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    The Landscapes of Our Patients' Journeys
    The Landscapes of Our Patients' Journeys
    The Landscapes of Our Patients' Journeys
    Ebook136 pages1 hour

    The Landscapes of Our Patients' Journeys

    By Keith Rasey

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    About this ebook

    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.

    LanguageEnglish
    PublisherKeith Rasey
    Release dateNov 9, 2011
    ISBN9781452498775
    The Landscapes of Our Patients' Journeys
    Author

    Keith Rasey

    Keith A. Rasey is a graduate of Eastern Michigan University, Yale Divinity School and Kent State University. He has Bachelor of Science degrees in History and Economics and Gerontology and Long Term Health Care Management. He has a Master of Divinity. Keith has done postgraduate work in organizational leadership and advancement at Perkins School of Theology at Southern Methodist University. He is also a Licensed Nursing Home Administrator. Keith has over twenty-five years of experience in working with patients and families at the end of life. The very first patient to die at home in the United States, while receiving care from hospice, was a member of the parish he served as minister on May 25, 1977. Keith was working with hospice as a volunteer before hospice care was approved for payment by the Federal government. He is particularly skilled and experienced at Judeochristian and Buddhist approaches and practices for end of life care. He is currently exploring the ways in which traditional healers, aka shamans, practices can inform, enrich and deepen spiritual care at the end of life. He also understands that, from a family systems' viewpoint, humor, wit and whimsy are ways of being in the world that can create a way for change in organizations and groups that are stuck in a rut. Some of the "crazy" things that traditional healers do may offer us postmodern people a way to live more authentic, centered and whole lives in the sociocultural contexts of our present lives. "The Landscapes of Our Patients' Journeys" grew out of his interest in both science based or evidence based approaches and spirituality. The Center for Medicare and Medicaid Services is increasingly requiring hospices to measure the quality of care and the patient/family experience. "The Landscapes of Our Patients' Journeys" offers a method to marry narrative and data that provides a means to assess the patient/family experience of end of life and measure the quality of caregivers' responses. He is currently formating his newest book, "Polar Bear Angels: Humorous, Insightful and Irreverent Stories from a Reverend," to make it conform to epublishing platforms. It is based on real interactions. As has often been noted, real life is far more unbelievable, outrageous, poignant and humorous than anything that can be made up. Keith lives with Diane, his wife of twenty years, and two dogs, Benny and Sunshine. He enjoys theater, cinema, travel, reading and jogging his two canine housemates through a five mile route in a local cemetery.

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      Book preview

      The Landscapes of Our Patients' Journeys - Keith Rasey

      ACKNOWLEDGEMENTS

      I owe a great debt to many people. Jeanne Bennett, teacher of the adult development class at Kent, piqued my interest in the ways people face the final wave aka death. Sue McCausland urged me to submit a proposal for the workshop out of which this book grew. Jennifer Cleric was kind enough to review most of the content. Father Ed Luca was very kind to loan me two hymnal/service books from the Roman Catholic tradition. Michelle Vancisin, my daughter, a published author in her own right, helped me with putting it in a format that was useable by ebooks.

      Diane Davies Rasey, my wife, was kind enough to read the manuscript and offer suggestions on how to sharpen it.

      Of course, any mistakes in the book are completely my own responsibility as, to quote, the Psalmist, my sins are ever before me. Please contact me to report errors or formatting issues at krasey1@kent.edu .

      Although I wanted to do a more expansive work that included resources from all the major religions, it soon became apparent that would be unworkable. I hope this will be useful to those who accompany patients and their loved ones at the end of their lives here.

      Keith A. Rasey, M. Div, LNHA

      Medina, Ohio 2011

      FOREWORD

      It has only been a short time that I have had the privilege to work with Keith Rasey in hospice care. We have had the opportunity to work together in building a new hospice program from the ground up. During this time, I have come to know him as deeply thoughtful, highly intelligent, and fiercely passionate about hospice care. He obtained his Master of Divinity degree from Yale University and has led a number of Christian congregations. He has been a pioneer in the hospice movement, having provided pastoral care to the very first hospice patient in the United States in 1977. While he has done various types of work in his lifetime, his calling has always been the care of the dying.

      This book itself has been an intense challenge as well as a labor of love. Because of his commitment as a spiritual counselor in hospice care, Keith has found the writing and creative process to also be an evolution in his career as well as a time of growth in his perception of self.

      In the time that I have been working alongside Keith, I have been convinced of the power found in relating to each individual’s narrative during end of life care, and the importance of relating to them within that context. As caregivers we are always striving to improve our practice and do better by our patients and families. Herein is a powerful reminder that for all our knowledge and expertise, we have the opportunity to not only provide silent witness or passive presence, but allow the patient to guide us on their journey. We can bear witness on this journey to the grave spiritual concerns they face at end of life, and with insight we may have permission to provide individualized spiritual care.

      This book provides a construct in which the patient ‘journeys through a landscape’ as a metaphor for the emotional and spiritual experiences we witness at the end of life. The skilled nature of our care as professionals compels us to search for a way to individualize our response to spiritual distress or pain. This construct allows for just that. Rasey shows us how the use of a data collection tool that helps identify the domain or ‘landscape’ in which the patient finds themselves can help us individualize spiritual care. He shows us how we can come alongside the patient in presence, but also helping them identify landmarks in the landscape. In other words, we can learn how to journey with the patient and help them identify issues or concerns they need to address, instead of imposing a cookie cutter solution of what we think might help.

      Most importantly, it is about the patient’s journey. Not our response to it. The patient remains the center of care. And the better we are able to assess and develop insight about the landscape through which they travel, the more focused and effective our care can be.

      Jennifer Cleric RN, ND

      Aurora, Ohio 2011

      INTRODUCTION

      The variety of landscapes our patients journey through is breathtaking. Some are mountainous. Some are plains. Some are valleys.

      Some are lush and can nurture all kinds of life. Some are arid and it is difficult for any living creature to survive.

      Some are stony with monochromatic colors and themes. Some are full of beautiful flowers that make the journey pleasant.

      Some landscapes are a combination of many different kinds of terrain and flora and fauna that change with the seasons.

      The landscapes can change from day to day, sometimes even hour to hour, minute to minute.

      If we listen to our patients and their loved ones, we can discern the contours of the landscapes through which they are traveling. The words, metaphors, symbols and imagery they use will unfold their landscapes for us. The often asked question of end of life caregivers, What do you say to someone who is dying? is answered by a deep listening in which we use the language of the patients’/families’ own landscapes to let them know we are listening, we are present.

      We do not have to search for

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