5/9/20151 PALLIATIVE CARE SOUNDS AND SENSES IN THE GARDEN Charles Sourby, MS Ed. Bonsai Gardens, Seed Starting, Aroma Therapy, Plants of the Bible, Garden

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PALLIATIVE CAREPALLIATIVE CARE

SOUNDS AND SENSES IN THE GARDENSOUNDS AND SENSES IN THE GARDEN

Charles Sourby, MS Ed. Charles Sourby, MS Ed.

Bonsai Gardens, Seed Starting, Aroma Therapy, Bonsai Gardens, Seed Starting, Aroma Therapy, Plants of the Bible, Garden Prayers, Useful Terminology,Plants of the Bible, Garden Prayers, Useful Terminology,

Useful Plants Useful Plants

Learn how therapeutic recreation & Horticultural therapy addresses a patient’s negative feelings; threats to self esteem, and help restore a sense of control, contributing to an improved

health related quality of life.

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ReflectionReflection

To affect the quality of the day is the highest of arts.To affect the quality of the day is the highest of arts.

Henry David ThoreauHenry David Thoreau

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Key WordsKey Words American Horticultural Therapy AssociationAmerican Horticultural Therapy Association Cancer CareCancer Care Commitment Commitment DisengagementDisengagement Horticultural TherapyHorticultural Therapy Life ContinuesLife Continues Non-abandonmentNon-abandonment Patient GardenPatient Garden Palliative CarePalliative Care Psycho-Social Impact of DyingPsycho-Social Impact of Dying R.O.P.E.sR.O.P.E.s Social Comparison TheorySocial Comparison Theory Terminal IllnessTerminal Illness

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The Horticultural TherapistThe Horticultural Therapist

Horticultural therapists, traditionally Horticultural therapists, traditionally concerned with the quality and potential of concerned with the quality and potential of

human life, face a difficult challenge in human life, face a difficult challenge in providing Horticultural Therapy in settings providing Horticultural Therapy in settings

that serve people with life threatening that serve people with life threatening illnesses such as advanced or end-stage illnesses such as advanced or end-stage

cancer. cancer. Connoly--1993

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Horticultural Therapy Horticultural Therapy

As defined by the American Horticultural Therapy As defined by the American Horticultural Therapy Association (AHTA), horticultural therapy is a Association (AHTA), horticultural therapy is a discipline that uses plants, gardening activities, discipline that uses plants, gardening activities, and the natural world as vehicles of professionally and the natural world as vehicles of professionally conducted programs in therapy and rehabilitation. conducted programs in therapy and rehabilitation. Horticultural therapy can be applied in every type Horticultural therapy can be applied in every type of medical and social service setting ranging from of medical and social service setting ranging from hospitals, to corrections, to youths at risk, to hospitals, to corrections, to youths at risk, to vocational programs.vocational programs.

AHTA

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Horticultural TherapyHorticultural Therapy

Horticultural therapy can address the dying patient’s Horticultural therapy can address the dying patient’s negative feelings; threats to self esteem and help restore a negative feelings; threats to self esteem and help restore a sense of control, contributing to an improved quality of life. sense of control, contributing to an improved quality of life.

Horticultural Therapy goals focus on alleviating stress and Horticultural Therapy goals focus on alleviating stress and anxiety, decreasing social isolation, rebuilding self-esteem, anxiety, decreasing social isolation, rebuilding self-esteem, increasing independence, and maximizing functioning. The increasing independence, and maximizing functioning. The role of HT is to support the palliative goal in the treatment role of HT is to support the palliative goal in the treatment of advanced cancer patients. of advanced cancer patients.

AHTA, 2004AHTA, 2004

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CancerCancer

Despite all of the technological advances in Despite all of the technological advances in medicine, some cancers simply cannot be medicine, some cancers simply cannot be cured. Cancer affects people from all cured. Cancer affects people from all cultures, socio-economic classes, ages, and cultures, socio-economic classes, ages, and backgrounds. More than 1.2 million backgrounds. More than 1.2 million Americans are diagnosed with cancer each Americans are diagnosed with cancer each year and no less than 500,000 die from the year and no less than 500,000 die from the disease annually. disease annually.

CNN--1995

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Treatment often involves surgery, radiation, and Treatment often involves surgery, radiation, and chemotherapy. The disease and subsequent treatments chemotherapy. The disease and subsequent treatments can be painful and uncomfortable.can be painful and uncomfortable.

For the patient who does not respond to treatment, or, who For the patient who does not respond to treatment, or, who

is medically determined to be at the end stage of the is medically determined to be at the end stage of the disease process, being admitted to a hospital or hospice is disease process, being admitted to a hospital or hospice is a common occurrence. a common occurrence.

Treatment for the patient at the terminal or end stage of Treatment for the patient at the terminal or end stage of cancer increasingly involves an approach called palliative cancer increasingly involves an approach called palliative care.care.

Cancer CareCancer Care

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Palliative CarePalliative Care

The palliative approach to treatment The palliative approach to treatment includes control of pain and other symptoms includes control of pain and other symptoms while simultaneously addressing the while simultaneously addressing the individual patient’s psychological, social, individual patient’s psychological, social, and spiritual concerns, in an effort to provide and spiritual concerns, in an effort to provide the best possible quality of life for the dying the best possible quality of life for the dying patient as well as his or her family.patient as well as his or her family.

Stoll--1988Stoll--1988

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““Palliative care is the active total care of patients Palliative care is the active total care of patients whose disease is not responsive to curative treatment. whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of Control of pain, of other symptoms, and of psychological, social, and spiritual problems is psychological, social, and spiritual problems is paramount. The goal of palliative care is achievement paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their of the best possible quality of life for patients and their families.families. Many aspects of palliative care are also Many aspects of palliative care are also applicable earlier in the course of the illness, in applicable earlier in the course of the illness, in conjunction with anti-cancer treatment.”conjunction with anti-cancer treatment.” Conference On Care Near The End Of Life, Harvard Medical School. Division of Continuing Education, Boston 1995Conference On Care Near The End Of Life, Harvard Medical School. Division of Continuing Education, Boston 1995


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The Psychosocial Impact of DyingThe Psychosocial Impact of Dying

Is monumental, involving the search for meaning, Is monumental, involving the search for meaning, confronting fears, dealing with the loss of control, confronting fears, dealing with the loss of control, and issues of loss.and issues of loss.

The dying patient often experiences anger, guilt, The dying patient often experiences anger, guilt, disorganization, isolation, and depression.disorganization, isolation, and depression.

Kubler-Ross--1969Kubler-Ross--1969

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The Psychosocial Impact of DyingThe Psychosocial Impact of Dying

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Terminal Illness Terminal Illness

Terminal illness, such as advanced cancer, is Terminal illness, such as advanced cancer, is defined as an defined as an illness that cannot be cured by illness that cannot be cured by present day medical technology and that present day medical technology and that generally leads to death within a specified generally leads to death within a specified period of timeperiod of time..

Turk & Feldman 1992Turk & Feldman 1992

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In Palliative Care, the sense of non-In Palliative Care, the sense of non-abandonment is paramount. abandonment is paramount.

Aaronson & Beckman--1987Aaronson & Beckman--1987

Non—AbandonmentNon—Abandonment

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Social Comparison TheorySocial Comparison Theory

Those receiving palliative care need to Those receiving palliative care need to socialize. Support is derived from seeing socialize. Support is derived from seeing others in similar situations. Research others in similar situations. Research demonstrates an elevated sense of hope demonstrates an elevated sense of hope and a better outlook following social and a better outlook following social interactions with peers.interactions with peers.

Brietbart & Holland—1993Brietbart & Holland—1993

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Description of PatientDescription of Patient

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Description of PatientDescription of Patient

The patient, often in pain, is to endure life’s The patient, often in pain, is to endure life’s final stages. (In some cases the diagnoses final stages. (In some cases the diagnoses is less than ninety days old.) The patient is less than ninety days old.) The patient receives palliative medical treatment and receives palliative medical treatment and has psychosocial needs addressed through has psychosocial needs addressed through contact support, compassion, and comfort contact support, compassion, and comfort provided by a number of disciplines to help provided by a number of disciplines to help complete life with dignity and grace.complete life with dignity and grace.

Rando—1984 Rando—1984

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Calvary HospitalCalvary Hospital

Case Study:Case Study: BarbaraBarbara ( (see hand-out)see hand-out)

Diagnosis: Diagnosis: Terminal cancer of larynx and breast 1 yearTerminal cancer of larynx and breast 1 year

Background Background – Complication of chemotherapy induces cardiac arrest.Complication of chemotherapy induces cardiac arrest.– History of alcohol abuseHistory of alcohol abuse– Smoked two packs of cigarettes a daySmoked two packs of cigarettes a day– Retired teacherRetired teacher

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BarbaraBarbara

Reason for referralReason for referral

ActivitiesActivities

ResultsResults

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Program Planning: Learning the Program Planning: Learning the R.O.P.E.S. R.O.P.E.S.

Review-What garden activity preceded this Review-What garden activity preceded this one?one?

Overview—What is the process?Overview—What is the process? Presentation—Today’s garden activitiesPresentation—Today’s garden activities Experiential—Immerse patient in the activityExperiential—Immerse patient in the activity Summary—Review what happenedSummary—Review what happened

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Program Concepts & DesignProgram Concepts & Design

Patient Garden—the plants belong to the patientsPatient Garden—the plants belong to the patients

Living Legacy of Plants—I plant you a dish garden Living Legacy of Plants—I plant you a dish garden

Life Continues—Through plants, life carries onLife Continues—Through plants, life carries on

Sounds, Senses and Healing—Music, Scents, Sounds, Senses and Healing—Music, Scents, Touch, Color and PrayerTouch, Color and Prayer

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Garden projectsGarden projects

Plants of the BiblePlants of the Bible– Hold, touch, reflectHold, touch, reflect

Aroma TherapyAroma Therapy– Aware of the breadth of life Aware of the breadth of life

Bonsai & Dish GardensBonsai & Dish Gardens– Disengagement giftsDisengagement gifts

Planting SeedsPlanting Seeds– RenewalRenewal

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The Spiritual Nature of PlantsThe Spiritual Nature of Plants

Plants have a spiritual value that is Plants have a spiritual value that is therapeutic in palliative care. Plants help therapeutic in palliative care. Plants help patients cope, enjoy a sense of healing and patients cope, enjoy a sense of healing and regain perspective. The fragrance of Biblical regain perspective. The fragrance of Biblical flowers and herbs revitalize people at the flowers and herbs revitalize people at the end of life. Interacting with a flower or herb end of life. Interacting with a flower or herb from the Bible lifts spirits and a sense that from the Bible lifts spirits and a sense that life continues.life continues.

Sourby--1998Sourby--1998

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Group Therapeutic HorticultureGroup Therapeutic Horticulture

JanuaryJanuary– Winter twig studyWinter twig study– Seed catalogsSeed catalogs– Division propagation:Division propagation:

Pot up various fernsPot up various ferns

FebruaryFebruary– Start Caladium bulbs, plan gardenStart Caladium bulbs, plan garden– Pressed flowers for Valentine CardsPressed flowers for Valentine Cards– Sweet Potato House Plants Sweet Potato House Plants

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MarchMarch– Vegetable seed study/ posterVegetable seed study/ poster– Plant annualsPlant annuals– Plants of the BiblePlants of the Bible– Fantasy Garden CollageFantasy Garden Collage

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AprilApril– Signs of SpringSigns of Spring– Seedling maintenanceSeedling maintenance– Plant early peasPlant early peas– Flower arrangements for Easter and PassoverFlower arrangements for Easter and Passover

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MayMay– Window box planting (3 sessions)Window box planting (3 sessions)– Mothers’ Day Flowers everywhere.Mothers’ Day Flowers everywhere.

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JuneJune– Nature DrawingNature Drawing– Press flowers, drying flowersPress flowers, drying flowers– Pinch mumsPinch mums– Make Herb VinegarMake Herb Vinegar

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JulyJuly– Window box maintenanceWindow box maintenance– Press dry flowersPress dry flowers– Leaf and twig studyLeaf and twig study– Sensory experience: herbs and flowersSensory experience: herbs and flowers– Order bulbs for forcingOrder bulbs for forcing

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AugustAugust– Divide house plantsDivide house plants– Taste this year’s tomato cropTaste this year’s tomato crop– Garden party with iced teasGarden party with iced teas– Press flowersPress flowers– Make natural dyesMake natural dyes

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SeptemberSeptember– Press leavesPress leaves– Plant mums in containersPlant mums in containers– Start topiary with IvyStart topiary with Ivy– Sensory SachetsSensory Sachets– Harvest PartyHarvest Party

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OctoberOctober– Dried flower arrangementsDried flower arrangements– Cuttings from scented geraniumsCuttings from scented geraniums– Amaryllis BulbsAmaryllis Bulbs– Paper-whites Paper-whites – Make scarecrows Make scarecrows

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NovemberNovember– Sun catchersSun catchers– Pinecone bird feedersPinecone bird feeders– BulbsBulbs– Natural holiday decorationsNatural holiday decorations

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DecemberDecember– Natural ornamentsNatural ornaments– Pressed flower holiday cardsPressed flower holiday cards– Dried leaf wreathsDried leaf wreaths– Winter solstice programWinter solstice program

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SummarySummary Horticultural TherapyHorticultural Therapy is an effective intervention in is an effective intervention in Palliative CarePalliative Care involving involving

the the search for meaning, confronting fears, dealing with the loss of search for meaning, confronting fears, dealing with the loss of control, and issues of loss.control, and issues of loss.

Horticultural TherapyHorticultural Therapy can address the dying patient’s negative feelings; can address the dying patient’s negative feelings; threats to threats to self esteemself esteem and help restore a and help restore a sense of control, contributing to sense of control, contributing to an improved quality of life. an improved quality of life.

Approach to treatment includes control of pain and other symptoms while Approach to treatment includes control of pain and other symptoms while simultaneously addressing the simultaneously addressing the patient’s psychological, social, and spiritual patient’s psychological, social, and spiritual concerns,concerns, in an effort to provide the best possible in an effort to provide the best possible quality of life.quality of life.

Therapeutic horticulture reduces boredom, fosters a sense of accomplishment Therapeutic horticulture reduces boredom, fosters a sense of accomplishment and enhances psycho-social supports within the patient’s community.and enhances psycho-social supports within the patient’s community.

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ReflectionReflection

We are invited to discover the inner garden We are invited to discover the inner garden of our soul. Connecting the soil seed and of our soul. Connecting the soil seed and gardens leads us to the presence of God gardens leads us to the presence of God and the mysterious rhythm of healing and and the mysterious rhythm of healing and growth.growth.

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Spiritual Nature of PlantsSpiritual Nature of Plants

Explore the healing of the soul that Explore the healing of the soul that gardening and gardens offer. gardening and gardens offer.

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NYBGNYBG

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Documents

5/9/20151 PALLIATIVE CARE SOUNDS AND SENSES IN THE GARDEN Charles Sourby, MS Ed. Bonsai Gardens, Seed Starting, Aroma Therapy, Plants of the Bible, Garden