For this, I used an MI technique referred to as a decisional balance. Betty already had the information about the advantages and disadvantages of feeding and not feeding, but I needed to help her sort through them. And you said the food could get stuck and he could aspirate. And what are some of the good things about continuing to feed him?
Her eyes widened and she sat up in her chair. It could cause him pain? Now imagine not being able to get that built-up food out through your stool. Do you think that his pain and agitation last night was because I gave him some mashed potatoes? She moved in her chair and did not make eye contact with me.
That was very intuitive and shows that you knew what to do in a crisis. Maybe he would live longer?
Palliative care for patients with a substance use disorder and multiple problems: a study protocol
I felt that we were finally getting somewhere with her ambivalence. And also with your relationship, feeding is not only part of your role as his caregiver for the past sixty-four years, but also the way you show him how much you love him. Like many therapeutic interventions, normalizing is useful in MI because it makes clients feel comforted that they are not alone. This is especially critical in hospice because family members often feel isolated as their loved ones transition through the dying process. Maybe things that are less risky, like reading to him, holding his hand, playing music for him.
How does that sound? He loves reading. So now you could maybe do that for him. But can he hear me? Some studies have shown that hearing is the last sense to go before someone dies, so I always tell families to behave like their loved ones can hear them. Betty and her children all confirmed that Betty had not tried to feed her husband again after our visit. I learned from my bereavement telephone call that Betty spent the last two days she had with her husband reading his favorite books to him, writing him a long letter that reflected their life together and the impact it had on Betty, playing their favorite music on an old record player, and holding his hand and providing a supportive presence.
Like so many of the families I see, Betty needed someone to validate what she was feeling and also hear, understand, and affirm what feeding represented to her relationship with her husband. Motivational interviewing skills, such as reflections and the decisional balance that I used with Betty, have been effective in my clinical practice with hospice patients and families who experience ambivalence with administering morphine for pain, hiring caregivers, or asking family members for help to protect the primary caregiver from burnout, and processing denial related to rapid decline.
Although they may not be ambivalent about providing care, they are still at risk for becoming so overwhelmed that effective coping and a healthy life balance are damaged.
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Emphasizing individual strengths through genuine affirmations empowers the caregiver and results in better care and support for the patient. The patient having a peaceful death with dignity is not only valuable for the patient, but also for caregivers and family members as it decreases their risk for complicated bereavement. The spirit of MI is rooted in the notion that the practitioner and client have a collaborative relationship. If I had come into her home telling her why she should not feed her dying husband, she likely would not have listened. MI techniques emphasize and foster a collaborative therapeutic relationship, which is critical in hospice work, and more generally in working with individuals and families coping with terminal illness.
Using MI techniques not only helps hospice patients and families process their ambivalence, but are also extremely valuable in conveying empathy in a way that moves towards change. My work with Betty was the first experience I had in applying MI to my clinical work in hospice. I was initially unsure how the MI skills, specifically reflections and affirmations, would help Betty resolve her ambivalence, but this experience showed me their value.
I believe that my ability to avoid the righting reflex and simply repeat back to Betty her confusion and fear helped her feel heard and validated. The reflections also allowed her to process her thoughts that supported the ambivalence.
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These skills allowed me to use the decisional balance, which ultimately led to her resolving her ambivalence and not feeding her husband again. I feel tremendously honored to have the opportunity to work with hospice patients and families. Being present with patients in their dying process, and supporting their families as they navigate the demands of caregiving and effects of anticipatory grief, is an incredible privilege. I believe strongly that everyone deserves a peaceful death with dignity and am passionate about being part of providing that experience to all of my patients and families. Apply MI concepts and techniques to an actual counseling session in a hospice setting See MI strategies in action over the course of a conversation Distinguish the flow of assessment and response in an ambivalent client through an MI lens.
While in graduate school, Ellen discovered her passion for medical social work, specifically with hospice and palliative care. Ellen is currently living in New Orleans, Louisiana, and hopes to continue working in the healthcare field, helping patients and families cope with stress related to trauma, illness, and end-of-life care.
Ellen can be reached at eoyoung1 gmail. Motivational Interviewing for Concurrent Disorders. Motivational Interviewing.
Through his private practice, Thresholds, he is a certified transitions consultant and life coach. Brad has been a church pastor, a hospice chaplain, and the leader and developer of a bereavement program. Convert currency. Add to Basket.
Q. What is palliative medicine?
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Shipped from UK. Language: English. Brand new Book. Seller Inventory APC Within the Connectiuct Department of Correction, appropriate inmates are trained as hospice volunteers to provide end of life care to their fellow offenders at the York, Mac-Dougall-Walker and Osborn Correctional Institutions. Palliative care is the active care of inmate patients whose disease is not responsive to curative treatment.
The goal of palliative care is achievement of the best possible quality of life for inmate patients and their families. Service extends across all stages of illness. Top Connecticut State Department of Correction. What is Hospice?
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