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End of Life Experience (ELE) Phenomena - Dreams Significance and Implication to Nursing Practice Harriet Yarmill RN.

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Presentation on theme: "End of Life Experience (ELE) Phenomena - Dreams Significance and Implication to Nursing Practice Harriet Yarmill RN."— Presentation transcript:

1 End of Life Experience (ELE) Phenomena - Dreams Significance and Implication to Nursing Practice Harriet Yarmill RN

2 Outline Introduction to ELE Phenomena Why the interest? Dreams Communication Barriers and Benefits Responding Therapeutically Summary Discussion

3 End of Life Experience (ELE) Definition: any one of a wide range of pre-death phenomena which comfort or prepare the dying person spiritually for death. Fenwick Lovelace & Braye, (2007)

4 End of Life Experiences (ELE) Occur frequently and are varied Theorized to be part of the dying process May occur hours, days, or weeks before death. Fenwick & Fenwick (2008), Muff (1996)

5 Categories of ELEs Transpersonal Final-Meaning Brayne & Fenwick (2008)

6 4 types of ELE: Deathbed visions Physical changes at time of death Deathbed coincidences Dreams Fenwick, Lovelace & Brayne (2007)

7 The Story of Sarah Dying womans personal account of her dream told to me approx 2 weeks before death ELE dream gave meaning to her illness Sara profoundly affected Dramatic change in her coping, her behaviour Family able to be more involved with her at time of death because of this change

8 Hallucination or ELE Dream? Effect on patient Viewed by patient Prelude to death Response to Medication

9 Types of Dreams Everyday Dreams - belonging to the personal unconscious - mundane - no special meaning Archetypal dreams - part of the collective unconscious - certain dream types common to all mankind - Universal stages of life

10 Archetypal Dream Themes CreationGreat passage or journey Crossing over water or bridge Reformation of person in a new body Weighing or judging of the soul Return to another realm of existence Reincarnation, occasionally Adapted from von Franz, 1986

11 More Dream Types Wake-up dreamsSetting Things in Order dreams Opposition & Conflict dreams Alchemic Imagery dreams Transformation dreams Spiritual/Archetypal dreams (Adapted from Muff, 1998)

12 Dream Analysis vs Dream Work Structured Invasive Specialized Time consuming Painful Patient leads No attempt to decipher by listener No special training or experience Patient arrives at own conclusion or not.

13 Dream Work Applications Childhood trauma Vietnam veterans AIDS patients

14 Symbolism – the language of dreams Unconscious expression is through use of symbolism Metaphors are another way of saying one kind of thing in terms of another one common metaphor re: existential matters is that life is a journey Bulkeley and Bulkley (2005)

15 How to identify Symbolic Communication Often occur when client is actively dying no absolutely fixed meanings May not make sense to caregivers Caregiver response is important

16 Barriers to Verbalization For Patients For Caregivers

17 Benefits of ELE Work Patients & Families Caregivers Mutual benefits

18 Caregiver Challenges Communication skills Training in language of death Team Support Training to deal with existential issues Discomfort with new priesthood aspect Environmental constraints Brayne, Lovelace & Fenwick (2008)

19 What Can We Do to Help? Be open; recognize. Empathize (put yourself in their position) Suspend judgement….Realize you dont have to agree, believe, understand ….just BE Support for all (patients, families, co- workers) Normalize the experience

20 In grateful Acknowledgement for the encouragement and support of : Sue Brayne, MA and Dr. Peter Fenwick Dr. Susan McClement

21 References Brayne, S., Farnham, C., & Fenwick, P. (2006). Deathbed phenomena and their effect on a palliative care team: A pilot study. American Journal of Hospice & Palliative Medicine, 23(1), Brayne, S., & Fenwick, P. (2008). The case for training to deal with end-of-life experiences. European Journal of Palliative Care, 15(3), Brayne, S., & Fenwick, P. (2008). End-of-life experiences: A guide for carers of the dying. Available at: Retrieved: October 12, Brayne, S., Lovelace, H., & Fenwick, P. (2008). End-of-life experiences and the dying process in a Gloucestershire nursing home as reported by nurses and care assistants. American Journal of Hospice & Palliative Medicine, 25(3), Bulkeley, K., & Bulkley, P. (2005). Dreaming beyond death: A guide to pre-death dreams and visions. Boston: Beacon Press. Dosa, D. (2007). A day in the life of Oscar the cat. New England Journal of Medicine, 357(4), Fenwick, P., & Fenwick, E. (2008). The art of dying: A journey to elsewhere. New York: Continuum. Fenwick, P., Lovelace, H., & Brayne, S. (2007). End of life experiences and their implications for palliative care. International Journal of Environmental Studies, 64(3), Muff, J. (1996). From the wings of night: Dream work with people who have acquired immunodeficiency syndrome. Holistic Nursing Practice, 10(4), O'Connor, D. (2003). Palliative care nurses' experiences of paranormal phenomena and their influence on nursing practice. Presented at: 2nd Global Making Sense of Dying and Death Inter-Disciplinary Conference, Nov 21-23, 2003, Paris, France. Available at: Retrieved: October 11, 2008.

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