What do you say that is helpful to those at the end of life? Are
you an end of life caregiver and want to be more certain your
interactions are helpful and relevent to those you care for? This
book overs a science based method of understanding what people and
their families at the end of life are experiencing. It offers an
approach to caregiving that individualizes care so those at the end
of life know they are not alone and that the caregiver understands
what is being felt and thought. Those who work with the dying have
informal understandings of the ideational worlds in which their
patients and families live. We know those who have a fervent belief
in a life to come and rely upon that for comfort and sustenance in
their transition and we know those who are more matter of fact
about death being a part of life. Formalizing these understandings
can give us a more exact picture of the ideational and emotional
landscapes our patients are traveling through. This assists
caregivers in more precisely targeting their interactions and
interventions in ways that help the patient know they are not alone
and their journey is understood. Caregivers are then equipped to
use the patient's own resources and ideations to assist them in
their journey and transition. This book uses a psychological
assessment tool, Death Attitude Profile-Revised, to understand
these distinctive landscapes and offers resources to creatively
individualize care in each of the five specific death "domains."
Robert Kastenbaum in, "The Psychology of Death," has noted that
post mortem case studies have indicated that knowing the patient a
little better would have resulted in better care. This book offers
a way to know the patient and this/her worldview and self-concepts
vis a vis death and dying better so that they will know we are
accompanying them on their journey and they are not alone. The five
death domains, Approach Acceptance, Escape Acceptance, Neutral
Acceptance, Fear of Death and Death Avoidance are explained and
explored. A heuristic is offered, based on how closely the
statements that comprise each domain are related, that makes this
easy to use in clinical practice. Prayers, hymns, scriptures,
readings and songs are suggested for each "landscape" aka domain.
With quality indicators being increasingly used by the Center for
Medicaid and Medicare Services, this book offers a way to marry
narrative with data. Each patient's landscape can be assessed at
admission and, through interviews with family and loved ones, after
death, a post mortem assessment can be devised which uses both
numerical and narrative information. Keith A. Rasey, M.Div., LNHA,
is a graduate of Eastern Michigan University, Yale Divinity School
and Kent State University. He has over 25 years of experience in
working with patients and their loved ones at the end of life. The
very first patient to die at home while receiving hospice care in
the United States on May 25, 1977 was a member of the parish he
served as minister in New Haven, Connecticut. Some have called him
a pioneer in the hospice movement as he was one of the thousands of
nameless volunteers who provided care, education and lobbying of
the government to pay for hospice care.
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