ebook img

Living, Dying, Caring: Life and Death in a Nursing Home PDF

310 Pages·2001·7.87 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Living, Dying, Caring: Life and Death in a Nursing Home

AUSMED PUBLICATIONS This book, written from practical experience, offers reflections on relationships within the nursing home, particularly at the time of a resident’s death. Building on their previous very popular book, Unique and Ordinary, the authors offer fresh insights together with practical implications for improved quality of care. The stories capture the humorous, the sad, the poignant and the down-to-earth realities of living and dying in a nursing home; the stories include exemplars as well as gaps in care. Residents, families, staff, visiting health professionals, pastoral carers and volunteers have provided their own unique contribution to this reflection on practice. Their wisdom offers encouragement to all engaged in this rewarding work, to reflect and learn from their experience. The book is finely illustrated with poignant photographs of residents. The photographer, Michel Faber, is a nurse who knew and cared for the residents in this nursing home. TheAuthors Rosalie Hudson is director of nursing at Harold McCracken House, in Melbourne, Australia, where a palliative care philosophy provides the framework for the care of residents who are dying, and a partnership philosophy guides all relationships. Rosalie’s postgraduate research in gerontic nursing and theology has stimulated further insights for several journal articles and for this second book on living and dying in a nursing home. Personhood, death and community are the themes for her PhD thesis, inspired by the ordinary and extraordinary experiences in a rather special nursing home. Rosalie is married with a daughter, two sons, two daughters-in-law and three grandchildren. Jennifer Richmond’s first career was in nursing. In hindsight, she says, the highlight of her nursing years was a long asociation with Melbourne LivingDyingCaring Citymission’s Harold McCracken House. During this time her creative partnership with Rosalie yielded a valued friendship and a number of nursing publications. At Harold McCracken House Jennifer worked with many extraordinary and gifted staf, one of whom is novelist Michel Faber L IFE AND DE ATH IN A NURSING HOME whose photographs appear in this book. After the privilege of an editing A thought ful, pract ical text for nurses and heal th professionals, famil ies, carers, volunteers . . . association with Ausmed Publications and a postgraduate qualification in editing and writing, Jennifer now writes fiction and works part-time as an inhouse medical and scientific editor for a major publisher. She lives in R O S A L I E H U D S O N & J E N N I F E R R I C H M O N D inner-city Melbourne with her family, which includes dogs Minnie and John. ISBN 0 9577988 6 5 F O R E W O R D B Y A L A N P E A R S O N LIFE AND DEATH IN ROSALIE HUDSON & JENNIFER RICHMOND AUSMED PUBLICATIONS LivingDying Caring A NURSING HOME FOREWORD Living, Dying, Caring i KEEPING IN TOUCH Other titles published by Ausmed Publications Renal Nursing – a guide to practice Bobbee Terrill Infectious Diseases in Children Tara Walker Ageing at Home: Practical Approaches to Community Care Edited by Theresa Cluning Complementary Therapies for Nurses and Midwives — from vision to practice Edited by Pauline McCabe Keeping in Touch with someone who has Alzheimer’s Jane Crisp nd Geriatric Medicine, 2 edn Len Gray, Michael Woodward, Ron Scholes, David Fonda and Wendy Busby The Midwife and the Bereaved Family Jane Warland Living in a New Country: Understanding Migrants’ Health Edited by Pranee Liamputtong Rice Palliative Care Nursing: A Guide to Practice Edited by Sanchia Aranda and Margaret O’Connor Caring for the Person with Faecal Incontinence Karen Cavarra, Andrea Prentice and Cynthea Wellings Revised by Janette Williams Practical Approaches to Infection Control in Residential Aged Care Kevin J. Kendall Promoting Men’s Health Edited by Tom Laws Nursing the Person with Cancer Edited by Gordon Poulton Nursing Documentation: writing what we do Edited by Jennifer Richmond Spirituality: The Heart of Nursing Edited by Professor Susan Ronaldson Rethinking Dementia — an Australian approach Edited by Sally Garratt and Elery Hamilton-Smith Thinking Management: Focusing on People Edited by Jean Anderson Caring for People with Problem Behaviours, 2nd edn Bernadette Keane and Carolyn Dixon Asian Mothers, Western Birth Edited by Pranee Liamputtong Rice Unique and Ordinary Rosalie Hudson and Jennifer Richmond ii FOREWORD Living, Dying, Caring: life and death in a nursing home ROSALIE HUDSON and JENNIFER RICHMOND Foreword by ALAN PEARSON AUSMED PUBLICATIONS Melbourne iii KEEPING IN TOUCH Australasian Health Education Systems Pty Ltd (ACN 005 611 626) trading as Ausmed Publications 277 Mount Alexander Road Ascot Vale, Victoria 3032, Australia © Ausmed Publications 2000 Reprinted January 2002 First published June 1994 (as Unique and Ordinary: Reflections on living and dying in a nursing home) Reprinted September 1996 Second edition published October 2000 (as Living, Dying, Caring: life and death in a nursing home) Photographs © Michel Faber 1994 Poetry (with photographs) © Jennifer Richmond All Rights Reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the written permission of Ausmed Publications. Requests and inquiries concerning reproduction and rights should be addressed to the Manager, Ausmed Publications, PO Box 4086, Melbourne University, Victoria 3010, Australia. Further copies of this book and of all other Ausmed publications are available from the Distribution Manager, Ausmed Publications, PO Box 4086, Melbourne University, Victoria 3010, Australia. Telephone +61 3 9375 7311. Fax +61 3 9375 7299. E-mail FOREWORD FOREWORD As Australia moves into the 21st century, new strategies are needed to provide services that keep pace with the rapidly rising ageing population. Not only will there be a larger number of Australians over age 65, this age group will constitute a greater proportion of the total population (from 10 per cent in the late 1990s to 11.7 per cent — 2.33 million people — by the year 2001). The number of people 80 years or older will double during the next two decades and many will require nursing home or domiciliary care. Nursing homes provide supportive accommodation and nursing for people who need assistance to reach their own aspirations in their daily lives. Although only 4.4 per cent of all Australians reside in nursing homes, the deleterious effects on older people living in institutional settings has been well documented. Commonwealth governments have instigated a series of reforms over the past 20 years, all aiming to provide quality care and to promote resident rights. Early measures focused on demedicalising nursing homes and providing a more home-like environment. There is now much less emphasis placed on the treatment of physical problems and more attention is directed to providing holistic care and improving quality of life. Caring, intelligent, sensitive and creative nursing is central to quality care in the nursing home setting; it embodies the values identified, assembled and preserved by countless numbers of nurses throughout the ages; and it has touched the lives of a large proportion of the world’s population at some time or other. Nursing’s very essence, though dependent upon a thorough understanding of the physical and social sciences, lies in the nurse’s ability to reach out to another in a very human, practical way and to ‘be there’ as a caring other. It is this very essence that nurses, doctors, health service managers and planners, governments and the general population find so difficult to describe or define, and it is the most difficult to pass on to those who are learning to become nurses. Most significantly, all of us who are nurses have experienced difficulty in holding onto the essence of nursing in the hurly-burly, ever-changing reality of contemporary health care. This book skilfully and elegantly exposes the essence or core of nursing that is so highly valued by society as a whole and by nursing home residents in particular. Beautifully written, the practical wisdom of the authors and their ability to articulate complex concepts shines throughout this important text. Living and dying in a v KEEPING IN TOUCH nursing home can be a positive, affirming experience for older people and their relatives and friends and this book offers a solid foundation on which nurses and care workers can create possibilities to ensure that such an experience takes place. I congratulate the authors on this illuminating work and commend it to health policy makers, managers, nurses, medical practitioners, allied health workers and care workers in aged care. Alan Pearson RN, ONC, DipNEd, DANS, MSc, PhD, FCN(NSW), FINA, FRCNA, FRCN Professor of Nursing at La Trobe University, Melbourne, Victoria, Australia Melbourne November 2000 vi FOREWORD CONTENTS Page Foreword v INTRODUCTION 1 CHAPTER ONE Goals of care: Ideal and reality 5 CHAPTER TWO Conflict of interest: Comfort measures only 15 Cultural considerations: I want to go home 24 Dementia: Why bother? 35 The short-term resident: Ron’s choice 44 The long-term resident: This is my home 50 Relationships: Together or not? 57 CHAPTER THREE Interconnections: Will you be my family too? 64 Fears and anxieties: Don’t you ever put me in that bed! 69 Public and private: Community of difference 74 Disharmony and conflict: This is my space 79 CHAPTER FOUR Grief: It won’t be the same without him 84 Mixed emotions: If only we’d known 91 Support staff: I’ll miss him too 97 Robert’s wish: I want to die 101 Staff stress: Too many deaths 107 CHAPTER FIVE The doctor: That’s how death should be 120 The chaplain: I wore my best dress 130 The volunteer: I learned so much from Flora 141 The student: There is life in a nursing home 147 Allied health staff: Mary’s final fling 151 vii KEEPING IN TOUCH CHAPTER SIX Family responses 156 Mother and daughter: Old-old and old 157 The absent family: Wouldn’t you think they’d visit at a time like this? 159 Cultural considerations: Bread of life 168 Visitors: I’m not the only one 173 The bereavement visit: Send my love to all the girls 179 Couples: The milk carter and his wife 185 Unfinished business: Coming back 192 CHAPTER SEVEN Sudden death: No time to say goodbye 206 Site of care: Couldn’t I come back home? 212 Acute care: Keeping pace 218 CHAPTER EIGHT The funeral: Flora Benson’s spanner 228 Wrapping it up: I’ve seen the angels 235 Anniversaries: It’s three years tomorrow 244 CHAPTER NINE Documentation: Conveying the story as well as the tasks 250 Environmental factors: More than bricks and mortar 259 Standards: A measure of dignity 267 Economic/political issues: We must fill the bed today 278 THE LAST WORD: A SHARED WORLD 284 Further reading 292 Index 296 viii INTRODUCTION INTRODUCTION This book is based on our 1994 publication Unique and Ordinary: Reflections on living and dying in a nursing home When considering a second edition, we realised there were many changes required and more stories to tell. These changes and stories are more significant than mere amendments, so they find themselves in a new book. However, the basic theme of death and dying is common to all humans, and those readers familiar with our first title will recognise this piece of wisdom in our carrying forward into the new book so many of the old stories that have endured and maintained their relevance. The experience of death is unique to those who are dying. The residents are, therefore, our teachers. This philosophy translates into practice when care is individualised and continuously evaluated. In this way the residents help us to build on previous learning. These stories have caused us to pause and reflect on the nature of each resident’s unique life and death and what it is that stimulates us to improve their care. In action–reflection mode, this book recalls the stories of residents who have lived and died in our nursing home, and draws implications for enhanced practice. We have discovered that, while there is much in our practice to be commended, there is also much that could be improved. These are ordinary stories reflecting the lives and deaths of ordinary nursing home residents. However, although there are some common threads, there is no general prescription of care which may be applied to every situation. The stories also bear the stamp of the staff; of the organisational culture and the philosophy of partnership that guides all our care. These are our stories; they are not intended to convey any distinctions of quality. Your stories may reflect similar or quite different facets of care. There is no intrinsic ‘rightness’ about our illustrations; they do not reflect perfect care. However, many issues are raised which may provoke deeper thought, different educational emphases and attitudinal changes in carers. Our aim in publishing these reflections is to invite discussion aimed at promoting best practice in the care of nursing home residents. In bringing these stories to you, we acknowledge that they are both extraordinary and ordinary; extraordinary in their individuality, yet ordinary in the sense that residents die in nursing homes every day. We confess to a degree of sadness in changing deceased residents’ names to protect confidentiality; for their names and personalities 1

See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.