Transcript PALLIATIVE CARE - Therapeutic Recreation Resources for

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.
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Reflection
To affect the quality of the day is the highest of arts.
Henry David Thoreau
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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
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Terminal Illness
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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
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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
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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
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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
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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.
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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
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Palliative Care
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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
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Palliative Care
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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
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The Psychosocial Impact of Dying
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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
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Non—Abandonment
In Palliative Care, the sense of nonabandonment is paramount.
Aaronson & Beckman--1987
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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
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Description of Patient
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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
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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
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Barbara
 Reason for referral
 Activities
 Results
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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
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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
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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
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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
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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
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Group Therapeutic Horticulture
 March
– Vegetable seed study/ poster
– Plant annuals
– Plants of the Bible
– Fantasy Garden Collage
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Group Therapeutic Horticulture
 April
– Signs of Spring
– Seedling maintenance
– Plant early peas
– Flower arrangements for Easter and Passover
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Group Therapeutic Horticulture
 May
– Window box planting (3 sessions)
– Mothers’ Day Flowers everywhere.
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Group Therapeutic Horticulture
 June
– Nature Drawing
– Press flowers, drying flowers
– Pinch mums
– Make Herb Vinegar
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Group Therapeutic Horticulture
 July
– Window box maintenance
– Press dry flowers
– Leaf and twig study
– Sensory experience: herbs and flowers
– Order bulbs for forcing
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Group Therapeutic Horticulture
 August
– Divide house plants
– Taste this year’s tomato crop
– Garden party with iced teas
– Press flowers
– Make natural dyes
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Group Therapeutic Horticulture
 September
– Press leaves
– Plant mums in containers
– Start topiary with Ivy
– Sensory Sachets
– Harvest Party
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Group Therapeutic Horticulture
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Group Therapeutic Horticulture
 October
– Dried flower arrangements
– Cuttings from scented geraniums
– Amaryllis Bulbs
– Paper-whites
– Make scarecrows
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Group Therapeutic Horticulture
 November
– Sun catchers
– Pinecone bird feeders
– Bulbs
– Natural holiday decorations
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Group Therapeutic Horticulture
 December
– Natural ornaments
– Pressed flower holiday cards
– Dried leaf wreaths
– Winter solstice program
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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.
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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.
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Spiritual Nature of Plants
Explore the healing of the soul that
gardening and gardens offer.
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NYBG
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Bibliography
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 Breitbart, W. & Holland, J.C. (1993) Psychiatric
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 Cimino, J.E. (1997) Commentary: Nonabandonment, physicians and nurses as allies,
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 Cimino, J.E. (1995) Definition of palliative
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 Connoly, P. (1993) Balancing changing health
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 Sourby, Charles A. (2002), from: Flowers of the
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