The article is based on the presentation given by Louise Lachowskyj, RN.
Louise talks about one of the toughest topic of “Humour in Palliative Care”.
It is important for everyone to examine their outlook on death. One way to look at this is to write your own obituary.
By doing this you will be prepared for how you might react when a patient dies.
This event is something which all Personal Support Workers will face especially those of you who work in palliative care. PSW’s working in such settings will be assisting patients with serious illnesses, helping them face the last days of their lives.
Under the supervision of other healthcare professionals, Personal Support Workers provide basic care to patients with serious illnesses. The goal of palliative care is to provide relief from the symptoms and pain of these illnesses along with stress relief and support for both patients and their families.
This type of supportive care allows patients to face the end days of their lives with dignity, humor and their self-respect intact.
This is the most important goal, for it is “an honor and a privilege to be allowed into such an intimate time of their lives”.
However, this goal doesn’t always meet the practical reality of palliative care and that is something that need to be changed.
It is sad but true that even those in the medical profession often treat the dying as if they are already dead. They speak to their patients in whispers and solemn tones, avoiding any talk not only of death itself but of the lives their patients have lived up to this point.
These actions create a stifling environment that negates the personality of the person with the illness and causes them to lose out on the opportunity to face their death with dignity and beauty.
They are instead left frustrated by not only the limitations placed on them by the disease but also the limitations placed on the human interactions they need at this time.
Rather than making their last days comfortable and happy, this type of gloomy behavior creates more tension for the patient to endure at a time when they are already stressed.
TREAT PATIENT AS A PERSON
To reach this desired change, nurses and Personal Support Workers must strive for a standard of care that treats the patient as a person first and foremost.
A caregiver’s intent should be reflected in the way one answers people who ask if their job is to help people die.
PSW must tell them “No, I help them live the rest of their lives”.
It is this philosophy that tends to be the opportunity to make their deaths beautiful and peaceful.
Louise is the mother of this philosophy. It comes not only from her nursing experience but from her childhood as well.
As a child Louise found herself, as she puts it, surrounded by death.
Her parents ran a tombstone company.
To assist in her family’s business, it was her job to cut out the obituaries and save them for the families of those who purchased a tombstone. This experience taught her to see death as a part of life rather than an unnatural and frightening occurrence.
Treating death as unnatural or extremely dramatic, is what makes it so scary for people. For Personal Support Workers this philosophy is extremely important for, as you are the eyes and ears out there among the patients.
The first step for every PSW who takes care of a palliative patient is to find out who their patient is on a personal level.
The key to that is all about knowing the person, who they are inside, what they like and don’t like, how they have lived their lives up till now and what their interests are. Getting to know the person will tell you how to interact with them.
Is humor acceptable for this person or is their nature more serious?
Is this someone they can talk to frankly or do they frown on bad language?
These are the type of questions that will give the Personal Support Worker the tools to assist not only their patient but also the patient’s family. The families are suffering from stress too and laughter is good medicine for them as well as the patient.
Another way PSW’s can make a connection with their patients is by giving them back even a small part of the routine of their lives.
Louise tells the story of a woman who always had a sip of brandy in the evening. The problem was she didn’t like to drink alone. When her shift ended, Louise would sit with her and have a brandy while they talked. This was a simple thing but it allowed the woman to regain a small routine she used to have.
Thanks to this, the woman began sleeping better at night.
STAYING INVOLVED IN LIFE
It is also important for PSW’s to encourage patients to continue to be involved in life and learning, even in small ways.
Louise once asked her patient if she would like to do a puzzle. The woman responded by saying she had never done a puzzle before in her life. To which Louise responded, “You better get started then because you don’t have much time”.
This got a laugh from the patient.
Humor should be a strong component of palliative care. Using humor makes the situation normal rather than scary. Laughter helps the patient relax and use the time they have left to create beautiful memories for their families.
This approach allows those with serious illnesses to live every moment up until their death.
Louise told another story of a woman facing death whose children came to stay with her.
For two days her children held a bedside vigil, filling the room with flowers, lowering the lights to dim, closing the curtains and speaking in hushed tones. After those two days, women’s room started to smell like a funeral home and her patient at her wit’s end with the treatment her family was giving her.
Rather than easing her journey, her family’s tactics were making the woman feel as if she was already dead.
Louise opened the curtains, turned up the lights and cleared out the flowers. By the time the woman’s children returned, she was sitting up in bed, laughing, with a cool breeze coming in through the open window.
Two days later the woman died with the curtains open, a single rose in a vase and a smile on her face.
It is these types of death experiences that all PSW’s should create.
The question that you should ask is what I need to do to make that person happy. Once you’ve asked, you need to listen to what the person is saying and give them what they want to the best of your ability.
It is also possible that when providing the best possible care, sometimes you can be taken out of your comfort zone but that is a learning experience as well.
Through interactions such as these, you will not only allow your patients to live the remaining part of their lives in a way that is beautiful and peaceful, but you will learn much about how they want to live their own lives as well.