PALLIATIVE CARE

1. PALLIATIVE CARE SOUNDS AND SENSES IN THE GARDEN Charles Sourby, MS Ed. Bonsai Gardens, Seed Starting, Aroma Therapy, Plants of the Bible, Garden Prayers, Useful Terminology, Useful Plants Learn how therapeutic recreation & Horticultural therapy addresses a patient’s negative feelings; threats to self esteem, and help restore a sense of control, contributing to an improved health related quality of life.

2. Reflection To affect the quality of the day is the highest of arts. Henry David Thoreau

3. Key Words • American Horticultural Therapy Association • Cancer Care • Commitment • Disengagement • Horticultural Therapy • Life Continues • Non-abandonment • Patient Garden • Palliative Care • Psycho-Social Impact of Dying • R.O.P.E.s • Social Comparison Theory • Terminal Illness

4. The Horticultural Therapist Horticultural therapists, traditionally concerned with the quality and potential of human life, face a difficult challenge in providing Horticultural Therapy in settings that serve people with life threatening illnesses such as advanced or end-stage cancer. Connoly--1993

5. Horticultural Therapy • As defined by the American Horticultural Therapy Association (AHTA), horticultural therapy is a discipline that uses plants, gardening activities, and the natural world as vehicles of professionally conducted programs in therapy and rehabilitation. Horticultural therapy can be applied in every type of medical and social service setting ranging from hospitals, to corrections, to youths at risk, to vocational programs. AHTA

6. Horticultural Therapy • Horticultural therapy can address the dying patient’s negative feelings; threats to self esteem and help restore a sense of control, contributing to an improved quality of life. • Horticultural Therapy goals focus on alleviating stress and anxiety, decreasing social isolation, rebuilding self-esteem, increasing independence, and maximizing functioning. The role of HT is to support the palliative goal in the treatment of advanced cancer patients. AHTA, 2004

7. Cancer • Despite all of the technological advances in medicine, some cancers simply cannot be cured. Cancer affects people from all cultures, socio-economic classes, ages, and backgrounds. More than 1.2 million Americans are diagnosed with cancer each year and no less than 500,000 die from the disease annually. CNN--1995

8. Cancer Care • Treatment often involves surgery, radiation, and chemotherapy. The disease and subsequent treatments can be painful and uncomfortable. • For the patient who does not respond to treatment, or, who is medically determined to be at the end stage of the disease process, being admitted to a hospital or hospice is a common occurrence. • Treatment for the patient at the terminal or end stage of cancer increasingly involves an approach called palliative care.

9. Palliative Care • The palliative approach to treatment includes control of pain and other symptoms while simultaneously addressing the individual patient’s psychological, social, and spiritual concerns, in an effort to provide the best possible quality of life for the dying patient as well as his or her family. • Stoll--1988

10. Palliative Care

11. Palliative Care • “Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their families.Many aspects of palliative care are also applicable earlier in the course of the illness, in conjunction with anti-cancer treatment.” Conference On Care Near The End Of Life, Harvard Medical School. Division of Continuing Education, Boston 1995

12. Palliative Care

13. The Psychosocial Impact of Dying • Is monumental, involving the search for meaning, confronting fears, dealing with the loss of control, and issues of loss. • The dying patient often experiences anger, guilt, disorganization, isolation, and depression. Kubler-Ross--1969

14. The Psychosocial Impact of Dying

15. Terminal Illness • Terminal illness, such as advanced cancer, is defined as an illness that cannot be cured by present day medical technology and that generally leads to death within a specified period of time. Turk & Feldman 1992

16. Non—Abandonment In Palliative Care, the sense of non-abandonment is paramount. Aaronson & Beckman--1987

17. Social Comparison Theory • Those receiving palliative care need to socialize. Support is derived from seeing others in similar situations. Research demonstrates an elevated sense of hope and a better outlook following social interactions with peers. Brietbart & Holland—1993

18. Description of Patient

19. Description of Patient The patient, often in pain, is to endure life’s final stages. (In some cases the diagnoses is less than ninety days old.) The patient receives palliative medical treatment and has psychosocial needs addressed through contact support, compassion, and comfort provided by a number of disciplines to help complete life with dignity and grace. Rando—1984

20. Calvary Hospital Case Study:Barbara (see hand-out) • Diagnosis: Terminal cancer of larynx and breast 1 year • Background • Complication of chemotherapy induces cardiac arrest. • History of alcohol abuse • Smoked two packs of cigarettes a day • Retired teacher

21. Barbara • Reason for referral • Activities • Results

22. Program Planning: Learning the R.O.P.E.S. • Review-What garden activity preceded this one? • Overview—What is the process? • Presentation—Today’s garden activities • Experiential—Immerse patient in the activity • Summary—Review what happened

23. Program Concepts & Design • Patient Garden—the plants belong to the patients • Living Legacy of Plants—I plant you a dish garden • Life Continues—Through plants, life carries on • Sounds, Senses and Healing—Music, Scents, Touch, Color and Prayer

24. Garden projects • Plants of the Bible • Hold, touch, reflect • Aroma Therapy • Aware of the breadth of life • Bonsai & Dish Gardens • Disengagement gifts • Planting Seeds • Renewal

25. The Spiritual Nature of Plants • Plants have a spiritual value that is therapeutic in palliative care. Plants help patients cope, enjoy a sense of healing and regain perspective. The fragrance of Biblical flowers and herbs revitalize people at the end of life. Interacting with a flower or herb from the Bible lifts spirits and a sense that life continues. Sourby--1998

26. Group Therapeutic Horticulture • January • Winter twig study • Seed catalogs • Division propagation: • Pot up various ferns • February • Start Caladium bulbs, plan garden • Pressed flowers for Valentine Cards • Sweet Potato House Plants

27. Group Therapeutic Horticulture • March • Vegetable seed study/ poster • Plant annuals • Plants of the Bible • Fantasy Garden Collage

28. Group Therapeutic Horticulture • April • Signs of Spring • Seedling maintenance • Plant early peas • Flower arrangements for Easter and Passover

29. Group Therapeutic Horticulture • May • Window box planting (3 sessions) • Mothers’ Day Flowers everywhere.

30. Group Therapeutic Horticulture • June • Nature Drawing • Press flowers, drying flowers • Pinch mums • Make Herb Vinegar

31. Group Therapeutic Horticulture • July • Window box maintenance • Press dry flowers • Leaf and twig study • Sensory experience: herbs and flowers • Order bulbs for forcing

32. Group Therapeutic Horticulture • August • Divide house plants • Taste this year’s tomato crop • Garden party with iced teas • Press flowers • Make natural dyes

33. Group Therapeutic Horticulture • September • Press leaves • Plant mums in containers • Start topiary with Ivy • Sensory Sachets • Harvest Party

34. Group Therapeutic Horticulture

35. Group Therapeutic Horticulture • October • Dried flower arrangements • Cuttings from scented geraniums • Amaryllis Bulbs • Paper-whites • Make scarecrows

36. Group Therapeutic Horticulture • November • Sun catchers • Pinecone bird feeders • Bulbs • Natural holiday decorations

37. Group Therapeutic Horticulture • December • Natural ornaments • Pressed flower holiday cards • Dried leaf wreaths • Winter solstice program

38. Summary • Horticultural Therapy is an effective intervention in Palliative Care involving the search for meaning, confronting fears, dealing with the loss of control, and issues of loss. • Horticultural Therapy can address the dying patient’s negative feelings; threats to self esteem and help restore a sense of control, contributing to an improved quality of life. • Approach to treatment includes control of pain and other symptoms while simultaneously addressing the patient’s psychological, social, and spiritual concerns, in an effort to provide the best possible quality of life. • Therapeutic horticulture reduces boredom, fosters a sense of accomplishment and enhances psycho-social supports within the patient’s community.

39. Reflection We are invited to discover the inner garden of our soul. Connecting the soil seed and gardens leads us to the presence of God and the mysterious rhythm of healing and growth.

40. Spiritual Nature of Plants Explore the healing of the soul that gardening and gardens offer.

41. NYBG

42. Bibliography • Aaronsen, N.K. & Beckman, J.H. (1987) The quality of life of Cancer Patients, New York, Raven Press. pp.75-86 • Avedon, E. (1966) Recreation research, The American Association for Health, Physical Education, & Recreation. • Bost L.S. & Brown E.M. (1982) Recreation therapy: A humanistic adjunct to oncology treatment. Oncology Nursing Forum , (Vol. 9[4] pp.43-49.

43. Breitbart, W. & Holland, J.C. (1993) Psychiatric aspects of symptom management in cancer patients, Washington DC, The American Psychiatric Press. pp. 155-165. • Burlingame, J. & Blaschko, T.M. (1994) Assessment Tools For Recreation Therapy: Redbook #1. Revensdale, Washington. Idyll Arbor, Inc. pp.117-125

44. Cimino, J.E. (1997) Commentary: Non-abandonment, physicians and nurses as allies, New York, The American Journal of Hospice & Palliative Care (Vol14 [3]) pp. 106-107. • Cimino, J.E. (1995) Definition of palliative medicine, Third Year Class Orientation Lecture Notes, New York Medical College

45. Connoly, P. (1993) Balancing changing health care needs with the shortage of quality health care professionals: Implications for therapeutic recreation, Journal of Loss, Grief & Care, New York , Haworth Press. pp.15-21. • Davison, D.C. & Neale, J.M. (1996). Abnormal Psychology. New York: John Wiley & Sons, Inc . • Kane, Brunton & Fournier (1999) Cancer, Press. • Kavanaugh, R. E. (1972) Facing death, Baltimore, Maryland,, Friedman Fairfax, pp.14-68

46. Kavanaugh, R. E. (1972) Facing death, Baltimore, Maryland, Penguin Press. pp.105-124. • Kubler-Ross, E. (1969) On death & dying, New York, Macmillan Publishing, pp. 38-110. • Korchin, S.J. (1976) Modern Clinical Psychology (1976). New York. Basic Books.

47. Kunstler R. & Sokoloff, S. (1993) Clinical effectiveness in intensive therapeutic recreation: A multiple case study of private practice intervention. Journal of Loss, Grief & Care, New York. 23-28. • Lahey, M.P. (1993) Acute care vs. chronic care models of services to the elderly: Implications for therapeutic recreation, Journal of Loss, Grief & Care, New York. 55-62.

48. Rando, T. A. (1984) Grief, Death, & Dying: Clinical interventions for caregivers, Champaign, Illinois, The Research Press. pp. 227-250. • Simpson, S. (1996) Journal of Therapeutic Horticulture, Gathersburg , MD.

49. Sourby, Charles A. (2002), from: Flowers of the Bible and How to Grow Them, New York, Citadel Press. • Sourby, Charles A. (2003) from: Herbs of the Bible and How to Grow Them, New York, Citadel Press. • Sourby, Charles A. (1998), Barbara-Palliative Care, Journal of Therapeutic Horticulture.

50. Swenson, Allan A. (1995) Plants of the Bible and How to Grow Them, Citadel Press. • Spacapan, S. & Oscamp, S. (1988) The social psychology of Health, Beverly Hills, California pp. 285-193 • Steuer, F.B. (1994) The Psychological Development of Children. Pacific Grove, California. Brooks/Cole Publishing.