Monday, December 28, 2020
Friday, December 25, 2020
Thursday, November 12, 2020
Monday, August 3, 2020
Existential Distress, Dignity Therapy, and Peaceful Death
Links etc
Grech, A. Marks, A. Existential Suffering Part 1: Definition & Diagnosis; Part 2: Clinical Response & Management. J Pal Med. 2017;20(1):93-96.
Keall, R. Clayton, J. Butow, P. Australian Palliative Care Nurses’ Reflections on Existential/Spiritual Interventions. J Hosp Pal Nsg 2014;16(2):105-112.
SEINFELD - DAVID PUDDY MAD DEVILS FAN [Video]. [xBRUISERx2007]. (2011, Jun 14). YouTube.
Sinatra, Frank - My Way (Live At Madison Square Garden, 1974) [Video]. [Frank Sinatra]. (2019, Sep 16). YouTube
Listening to Francis Albert at the other end of his trajectory
Thursday, June 25, 2020
White Supremacy in Nursing and America
So the basic idea is to publish a Google presentation as one channel to distribute educational content, and encourage learners to treat it like a digital picture book. Use the controls to maximize the screen, tab through at your own pace, or let it auto-run (2 secs/slide).
Click any of the resources and references on the final page to learn more about the issues raised in the presentation.
Today's topic is white supremacy in nursing and America - specifically how some nursing and other orgs have responded to the murder of George Floyd by Minneapolis police.
Click any of the resources and references on the final page to learn more about the issues raised in the presentation.
Today's topic is white supremacy in nursing and America - specifically how some nursing and other orgs have responded to the murder of George Floyd by Minneapolis police.
Tuesday, June 23, 2020
Celebrating Nurses Yet Again Another Time with Free Self-Paced Online Learning - Hastened Death by Voluntarily Stopping Eating and Drinking (VSED)
Press 'Play' or use the controls
Another self-paced continuing education program for clinicians, caregivers, and the community. This is 1/2 of a work in progress so still one more coming. Love the smiling baby.
Monday, June 8, 2020
Celebrating Nurses Yet Again with Free Self-Paced Online Learning - Death Care and Final Disposition
Press 'Play' or use the controls
Another self-paced continuing education program for clinicians, caregivers, and the community. One more coming. Same smiling baby.
Friday, May 22, 2020
For anniversaries and admissions to the club nobody wants to join
Yeop, still helping me gieve...
I think pretty much every song David Bowie ever wrote had something to do with living and/or dying so here's one that tells a story about what we might want to say to a loved one who's died. Going out today especially to friends and fellow club members Jack and Lucy.
Monday, May 18, 2020
Celebrating Nurses Again with Free Self-Paced Online Learning - End of Life Trajectories
Press 'Play' or use the controls
The experiment continues with a second self-paced continuing education program for clinicians, caregivers, and the community. More soon. Who can resist a smiling baby?
Thursday, May 7, 2020
Celebrating Nurses with Free Self-Paced Online Learning - Terminal Secretions
Just press 'Play' or use the controls!
This is an experiment, and I'll update soon. Thanks!
Link to similar Google form combined post-test and evaluation
"Rosebud!"
Wednesday, May 6, 2020
Thursday, April 30, 2020
Six Roles for a Death Nurse - 5/6 Activist
just following orders
Nursing orgs resisting concentration camps and genocide - so far, not so good
Corporate Hospice and the Hospice Industry Trade Group
searching for hospice at a place in massachusetts
searching for hospice at a place in massachusetts, part 2
Peeking up from the rabbit hole
At least it's not a meat grinder
Peeking up from the rabbit hole
At least it's not a meat grinder
Orange Crate Update #3
Orange Crate Update #4 - Welcome Our New Robot Brain Friends to the Hospice Team
Exercising every shareholder's responsibility
November is Hospice Month!
So, what's news in corporate hospice? A story told mostly in pictures
Orange Crate Update #4 - Welcome Our New Robot Brain Friends to the Hospice Team
Exercising every shareholder's responsibility
November is Hospice Month!
So, what's news in corporate hospice? A story told mostly in pictures
Can one number tell us if this hospice is any good?
Axial tilt is the reason for the season
HOSPICEFAIL
Sadly, not rare - #hospicefail
Hospice 101 - Part 1: Meet your nurse
New Series! Stories for Info and Edo #WhoseHospice
Another hospice story for Info and Edo - How hospice and others made things worse
Ending the year with a look back at a hospice service failure
One year, two CEO's, and lots of money
How to choose a hospiceEnding the year with a look back at a hospice service failure
One year, two CEO's, and lots of money
Questions to ask when you're looking at a hospice
Is the hospice LGBTQ-Inclusive?
searching for hospice at a place in massachusetts
searching for hospice at a place in massachusetts, part 2
Six Roles for a Death Nurse - 4/6 Educator
Welcome to my Calcutta
Death Nurse Community Open Office Hours
What it really looks like (not exactly)
Instructional Video - CPR, Intubation, and Soup
Straight up, no nonsense
Instructional Video - Advance Care Planning and COVID19
I adapted the script for the ACP video into a letter to the editor (LTE) at the suggestion of Dr. Monica McLemore. The editor said 500-word limit. They ran it, but with a glaring gap because I submitted 540. I need to follow instructions.
Advance care planning time is now - Concord MA Journal
Caring for the dead and bereaved
Options for the Final Disposition of a Dead Body
Here’s another informative and engaging program that I hope to do again, using a documentary film as the starting point, in this case ‘End Game.’ Please take - either intact for free, open source, creative commons - or build on the idea.
Reporting in pictures: Excellent brunch, people, connections, and contact hours made possible by End Game - FREE!
“When the roller coaster ride of a serious illness becomes too much to bear, we need expert clinical support to meet our final goals for care. Most of us want to avoid suffering and achieve a peaceful death. In order to do that, we need to find the best hospice.”
ATENT - A prescription anyone can write that’s simple to learn, easy to use, safe, and costs next to nothing.
Wed's clip on Thu: First steps to comfort
Hierarchy of Pain Measures, Checklist of Nonverbal Pain Indicators (CNPI)
Assessing patients who can't communicate their pain
modified Mini Suffering State Exam (mMSSE)
video clip + survey!
Nu-DESC
Fast, Systematic, and Continuous Delirium Assessment in Hospitalized Patients: The Nursing Delirium Screening Scale (pdf)
Equianalgesia Opiophobia
Fast Fact #36 Calculating Opioid Dose Conversions
Six Roles for a Death Nurse - 4/6 Educator #NMA2020
Six Roles for a Death Nurse - 3/6 Clinician
True story
"Teachers change lives. Karen certainly changed mine. She was an expert clinician filled with positive reinforcement and the kind of practical, actionable advice that still holds for me today.”
Palliative Care Network of Wisconsin
Palliative Care Fast Facts and Concepts
Just one word…
Good advice
Something about delirium, Part 1
Some more about delirium
Again with the delirium
Still more delirium
Bubba's Dumb RASS
Quick take - delirium and clinical trials
When your hospice medical director is a useless idiot
Prodrome to delirium
Cheat sheet - benzos for delirium
Delirium med cage fight
Dopaminergic drugs for delirium
Oh no, love, you're not alone
No matter what or who you've been
No matter when or where you've seen
All the knives seem to lacerate your brain
I've had my share, I'll help you with the pain
You're not alone
Six Roles for a Death Nurse - 3/6 Clinician #NMA2020
Six Roles for a Death Nurse - 2/6 Student
third movement go to 1:18:00
I heard music and saw musicians as never before. Jeanne and I attended almost every concert from the first in 2000 to the last performance we could comfortably navigate in January, 2015.
In January 2008 my closest friend through this venture died suddenly. I had been listening closely to Shostakovich on my new iPod, and his music became part of the grief. I think about Bill whenever I hear Shostakovich.
Symphony No. 5 took shape beneath the cloud of Stalin’s Great Terror, and Shostakovich himself faced death.
Michael Tilson Thomas beautifully deconstructs the piece, composer, and time in the program, which also includes an exquisite performance at the Royal Albert Hall and is totally worth watching - but especially the essential third movement which Tilson says, “brought people to tears when weeping was an act of courage.”
I’ve come to appreciate the symphony as a meditation on being diagnosed with a serious illness - the first movement roller coaster ride of treatment and hope; the second, trying to get on with life despite the challenges; dying and death (harp strings); and finally trying to explain, pretend, deny, change.
Some books I like
Blogging about blogging
Palliative Care Grand Rounds 1.11
With Caitlin Doughty, the Julia Child of Death
An interview with Caitlin Doughty
“After a death, when we keep the dead body in the home, go out and dig the grave with our own hands, place the shrouded body in the grave and place the dirt onto the body, allowing it to decompose beneath the earth, what we are saying is, “we accept death as a reality, and we would like to engage with it.”
The artist Rachel Perry changed my life when I saw her work in the 2002 faculty show at the Museum School. I later got to thank her.
Rachel Perry's Commencement Speech Montserrat School of Art 2018
More personal/professional life-changing events
Peggy Chinn and 2018 Nursing Think Tank
Comics in Medicine at the Center for Cartoon Studies
Comic Nurse
Some cartoons I drew
Patients and families are the best teachers
"Pay attention. Rachel Lindsay has four awesome strengths - Smart, Funny, Talented, Brave."
Rx A Graphic Memoir
ELNEC training was a powerful experience. Awesome faculty and clear message: "You know your learners and situations. Here's a toolbox - take what you need, use what works, make new stuff."
HPNA - worth it for the journal
Don't deceive with belief
Knowledge comes in death's release
Oh-oh, oh-oh, oh-oh, oh-oh
Six Roles for a Death Nurse - 2/6 Student #NMA2020
Six Roles for a Death Nurse - 1/6 Personal
Welcome!
There are many ways to practice nursing, and there are many roles for a Death Nurse.
I developed this tour for Nursing Mutual Aid 2020 to honor and share some of the people, places, ideas, and events that have brought us together.
Each Tweet leads to a page and explores one of the six roles I have served as a Death Nurse.
This is the first one. This one is personal.
There are many ways to practice nursing, and there are many roles for a Death Nurse.
I developed this tour for Nursing Mutual Aid 2020 to honor and share some of the people, places, ideas, and events that have brought us together.
Each Tweet leads to a page and explores one of the six roles I have served as a Death Nurse.
This is the first one. This one is personal.
I hope you’ll feel comfortable poking around as you would a favorite antique shop, chic boutique, book store, bar, livestock auction, barbecue joint, quiet forest, babbling brook, movie theater...
Can’t get more personal
Nostalgic hospital bill (NOT a bill)
Every story starts somewhere.
We rushed to the Floating Hospital in my Uncle Jerry’s station wagon. A police car led the way.
I came home two weeks later. Here's the receipt:
“My personal encounters with death started early, thanks to a culture that didn’t think twice about dragging an entire first-grade class over to the convent, to pray the rosary in French while stuffed into a tiny room with several other grades, two radiators, no windows, and a dead nun.”
She often said,"Bring me flowers while I'm alive to enjoy them."
Posts I've written about Jeanne
A death I nursed
David Bowie is helping me grieve
Unconditional love (most popular post!)
Remembering Jeanne today
This is what a green burial looks like
Saint Brigid’s Prayer
Things that went badly, Part 1
Things that went badly, Part 2
I remember the day
Posts I've written about Jeanne
A death I nursed
David Bowie is helping me grieve
Unconditional love (most popular post!)
Remembering Jeanne today
This is what a green burial looks like
Saint Brigid’s Prayer
Things that went badly, Part 1
Things that went badly, Part 2
I remember the day
Six Roles for a Death Nurse - 1/6 Personal #NMA2020
Tuesday, April 28, 2020
Thursday, April 23, 2020
Friday, April 17, 2020
Tuesday, April 14, 2020
A physician finally says it - will they listen?
Where ya goin', bud?
I’ve come to the conclusion that lots of people in palliative medicine are afraid to talk about death. It’s ironic but also no surprise. We’re all afraid of dying.
I think Ernest Becker had the right idea: “...death-denial often shapes our behavior in highly subtle and unconscious ways.... Medicine has death-denial built in to its core; it is designed to prevent or delay death.”
In terms of clinical practice, I don’t think it’s a good idea. I think it fails the patients and families who have/will experience death in this pandemic.
I’m glad that Amit Arya and Naheed Dosani finally broke the ice among physicians:
“... the use of a ventilator is a very aggressive form of treatment that requires the patient to be deeply sedated. And outcomes are often poor. Many patients who are put on a ventilator do not survive. Some who survive will never return to their previous health. With proper counselling and the promise of good palliative medical care to ease suffering and symptoms, patients such as the frail elderly or those with serious complicating disease, who have poorer prospects on ventilators, might well choose not to face the rigours of the ICU. In other words, they might choose to die in peace.”
One more time for folks in the back:
“In other words, they might choose to die in peace.”
A peaceful death is one of three viable goals for care. We can only pursue one goal at a time.
- Try to beat an illness, go for the cure, aggressive treatment;
- Try to manage an illness, set limits on measures or time frame, selective treatment;
- Try to achieve a peaceful death with treatment focused solely on comfort.
Clinicians tend to make things more complicated and confusing for patients and families, especially in crises and/or academic medical centers. This usually includes way too much talking, running down rabbit holes, and frustration.
Thanks for reading - see you next time.
Also too:
Sunday, April 12, 2020
Sunday, April 5, 2020
Let's talk about cardiopulmonary resuscitation (CPR) #pallicovid
Eat leafy greens daily for good health
Friday, April 3, 2020
Because Seu Jorge playing David Bowie is helping me grieve #pallicovid
Why didn't I know about this before? I saw the movie and liked it, but completely blanked on the music. Glad to get caught up.
I developed what the Catholics call a special devotion to David Bowie in the final days of Jeanne's dying, through my immediate bereavement, and ever since - because that's the whole point of developing a special devotion.
Sometimes music is the best way to bridge gaps presented by language, culture, disability, advanced illness, or fear.
There's much more here when you need it.
Tuesday, March 31, 2020
COVID19 Triage Policy Death Dying DNR and Ventilators #pallicovid
Also too advance care planning
My first attempt with this one was a bust because I used music that wasn't free to use.
If the royalty-free techno track in this version isn't to your liking, you can mute the sound and play my first choice -
Who listens to the narrator, anyway?
Other recent COVID19 videos and posts
With Kia, Boo, Kaiser Robot Doctor, Always Honest Nurse, and Doctor Cigarette
Straight-up version
With Skelly and Boo Boo
How can you tell over the telly?
And this is just the beginning
Sunday, March 29, 2020
Friday, March 27, 2020
Difficult conversations and COVID19 - Vital Talk
talking beats not talking
Communication skills for clinicians dealing with serious illness
Atul Gawande on YouTube
Advance care planning and more
Physician Orders for Life Sustaining Treatment
Thursday, March 26, 2020
Advance Care Planning and COVID19
Hello, it's me again
Atul Gawande channels Susan Block on YouTube
Advance Care Planning Toolkit and Guides
Advance Care Planning
Advance Care Planning and More
National POLST Form
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