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2011 PPEDisclosure Statement It is the policy of the Oregon Hospice Association's (OHA) Continuing Medical Education Program to insure balance, independence, objectivity, and scientific rigor in all its educational programs. All faculty participating in any OHA-sponsored programs are expected to disclose to the program audience any real or apparent affiliation(s) that may have a direct bearing on the subject matter of the continuing education program. This pertains to relationships with pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter of the presentation topic. The intent of this policy is not to prevent a speaker from making a presentation. It is merely intended that any relationships should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. This presenter has no significant relationships with companies relevant to this presentation to disclose.
Lessons Learned from the Dying Presented By Jessica L. Shaller Gerweck, MM, MT-BC Willamette Valley Hospice September 28, 2011 OHA PPE
Introduction Speaker Focus of Presentation Set-up of opening music experiential
♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪ The unique qualities of music allow access to and connection with those hospice patients: • with severe cognitive impairment, • who are resistant and • who are minimally unresponsive.
The unique qualities of music It influences both hemispheres of the brain simultaneously - different elements of music are processed by different areas of the brain It evokes emotion and facilitates rapid emotional change It contains, sustains and expands space and energy It influences unconscious, basic responses It is non-threatening
Music in the care of end-stage dementia: Alzheimer’s pts appear to use unique or alternate neural processes for cognition and memory when perceiving and responding to music (Taylor, 1997, p.47). Musical processing is less impaired than nonmusical processing in dementia, responses are slower “…it is not an actual loss of memories but a loss of access to these-and music, above all, can provide access once again, can constitute a key for opening the door to the past, a door not only to specific moods and memories, but to the entire thought-structure and personality of the past” (Sambandham & Schirm, 1995, p. 80).
Music is accessible to pts with MR/DD, because it: “touches human emotions beyond cerebral command” (Porchet-Munro, 1993, p. 40) …is an accessible for of non-verbal communication, expression and emotional release …can provide soothing when other means fail …can communicate safety, holding
The influence of music on non-responsive pts Musical sounds traveling as nerve impulses, even in the absence of consciousness, activate the auditory system and, through their inevitable passage through the Reticular Activating System, create cortical arousal effects in the cerebrum that result in elevated skeletal muscle tonus (Taylor, 1997, p. 39).
Definition of Music Therapy • “Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” American Music Therapy Association
Context of Information Shared • The lessons I have learned from the dying, about presence, connection and transcendence, • Are in the context of music being a primary influence on the patient and their family. • Are in the context of a therapeutic relationship. • The “universality” of these lessons can help you better care for those pt’s who are the most difficult to connect with, interact with and sometimes help.
10. Maintain the perspective of a “learner” • Observe closely • Pay attention • Be humble • Practice self-awareness and personal reflection • Whose need does my behavior/choice serve?
9. Be Present, Intentional and Reflective • What does that mean and how do I do it? • Pts with neurologic impairments often have a heightened energetic and intuitive awareness • Developmentally disabled • Dementia • Minimally responsive
8. Determine the means of expression, connection and exchange purposeful use of breath, touch, Reiki, The voice - singing, humming, prayer facial expressions, movement, massage
7. Embrace or accept the mystery Experiences of “another world” The collective unconscious Hanna & Hanna
6. Honor the sacred space of those dying • Be aware of environmental stimuli and it’s influence on patients • Observe for startle response, hyper-sensitivity to sound • Honor values of patient – privacy, dignity, beliefs • Make friends with the patient’s animal companions • Use rituals • Make changes in the space as needed • Case ex. JM
Assist with relationship completion & closure, communicating “I love you,” “I’m sorry,” “I forgive you,” “Thank you” and “Good-bye” (Byock 1997) EOL education and teaching family members ways they can help, support, comfort pt. 5. Care of the Family is Care of the Patient
3. The power of choice often remains Window watching and practicing release
2. Bridge the Gap Create a vehicle of transcendence through Imagery, Singing, Prayer, Rituals lighting a candle prayer flags last rights communion Native Indian ceremony bathing… Requests of protection, guidance Forgiveness , Thank you I’ll keep you with me through…
1. Remember who the patient is, their values, their strongest qualities
In Closing… Summary remarks Honoring Chant Q & A to follow
Citations www.musictherapy.org Byock, I. (1997). Dying well: The prospect for growth at the end of life. New York:Riverhead Books. Porchet-Munro, S. (1993). Music therapy perspectives in palliative care education. Journal of Palliative Care, 9(4), 39-42. Sambandham, M., & Schirm, V. (1995). Music as a nursing intervention for residents with Alzheimer’s disease in long-term care. Geriatric Nursing, 16(2), 79-83. Taylor, D.B. (1997). Biomedical foundations of music as therapy. Saint Louis, MO:MMB Music, Inc.
