Volunteer Training

Ok so here is everything I learned today at a 10hr volunteer training I attended. Even though I'm not going to be a volunteer for the company, I still learned a lot about hospice and interacting with the pts and their families. Feel free to reference any of this information -- it's good stuff!

Oh, and I also gave a presentation on music therapy in a hospice setting... public speaking --- eeeek!

Volunteer Training Day 2.13.10

Things to keep in mind:
• Validate pt’s feelings. Listen to what they’re saying. Don’t be quick to judge. Pt. has a right to how they feel.
• “Speak for yourself” by using “I” language – I feel this way, I like/dislike this vs. we feel this way, people like/dislike this, etc.
• Do not give orders or make decisions for the pt. or family
o A pt. has a right to make his/her own decisions
o Can educate pt./family and offer suggestions, insight, resources, etc., but ultimately any decisions are theirs
• Gave presentation on music therapy (and how it is used in a hospice setting.) Power point presentation courtesy of:
Rebecca Thompson, MT-BC Seasons Hospice Pasadena Office
• Never forget that the pt is still alive! Yes, pt. knows he/she is about to die, but while you’re with the pt., he/she is still a living person and should be treated as thus
o Be empathetic, but don’t pity the pt.
o Offer support and pay close attention to understand what they’re going through to the best of your ability
o Keep an open mind
o Respect what the pt. knows/has experienced/believes
• Create a legacy for the pt so they can live on in some form after they die, for the sake of loved ones (and pt’s own feeling of self-worth; I made a difference and will continue to impact others even after I’m gone…)


Activities:
• Watched hospice video: Letting Go (HBO)
o Followed 3 real life pts receiving hospice services
• Young boy, middle aged woman, adult male
• Michael – mother came at the end, said father wouldn’t let her see her son, father didn’t want to traumatize daughter further, volunteer read books to daughter about death to help her cope – allow parents to make the decision on how much they include children on a death – not your place to tell a child of a dying loved one if the family chooses to keep them in the dark
• Anna – Anna and son held onto hope till the very end – mother and daughter come to turns with the terminal diagnosis – preacher came and prayed over her – if holding onto her faith and believing she’ll pull through is what gave her the best QOL, then that is her right and her decision and not hospice’s place to tell her to think or feel otherwise – if she chooses to deny her own terminal diagnosis then that is her right to do so
• Adult male – tough guy – independent – frayed relationship with wife – hospice did not judge their marriage – allowed them to feel how they wanted to about each other/his dying – eventually was able to open up emotionally, see his daughter, etc.

• Note card exercise
o Write 4 loved ones, 4 possessions, 4 activities, etc.
o Order them by importance
o One by one take them away
o Brad took 2 from us – loss of control



Some more things I learned:
• POAHC – Power of Attorney of Hospice Care
• If a pt is going to die very soon – pt is “actively dying”
• When you first enter pt room, ask if it’s a good time to visit, and if pt is in any pain
• Before leaving, assess pain again
• COP – Condition of Participation

Pain Management:
• Pain is what the pt says it is and can be controlled in a variety of ways
• Pain tolerance vs. pain threshold
o Pain tolerance – how much psychologically you can take
o Pain threshold – how much something must hurt before your body registers it as pain
• Acute pain vs. chronic pain
• Somatic pain – sharp, dull and/or aching pain
• Neuropathic pain – burning, shooting, and/or tingling pain
• Tissue or generalized pain, nerve pain, bone pain, visceral pain
• Cultural/gender/religious/etc. differences can affect pain tolerance and response to pain
• Pain with a rating higher than 4 requires notification to nurse/IDG
• Physical signs of pain:
o Tensing muscles, loss of appetite, nausea, weight loss, does not chew or swallow properly, spits out food, change in ADL routine, sleeplessness, moaning, groaning, sighing, change in gait, unwillingness to move, facial grimace, tachycardia, rapid/irregular breathing, high BP, constant fatigue
• Behavioral signs of pain:
o Agitation, irritability, anger, resentment, impatience, anxiety, tearfulness, less socializing, withdrawn, sadness, depression, confusion
• Pain medications can cause their own side effects i.e. sleeplessness, nausea, constipation

Physiological Signs and Symptoms of the Dying Process:
• Disorientation, sleep more, confusion, talking with unseen people
• Food, liquids, IV fluids may get to the point where they do more harm than good
• Change in BP, pulse, respiration rate, body temp
• Periods of apnea
• Increase in perspiration
• Congestion
• Restlessness, agitation
• “Last Hoorah” – sudden significant regaining of energy and mobility, shortly followed by death

Resources Received:
• Five Wishes + official state documents
• My wish for…
o The person I want to make care decisions for me when I can’t
o The kind of medical treatment I want or don’t want
o How comfortable I want to be
o How I want people to treat me
o What I want my loved ones to know
• Gone From My Sight: The Dying Experience by: Barbara Karnes
• Universal pain assessment tool