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Death and Dying Awareness Week. Aviva Hopkins, MS-3 University of Miami Miller School of Medicine Curriculum Presentation. Goals. Increase awareness of hospice and End of Life care among medical students Increase the number and the timeliness of hospice referrals in the future

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Death and DyingAwareness Week

Aviva Hopkins, MS-3

University of Miami Miller School of Medicine

Curriculum Presentation

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  • Increase awareness of hospice and End of Life care among medical students

  • Increase the number and the timeliness of hospice referrals in the future

  • Encourage and train medical students to pursue personal experiences with dying patients

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  • Monday- Movie Viewing

  • Tuesday- Death Exercise

  • Wednesday- Small Group Session

  • Thursday- Alternative Therapies

  • Friday- Debriefing/ Volunteer Training

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Monday: Movie Viewing

  • Show The Journey Home: Stories from Hospice (60 min)

    • candid stories of five patients

    • demonstrate the unique gifts of hope, relief, and dignity that hospice care programs offer to thousands of terminally ill patients each year

    • portray a way that patients can take control over where and how they will die

      • surrounded by loved ones

      • comfort and dignity

      • familiar environment

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Tuesday: Death Exercise

  • Nurse and Chaplain lead this re-enactment session

  • Select student volunteers to role play family members and a dying patient

  • Assign the dying patient a diagnosis and have him/her lie in a hospital bed

  • Dim the lights

  • Role play how the Chaplain alleviates spiritual pain through:

    • peace and reconciliation

    • prayer

    • religious rites and sacraments

    • discussions about God, eternal life, and hope

    • closure

      Gone From My Sight: The Dying Experience, Barbara Karnes

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Death Exercise (con’t)

  • Nurse narrates the physical signs that death is approaching

    • Eyes

      • may be open or semi-open but not seeing

      • glassy look, tearing

    • Hands, feet, knees, buttocks, elbows  purplish, blotchy

    • Loss of responsiveness

    • Restlessness increases due to a lack of oxygen in the blood

    • Breathing patterns become slower and more irregular

    • Congestion (death rattle)

  • Final Separation

    • Breathing stops

    • Last breath is followed by one or two long spaced breaths

      Gone From My Sight: The Dying Experience, Barbara Karnes

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Death Exercise (con’t)

  • Preparation of the body after death

    • Lay the body flat

    • Remove any catheters, tracheotomy tubing, or other medical devices remaining attached to the body

    • Redress or re-enforce any draining wounds

    • Wash the body

    • Close the eyes

    • Insert dentures

    • Head wrap to keep the jaw closed

  • Bereavement support for the family

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Wednesday: Innovative Hospice Care

  • Small group setting with VITAS representatives

  • Eligibility for Hospice care

    • General Criteria

      • Terminal illness (prognosis < 6 months)

      • Declining functional status

      • Alteration in nutritional status

      • Observable and documented deterioration in overall clinical condition in the past 4-6 months

      • Other comorbid conditions

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Wednesday: Innovative Hospice Care (con’t)

  • Eligibility for Hospice care (con’t)

    • Signs and symptoms such as

      • Uncontrolled or increased pain

      • Increased dyspnea

      • Progressive weight loss

    • Diagnoses such as

      • End stage dementia

      • End stage COPD

      • Metastatic malignancies

  • Patient Services

  • Physician Reimbursement

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Thursday: Alternative Therapies

  • Music Therapy

  • Pet Therapy

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Thursday: Music Therapy

"When words fail, music speaks“

-Hans Christian Anderson

  • Music communicates, motivates, soothes, calms or enlivens, alleviates pain and anxiety, lifts the spirit

  • Bring in a certified music therapist to demonstrate how the skilled use of music meets the physical, psychological, spiritual, and social needs of patients and their families

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Thursday: Pet Therapy

  • Introduce the pet therapy team: the handler and the dog

  • Pet therapist share stories

  • Explain the benefits of pet therapy:

    • Reducing anxiety

    • Releasing endorphins  decrease need for pain medication

    • Helping people reminisce

    • Encouraging people to talk about their feelings

    • Helping people talk about their grief and process it

    • Providing socialization opportunities with other people because of a common interest in the dog

    • Providing isolated people an opportunity for touch/snuggling

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Friday: Debriefing

  • Hospice Volunteer Training

    • Effective Communication/Non-verbal Listening

      • Discuss helpful/unhelpful responses

      • Identify importance of gestures and body language

    • Managing Stress

  • Students who make X# of hospice visits will have a special note in their Dean’s letter

  • Question and Answer session

  • Reflective Exercise

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Special Thanks to . . .

Carol Laporta and the Miami Heart Team

Dr. Suarez and Team 109

Dr. Coplowitz and Team 157

Our Teachers: Dr. Barry Kinzbrunner, Dr. Freddie Negron, Dr. Joel Policzer, Dr. Paul Rozynes

Regina Baptiste and Francine Samedy

And especially to VITAS Healthcare Corporation

For making this such a rewarding and enriching experience

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Thank you to the patients and families who allowed us the privilege of being part of their care during this sacred time at the end of life.