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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.

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Presentation on theme: "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."— Presentation transcript:


2 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

3 TODAY’S 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

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.'

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

6 Average Age (presently) Related to War Experience Gulf War 43 Vietnam 66 Korean War 82 WW II 90

7 Many factors to consider

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 member’s time in the military

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: Report to Secretary of the Dept. of VA on the Association between adverse health effects and exposure to Agent Orange.

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.)

11 aims-postservice-agent_orange.asp aims-postservice-agent_orange.asp ook.asp

12 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”

13 Cold War (Atomic Veterans) Nuclear testing & cleanup Radiation exposure which has been associated with leukemia, various cancers & cataracts

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

15 Discussion What other medical issues that could lead to psycho-social challenges not mentioned have you seen in your Veteran patients?

16 Why is it important to have a basic understanding of military culture and terms?

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

18 Discussion of some basic and advanced interventions after break Healing power of presence, EOL discussion tactics, caregiver stress, self care for YOU

19 Dementia & PTSD

20 Dementia Diagnosis is Increasing in Veterans Present in 500,000 current Veterans The number of Veterans with dementia will peak in 2018

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 – Don’t ask the question if you don’t plan to provide an intervention.

22 Intervention “you probably saw a lot of ugly things in that deployment. Is anything still troubling you?” Open the door, if they don’t walk through it, you didn’t 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.

23 Ask about Tattoos

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 don’t meditate

25 FRAME IT APPROPRIATELY Meditation & prayer is a way of responding to Life on Life’s terms. Pain is inevitable…….suffering is optional

26 3 Ways to Respond to Challenges Dissociation – Rejecting – Splitting off – Suppressing – Repressing – Separating

27 Fusion Identifying with Flooded by Taken over by Defining ourselves by

28 Disidentification Witnessing or “welcoming” the challenge With curiosity and kindness, without identifying with it

29 Not all Veterans experienced stress during their service. Some don’t feel they are actually a Veteran if they didn’t 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.

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.

31 Ask about art, pictures, posters when you are visiting….

32 MORAL INJURIES Could complicate death. Don’t 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.

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)

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 you’ve 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.

35 Five Wishes Form Presentation of the 5 wishes document can be difficult for families already in crisis. “Sharing the Gift” Go to : BROCHURES PLANNING AHEAD IF YOU OR SOMEONE YOU LOVE IS ILL to download this 2 page document.

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 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 If possible, ask family members what music patient enjoyed in the past.

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.

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?

39 Conclusion

40 Volunteer

41 Monster, therapy dog extraordinaire


43 “Ted” My Therapy Horse in Utah

44 Adaptive Hockey

45 What coins mean in the military

46 Volunteer, They Need You!

47 Another Deployment My Warrior Namaste’

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