Mythology and Depth Psychology (may be relevant to address cultural resistance to discussing death in society). She is a project manager at Amgen and a research assistant at UCLA’s Neuropsychiatric Hospital and Institute.

Nighttime Day Cares for People with Dementia and Alzheimers

In my recent interview with the author of Becoming Dead Right: A hospice volunteer in urban nursing homes, Frances Shani Parker told me about a new concept that is spreading across the nation. Nighttime Day Care Facilities for people with dementia and Alzheimers. Instead of giving the caregiver a break during the workday, the caregiver gets a good night sleep. This is exceptionally helpful because people with dementia tend to be up and night and want to be entertained. No wonder so many caregivers are exhausted if they are up all night taking care of their loved one. Not only is this a great idea for the caregiver, the person with dementia gets the interaction and attention they need. They feel less frustrated, less isolated and more content.

You can start out with one or two times a week and add more as necessary. There will be a period of adjustment but most people really enjoy getting out and spending time at these day or night cares. Frances also said that this can be a good option for people who will eventually need to go to a care facility full time. Going to day or night day care will help the person transition more easily when the time comes.

This is also good for business because now the day care can cater to a whole new group of customers. The night time crowd.

If you would like to listen to the interview about what we can do to improve nursing homes and the recent regulatory changes mandating these changes, click on http://tinyurl.com/lrjj8c. You can listen on line or download it through itunes.

Have a kind and respectful day.

“Protecting the Nursing Home Resident – The job of the ombudsman” Interview with Molly Davies, August 18th, at 10AM pacific.

“Protecting the Nursing Home Resident – The Job of the Ombudsman” Interview with Molly Davies, August 18th, at 10AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

After serving more than two years as a regional manager for the Long-Term Care (LTC) Ombudsman Program, two years as an Ombudsman care manager, and two years as a volunteer Ombudsman, Ms. Davies was named Program Director of the LTC Ombudsman Program in October 2006. She manages the Los Angeles County and City LTC Ombudsman programs and serves as the designated LTC Ombudsman “program coordinator” per state contract requirement.

In her capacity as program director, Ms. Davies oversees all aspects of the WISE LTC Ombudsman Program, including program development, implementing LTC policy changes, monitoring budgets and promoting the program to the public. She and her staff ensure that service delivery complies with all regulatory and contract guidelines and the policies and procedures that govern the program. She is responsible for monitoring and reporting on program performance monthly, maintaining a tracking system for reports of alleged elder abuse and assessing client satisfaction. She is also responsible for recruiting, training and evaluating ombudsmen. Ms. Davies holds a bachelor’s degree in Sociology from UCLA and is currently completing a master’s degree in Social Work at California State University Long Beach.

Have a kind and respectful day.

A Good Death – The Patient Gets to Decide

A good death is what the patient tells us it should be. No one can define what would make a good death for another person. We have to ask.

There is a famous bioethics case of a lady who needed to have her leg amputated. She didn’t want to have her leg cut off even though it meant she would die. The doctor argued with her again and again. He would ask, “Don’t you want to be alive to see your grandkids grow up? Don’t you want to spend time with them?” Finally the woman said to the doctor, “I hate my grandkids.” He was shocked. But she went on to explain that the only thing that brought her joy was working in her garden. And if her leg was cut off, then she couldn’t do that anymore. The doctor had thought that what would be valuable for him would be valuable for her. He was mistaken.

We have to ask the patient what they would want and then respect their answers. We have to respect the person. It is their life and their death.

I know it is difficult to accept when people want things we don’t understand. For instance, for some people suffering has meaning. If I understand this, I can understand when the patient doesn’t want to take their pain pills. Or if they want to trade a little bit of pain control for increased consciousness, then I will understand if the patient will only take a little of their pain meds. It is their death. We need to listen to them.

When I work as a hospice volunteer, I have lots of ideas for things people might want to do to create a legacy for their family but that is only if the person wants to. But I don’t assume that what other people want is what I would want. I ask. If someone wants to record their life history on an audio or a video tape, I will help them. Or perhaps they will want to write love letters for their family to open after they are gone. And some people want to write an “ethical will” outlining what values and beliefs they would like to pass on. Or if they would rather avoid thinking about dying, then I honor that. It is their decision to make. They get to choose what makes a good death for them, so I listen.

Have a kind and respectful day.

A Good Death – You Tell Me and I Will Help You Get It

A good death is what you tell me it should be. No one can define what would make a good death for you. If you tell people what would be meaningful for you, then those around you can get you what you need. I have lots of ideas for things you might want to do to create a legacy for your family but that is only if that is what you want to. Perhaps you want to record your life history on an audio or a video tape. Perhaps you want to write love letters for your family to open after you are gone. Perhaps you want to write an “ethical will” outlining what values and beliefs you would like to pass on.

Or maybe you want me to know about how to handle your physical symptoms. Maybe suffering has meaning for you. If you explain this to me, I will understand when you don’t take your pain pills. Or if you tell me that you don’t want to suffer, I will understand when you take your pills and sleep a lot. Or perhaps you want to trade a little bit of pain control for consciousness, then I will understand if you only take a little of your pain meds. You tell me. It is your death.

Or perhaps you don’t want to talk about it and just spend your days living. You get to decide but you have to tell people so they will know what is important to you. Otherwise, we won’t know what to do to support you.

There is a famous bioethics case of a lady who needed to have her leg amputated. She didn’t want to have her leg cut off even though it meant she would die. The doctor argued with her again and again. He would ask, “Don’t you want to be alive to see your grandkids grow up? Don’t you want to spend time with them?” Finally the woman said to the doctor, “I hate my grandkids.” He was shocked. But she went on to explain that the only thing that brought her joy was working in her garden. And if her leg was cut off, then she couldn’t do that anymore. The doctor had thought that what would be valuable for him would be valuable for her. He was mistaken.

You have to tell your doctor what matters to you. And if you can, write it down so people will know what to do when it comes time. When it is written down, you are more likely to get what you want. A good death on your own terms.

Have a kind and respectful day.

Are you interested in becoming a legal nurse? Patricia Coonan will tell you what you need to know to transition into this rewarding profession. August 10, 2pm pacific on blogtalkradio.com/kindethics

Are you no longer able to be a nurse due to latex allergies, a back injury or are you just looking for something with more flexibility.  You may want to consider becoming a legal nurse consultant and putting all of your knowledge and compassion into helping others in a new way.  Patricia Coonan will be answering your questions regarding how to transition into the rewarding career of legal nurse consulting. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Patricia been a RN for 24 years and Legal Nurse since 1997. She works for the Beasley Firm as an In-House Consultant and Legal Assistant. If you are being sued, she is the person that would go through the medical records to see what happened and if you have deviated from the Standards, Protocols and Industry Practices and if you may be negligent.

Patricia has also created a training program for those nurses interested in going into the legal field. If you are interested, you can find her products on eBay under Prrn12 or at www.legalnurseprrn12.com or at pc-rn@comcast.net.

You can follow her on Twitter: pcRN or reach her at pc-rn@comcast.net.

For legal help, The Beasley Firm website is http://www.beasleyfirm.com and their offices are as follows:
The Beasley Building
1125 Walnut Street
Philadelphia, PA 19107
Phone (215) 592-1000
Fax (215) 592-8360
3000 Atrium Way
Suite 258
Mount Laurel, NJ 08054
Phone (856) 273-6966
Fax (856) 273-6913
Have a kind and respectful day.

DNR (do not resuscitate or no CPR) does not mean do not treat or do not care. A warning for all of us.

Dear Viki,

I noticed that after my dad became a DNR in the hospital, the nurses didn’t come into the room as often anymore and the doctor didn’t visit the way he used to. Just because my dad didn’t want to have CPR didn’t mean that he still didn’t want to fight his cancer. But it seemed like everybody gave up on him. Did the DNR (do not resuscitate) decision really mean, Do Not Care?

I realize that not only are patients confused about what DNR means (do not do CPR), but nurses and physicians are also confused. I know that’s not what you want to hear, but it’s true. Somehow DNR has become a decision about treatment choices instead of just CPR. What DNR should mean is only one thing, do not do cardiopulmonary resuscitation.

Research has found that if a patient is a DNR, then healthcare professionals may believe that the patient doesn’t want any other types of aggressive treatment. But this isn’t true. A patient may want chemotherapy, surgery, radiation therapy or other kinds of aggressive treatments, and still not want to receive CPR. A DNR doesn’t tell you anything about what other treatments the patient might or might not want to receive.

I’m not telling you this to scare you out of being a DNR. Not at all. I am just reminding all of us that one part of the end-of-life decision making process does not dictate everything else we might want. So yes, you can be a DNR and still have appropriate aggressive medical treatments. Or you can be a DNR and choose only to have hospice care. Or you can be on hospice and not be a DNR. Or you can choose some of the medical treatments being offered and refuse others. These are all separate decisions. You get to choose from all of the appropriate medical options available. Choose some, choose all or choose none. It is up to you. The only thing you can’t choose is a treatment that is not a valid medical option. You cannot make the doctor gave you ineffective or non-beneficial treatments. You are only allowed to choose from the list of medically appropriate treatments for your condition.

Lastly, as a reminder to all the healthcare professionals. A DNR never represents a do not care order. We should still be going into their hospital room as often as we would for someone without a DNR. We should always treat the patient with respect and dignity and provide comfort care to manage their suffering.

Have a kind and respectful day.

When A Stranger Decides If You Should Live Or Die

There are so many things that happen behind the scenes in healthcare when it comes to dying. One of the hardest things for me to witness is when a patient has no one to speak for them at the end. We call this person the unrepresented patient or the unbefriended person. This is a person without any friends or family who can make sure they have a good death. So what happens to them? In some cases, a public conservator or guardian is appointed to make their decisions for them. This is a stranger making decisions for another stranger. There is nothing personal or meaningful in this process. The other thing that happens, if there isn’t a guardian available, is a group of people at the hospital will make the decision for this person. Sometimes we call this an advocate team and or a moral community. This group usually consists of a doctor, nurse, social worker, chaplain, members of the ethics committee and community members. As a group they will make the decision whether this person should live or die. Unfortunately this decision is based on very little information about who this person is or what would is important to them in their life. It is usually a medical decision instead of a human decision. Not that the advocate team doesn’t try to make it personal.

Let me tell you about one such patient who had this group of strangers make his decisions for him. This was an 83-year-old gentleman who had been living in a nursing home for the past 12 years. At the nursing home, he was able to eat and walk around, but he had severe dementia and could not communicate with the staff. In the 12 years he had been living there, nobody ever visited, nobody ever called and nobody sent him a letter. He had become invisible. The staff cared about him and took good care of him but they were not family. Just before I met this man, he had a massive stroke which left him paralyzed, in a coma, unable to eat or drink and dying. The social workers at the hospital did everything they could to try to find somebody who knew this man but nobody could be found. I live in Los Angeles and we don’t have enough people who are willing to be a public conservator or guardian. So now we use advocate teams to help make decisions for those who are completely alone and silenced by their disease.

I came into the hospital that day and I went to the patient’s bedside because I refuse to make a decision for somebody that I haven’t met or tried to connect with. I knew this person wasn’t going to be able to communicate back to me, but as I sat at his bedside, I held his hand and connected with the human inside this body in the bed. The only noise in the room was the sound of the machines breathing for him. His body was a shell and it seemed like he was already gone. I sat with him and talked to him and told him that I would try to do right by him. I cried a few tears as I realized he was already gone. These are the difficult moments in my job.

I went to the meeting and heard what the doctors had to say and listened to what the social worker had discovered about this man. This was a man who was dying and there was nothing we could do to change it. We asked all the questions we could think of about his medical condition and if there was any hope. We were told there was not. I then asked the social worker about who this person had been at the nursing home. Had he enjoyed his meals? Had he enjoyed interacting with others? What had brought him joy even in his limited condition? He had been living a life with small pleasures and not too much suffering. But now, he couldn’t feel anything. He couldn’t enjoy eating a cupcake, watching something on TV or going to the sing-along in the activity room.

In the advocate team meeting, we all have to agree on what we think we should do. In this team meeting, we decided that there was no way he was going to be able to return to enjoy any part of his life. He was dying and there was no turning back. Our team agreed that he should be made comfortable and be allowed to die a natural death. This included being taken off the ventilator and being allowed to die.

I wasn’t going to tell you his name because he had become invisible to the world. But I have changed my mind because he wasn’t invisible to me. His name was James and I was part of his life and his death.

These are really difficult decisions. These are decisions that should not be made by strangers. But people in hospitals all over the nation are having their life and death decisions made by committee. This is not how it’s supposed to be. People shouldn’t be dying alone and they shouldn’t be living for 12 years without one person visiting them.

Sometimes it’s hard to do the work I do. Sometimes it breaks my heart. But I have the courage to walk into the darkness with people. Whether it’s the family who is grieving at the bedside, the patient who is afraid of what is happening to their body or the health care professional who can’t bear to participate in one more death. I walk with people on this journey and ease their way.

Have a kind and respectful day.

“Medical Futility and a Legal Update From Across the Nation” Interview with Thaddeus Pope J.D, of the MedicalFutility.blogspot.com. August 4th, 10am, pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

I am honored to be interviewing the legal expert on futility, Thaddeus Pope J.D, regarding the issue of medical futility. You may not have heard much about this issue but you are going to be hearing a lot about it in the upcoming debate on healthcare reform. Every time President Obama says that we have to stop paying for treatments that will not work, he is talking about medical futility. Or when the politicians discuss using our healthcare dollars wisely, they are talking about medical futility. In healthcare, the number one problem being brought to bioethics committees is dealing with requests for treatments that are medically inappropriate or will not work. I encourage you to listen to this interview because when you or your loved one is in the hospital, this issue will be playing a factor in your treatment decisions. And even more importantly, this issue will be shaping the healthcare plan that is being proposed. Please let me know where you stand on this issue and feel free to call in with your questions.

“Medical Futility and a Legal Update from across the nation” interview with Thaddeus Pope J.D, of the MedicalFutility.blogspot.com and www.thaddeuspope.com. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Thaddeus Pope is an Associate Professor of Law and member of the Health Law Institute at Widener University School of Law. He came to Widener in 2007, after teaching at the University of Memphis since 2005. Before entering academia, he worked seven years for Arnold & Porter LLP (in Los Angeles and Washington, DC), and clerked for the U.S. Court of Appeals for the Seventh Circuit. He earned both my J.D. and Ph.D. (in philosophy & bioethics) from Georgetown University.

His current research focuses on:
Medical Futility and other legal obstacles to good end-of-life care
Internal Dispute Resolution mechanisms in healthcare, particularly ethics committees
Tort Law, particularly consent and the assumption of risk doctrine
Public Health Law, particularly the legitimacy of restricting voluntary self-regarding conduct
Normative Jurisprudence, particularly the justifiability of hard paternalism

He teaches the following courses:
Health Law I (Patient Care & Liability), End-of-Life Decisions Law, Health Law II (Finance & Regulation), Bioethics, Torts, Public Health Law, Business Organizations, Health Law Thesis

You can get copies of the articles he has written at:
www.thaddeuspope.com
http://works.bepress.com/thaddeus_pope/
http://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=180178

For more information about Thaddeus Pope go to: http://thaddeuspope.com/images/Pope_Bio_1p_-_futility_.pdf

“The Compassion Fatigue Project” Interview with Patricia Smith, August 3rd, at 9AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

“The Compassion Fatigue Project” Interview with Patricia Smith, August 3rd, at 9AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Patricia Smith, founder of the Compassion Fatigue Awareness Project,
has published To Weep For A Stranger: Compassion Fatigue In
Caregiving. Along with in-depth explanations of compassion fatigue and
its symptoms and causes, the paperback features the following
comprehensive chapters:

Chapter 1: When Caring Too Much Hurts
Chapter 2: What Is Compassion Fatigue?
Chapter 3: Burdens Of The Chosen
Chapter 4: The Decision To Heal
Chapter 5: Standards Of Self-Care
Chapter 6: To Family Caregivers
Chapter 7: To Those Entering The Helping Professions
Chapter 8: When the Workplace Suffers
Chapter 9: To Weep For A Stranger

To order direct from the Createspace website for only $15, visit:

http://www.createspace.com/3393286

Workbooks:
Healthy Caregiving: A Guide to Recognizing and Managing Compassion Fatigue Level 1 –
Presenter’s Guide www.createspace.com/3363699

Healthy Caregiving: A Guide to Recognizing and Managing Compassion Fatigue Level 1 –
Student Guide www.createspace.com/3363698

CF Marketplace: http://www.cafepress.com/CFMarketplace

To Weep for a Stranger: Compassion Fatigue in Caregiving
www.createspace.com/3393286 (available 7/14/09

Have a kind and respectful day.

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