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 .
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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.
Reflection To affect the quality of the day is the highest of arts. Henry David Thoreau
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 • Terminal Illness
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
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
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
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
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.
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
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
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
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
Non—Abandonment In Palliative Care, the sense of non-abandonment is paramount. Aaronson & Beckman--1987
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
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
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
Barbara • Reason for referral • Activities • Results
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
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
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
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
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
Group Therapeutic Horticulture • March • Vegetable seed study/ poster • Plant annuals • Plants of the Bible • Fantasy Garden Collage
Group Therapeutic Horticulture • April • Signs of Spring • Seedling maintenance • Plant early peas • Flower arrangements for Easter and Passover
Group Therapeutic Horticulture • May • Window box planting (3 sessions) • Mothers’ Day Flowers everywhere.
Group Therapeutic Horticulture • June • Nature Drawing • Press flowers, drying flowers • Pinch mums • Make Herb Vinegar
Group Therapeutic Horticulture • July • Window box maintenance • Press dry flowers • Leaf and twig study • Sensory experience: herbs and flowers • Order bulbs for forcing
Group Therapeutic Horticulture • August • Divide house plants • Taste this year’s tomato crop • Garden party with iced teas • Press flowers • Make natural dyes
Group Therapeutic Horticulture • September • Press leaves • Plant mums in containers • Start topiary with Ivy • Sensory Sachets • Harvest Party
Group Therapeutic Horticulture • October • Dried flower arrangements • Cuttings from scented geraniums • Amaryllis Bulbs • Paper-whites • Make scarecrows
Group Therapeutic Horticulture • November • Sun catchers • Pinecone bird feeders • Bulbs • Natural holiday decorations
Group Therapeutic Horticulture • December • Natural ornaments • Pressed flower holiday cards • Dried leaf wreaths • Winter solstice program
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.
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.
Spiritual Nature of Plants Explore the healing of the soul that gardening and gardens offer.
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