GATEWAY ALLIANCE FOR COMPASSIONATE CARE Providing Quality Care and Comfort for Our Veterans at End...
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GATEWAY ALLIANCE FOR COMPASSIONATE CARE Providing Quality Care and Comfort for Our Veterans at End of Life Charli Prather, MSW LCSW OSW RYT Board Certified Oncology Social Worker Certified Warriors at Ease™ Meditation & Yoga Teacher Wounded Warrior Project Odyssey Clinical Contractor Proud Blue Star Mom www.charliprathercounseling.com
GATEWAY ALLIANCE FOR COMPASSIONATE CARE Providing Quality Care and Comfort for Our Veterans at End of Life Charli Prather, MSW LCSW OSW RYT Board Certified
GATEWAY ALLIANCE FOR COMPASSIONATE CARE Providing Quality Care
and Comfort for Our Veterans at End of Life Charli Prather, MSW
LCSW OSW RYT Board Certified Oncology Social Worker Certified
Warriors at Ease Meditation & Yoga Teacher Wounded Warrior
Project Odyssey Clinical Contractor Proud Blue Star Mom
www.charliprathercounseling.com
Slide 3
TODAYS GOALS The basics of military culture and its importance
How to identify the unique needs and health risks of Veterans of
different eras How to utilize interventions to minimize patient
stress during visits The clinical applications of resilience in
Veterans How to prepare families to recognize and assist with the
unique issues faced by aging and end-of-life Veterans Self-care
techniques when working with Veterans Mono-task practice
Slide 4
"A veteran is someone who, at one point in his or her life,
wrote a blank check made payable to 'The United States of America
for an amount of up to and including my life.'
Slide 5
The Facts 22.48 Million Veterans living (Washington Post
4/15/12) Largest Segment is Vietnam (7.9 Million) One in four dying
Americans is a Veteran 1600 Per Day
Slide 6
Average Age (presently) Related to War Experience Gulf War 43
Vietnam 66 Korean War 82 WW II 90
Slide 7
Many factors to consider
Slide 8
Critical Time for enlistment Most people join the military
between the ages of 18 and 25 There have been changes in the role
for women during war time 8-10 family members are affected by 1
service members time in the military
Slide 9
Health Risks Associated with Each Era Unique Gulf War: Toxic
agents, exposure to smoke, preventive meds & vaccines.
Fibromyalgia Chronic fatigue syndrome Chemical sensitivities LATE
ADDITION RESOURCE FOR VETS W/ CANCER: http://www.gulfwarvets.com/ao
Report to Secretary of the Dept. of VA on the Association between
adverse health effects and exposure to Agent Orange.
http://www.gulfwarvets.com/ao
Slide 10
Vietnam War Agent Orange exposure Hepatitis C Bacterial &
fungal infections / skin diseases Associated with: Lung, lymphomas
& prostate cancer Birth defects Diabetes Highest incidence of
PTSD Embed Video, Nurses of Vietnam (4 min.)
Korean War Frostbite & immersion (trench) foot Increase in
arthritis pain These injuries can lead to long-term & delayed
aftereffects including: Peripheral neuropathy Skin cancer Nocturnal
pain Cold sensation Was considered a conflict
Slide 13
Cold War (Atomic Veterans) Nuclear testing & cleanup
Radiation exposure which has been associated with leukemia, various
cancers & cataracts
Slide 14
WW II Infectious diseases Wounds Frostbite or other cold injury
Mustard gas testing Exposure to nuclear weapons Can lead to various
cancers & painful effects of frostbite, like peripheral
neuropathy
Slide 15
Discussion What other medical issues that could lead to
psycho-social challenges not mentioned have you seen in your
Veteran patients?
Slide 16
Why is it important to have a basic understanding of military
culture and terms?
Slide 17
The Warrior Ethos I will always place the mission first. I will
never accept defeat. I will never quit. I will never leave a fallen
comrade
Slide 18
Discussion of some basic and advanced interventions after break
Healing power of presence, EOL discussion tactics, caregiver
stress, self care for YOU
Slide 19
Dementia & PTSD
Slide 20
Dementia Diagnosis is Increasing in Veterans Present in 500,000
current Veterans The number of Veterans with dementia will peak in
2018
Slide 21
Minimizing Patient Stress Assess your assessment forms Did you
see combat? Were you in situations that were very stressful for
long period of time? Did you witness things during your
humanitarian mission that were difficult for you? Is there anything
about your military service that still bothers you? Encourage
stories during the intake process, this develops your relationship
early on prior to care taking place Dont ask the question if you
dont plan to provide an intervention.
Slide 22
Intervention you probably saw a lot of ugly things in that
deployment. Is anything still troubling you? Open the door, if they
dont walk through it, you didnt lose anything by trying. Remember,
not all stories are told in words, or need to be. Watch body
language, look into the eyes of your patients if you want to see
into their heart.
Slide 23
Ask about Tattoos
Slide 24
MEDITATION OR PRAYER Common myths: I have to make my thoughts
stop I have to relax I have sit up straight I have to be religious
Christians dont meditate
Slide 25
FRAME IT APPROPRIATELY Meditation & prayer is a way of
responding to Life on Lifes terms. Pain is inevitable.suffering is
optional
Slide 26
3 Ways to Respond to Challenges Dissociation Rejecting
Splitting off Suppressing Repressing Separating
Slide 27
Fusion Identifying with Flooded by Taken over by Defining
ourselves by
Slide 28
Disidentification Witnessing or welcoming the challenge With
curiosity and kindness, without identifying with it
Slide 29
Not all Veterans experienced stress during their service. Some
dont feel they are actually a Veteran if they didnt deploy. Not
everyone who experienced battle will have unresolved emotional
wounds. Resiliency may not look the same in every Veteran. Not all
non-combat Veterans leave the military without sustaining trauma.
Safe assignments may have had challenges. Spiritual and moral
injuries can be devastating.
Slide 30
Environmental Basics Some home care and hospice patients may
feel like the VA is against them, some feel that their care from
the VA is like going home and will insist on moving their care to a
VA facility as they near the end of their life. Announce where you
are in the room. Keep loud noises to a minimum when possible.
Confinement Acknowledge Pain. It is what the patient says it is.
Many Veterans will under-report pain and under-report fear. Public
acknowledgement of their service.
Slide 31
Ask about art, pictures, posters when you are visiting.
Slide 32
MORAL INJURIES Could complicate death. Dont dismiss their guilt
with platitudes, create a safe emotional environment for guilt to
emerge. Be prepared to process at length. If you are part of the
direct medical team, defer to social work and pastoral care
whenever possible.
Slide 33
NAMASTE CARE (Nah-Mah-STAY) Targeted for patients at EOL who
are tagged as no longer engaging. Multi-sensory based activity.
Restores sense of peace to patient & family. Covered with an
American flag after death. Staff accompanies stretcher to ambulance
(distinguished transfer)
Slide 34
LIFE REVIEW Record or write in journal for the family. Writing
prompts can be very helpful conversation starters for caregivers
and patients Write a letter to your loved one with all the things
youve wanted to say throughout the years. Write a letter to
yourself 5 years from now complimenting yourself on how brave you
were in caring for your loved one and how you have healed and
helped others through the experience.
Slide 35
Five Wishes Form Presentation of the 5 wishes document can be
difficult for families already in crisis. Sharing the Gift
www.agingwithdignity.org/forms/5wishes.pdf
www.agingwithdignity.org/forms/5wishes.pdf Caringconnections.org Go
to : BROCHURES PLANNING AHEAD IF YOU OR SOMEONE YOU LOVE IS ILL to
download this 2 page document.
Slide 36
Music (this is in your notes) Amy Camie, St. Louis Harpist
whose research is supported by area physicians. The Magic Mirror
and many others available at www.amycamie.comwww.amycamie.com
Jennifer Berezan: ReTurning was recorded in the Oracle Chamber in
the Hypogeum at Hal Saflieni, Malta. A 6000 year old Goddess temple
made for sound. Steve & David Gordon www.sequoiarecords.com If
possible, ask family members what music patient enjoyed in the
past.
Slide 37
SELF CARE Safe space to discuss challenges of care without fear
of being evaluated poorly. Small ritual within your facility or in
staff meetings to mark the death of your patient. Utilize drive
time to shed last visit. Transition from work to home. Peer
support.
Slide 38
Self-Reflection Discussion What is my attitude toward war? What
is my attitude toward killing? Is violence warranted under any
circumstance or are you a pacifist? How would it feel to sit with
someone who has possibly killed another person? How do you predict
your values and moral views about violence will impact your
interactions with service members? What kinds of feelings/judgments
does this bring up for me? Is there a circumstance where I was
violent toward another, purposefully or not, and what feelings did
that bring up for me?
