PALLIATIVE CARE SOUNDS AND SENSES IN THE GARDEN

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. 3/19/2018 1

Reflection To affect the quality of the day is the highest of arts. Henry David Thoreau 3/19/2018 2

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 3/19/2018 3

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 3/19/2018 4

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 3/19/2018 5

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 3/19/2018 6

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 3/19/2018 7

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. 3/19/2018 8

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 3/19/2018 9

Palliative Care 3/19/2018 10

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 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 3/19/2018 11

Palliative Care 3/19/2018 12

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 3/19/2018 13

The Psychosocial Impact of Dying 3/19/2018 14

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 3/19/2018 15

Non—Abandonment In Palliative Care, the sense of nonabandonment is paramount. Aaronson & Beckman--1987 3/19/2018 16

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 3/19/2018 17

Description of Patient 3/19/2018 18

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 3/19/2018 19

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 3/19/2018 20

Barbara § Reason for referral § Activities § Results 3/19/2018 21

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 3/19/2018 22

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 3/19/2018 23

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 3/19/2018 24

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 3/19/2018 25

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 3/19/2018 26

Group Therapeutic Horticulture § March – Vegetable seed study/ poster – Plant annuals – Plants of the Bible – Fantasy Garden Collage 3/19/2018 27

Group Therapeutic Horticulture § April – Signs of Spring – Seedling maintenance – Plant early peas – Flower arrangements for Easter and Passover 3/19/2018 28

Group Therapeutic Horticulture § May – Window box planting (3 sessions) – Mothers’ Day Flowers everywhere. 3/19/2018 29

Group Therapeutic Horticulture § June – Nature Drawing – Press flowers, drying flowers – Pinch mums – Make Herb Vinegar 3/19/2018 30

Group Therapeutic Horticulture § July – Window box maintenance – Press dry flowers – Leaf and twig study – Sensory experience: herbs and flowers – Order bulbs forcing 3/19/2018 31

Group Therapeutic Horticulture § August – Divide house plants – Taste this year’s tomato crop – Garden party with iced teas – Press flowers – Make natural dyes 3/19/2018 32

Group Therapeutic Horticulture § September – Press leaves – Plant mums in containers – Start topiary with Ivy – Sensory Sachets – Harvest Party 3/19/2018 33

Group Therapeutic Horticulture 3/19/2018 34

Group Therapeutic Horticulture § October – Dried flower arrangements – Cuttings from scented geraniums – Amaryllis Bulbs – Paper-whites – Make scarecrows 3/19/2018 35

Group Therapeutic Horticulture § November – Sun catchers – Pinecone bird feeders – Bulbs – Natural holiday decorations 3/19/2018 36

Group Therapeutic Horticulture § December – Natural ornaments – Pressed flower holiday cards – Dried leaf wreaths – Winter solstice program 3/19/2018 37

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. 3/19/2018 38

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. 3/19/2018 39

Spiritual Nature of Plants Explore the healing of the soul that gardening and gardens offer. 3/19/2018 40

NYBG 3/19/2018 41

Bibliography § Aaronsen, N. K. & Beckman, J. H. (1987) The quality of life of Cancer Patients, New York, Raven Press. pp. 75 -86 § Avedon, E. (1966) Recreation research, The American Association for Health, Physical Education, & Recreation. § Bost L. S. & Brown E. M. (1982) Recreation therapy: A humanistic adjunct to oncology treatment. Oncology Nursing Forum , (Vol. 9[4] pp. 43 -49. 3/19/2018 42

§ Breitbart, W. & Holland, J. C. (1993) Psychiatric aspects of symptom management in cancer patients, Washington DC, The American Psychiatric Press. pp. 155 -165. § Burlingame, J. & Blaschko, T. M. (1994) Assessment Tools For Recreation Therapy: Redbook #1. Revensdale, Washington. Idyll Arbor, Inc. pp. 117 -125 3/19/2018 43

§ Cimino, J. E. (1997) Commentary: Nonabandonment, physicians and nurses as allies, New York, The American Journal of Hospice & Palliative Care (Vol 14 [3]) pp. 106 -107. § Cimino, J. E. (1995) Definition of palliative medicine, Third Year Class Orientation Lecture Notes, New York Medical College 3/19/2018 44

§ Connoly, P. (1993) Balancing changing health care needs with the shortage of quality health care professionals: Implications for therapeutic recreation, Journal of Loss, Grief & Care, New York , Haworth Press. pp. 15 -21. § Davison, D. C. & Neale, J. M. (1996). Abnormal Psychology. New York: John Wiley & Sons, Inc. § Kane, Brunton & Fournier (1999) Cancer, Press. § Kavanaugh, R. E. (1972) Facing death, Baltimore, Maryland, , Friedman Fairfax, pp. 14 -68 3/19/2018 45

§ Kavanaugh, R. E. (1972) Facing death, Baltimore, Maryland, Penguin Press. pp. 105 -124. § Kubler-Ross, E. (1969) On death & dying, New York, Macmillan Publishing, pp. 38110. § Korchin, S. J. (1976) Modern Clinical Psychology (1976). New York. Basic Books. 3/19/2018 46

§ Kunstler R. & Sokoloff, S. (1993) Clinical effectiveness in intensive therapeutic recreation: A multiple case study of private practice intervention. Journal of Loss, Grief & Care, New York. 23 -28. § Lahey, M. P. (1993) Acute care vs. chronic care models of services to the elderly: Implications for therapeutic recreation, Journal of Loss, Grief & Care, New York. 55 -62. 3/19/2018 47

§ Rando, T. A. (1984) Grief, Death, & Dying: Clinical interventions for caregivers, Champaign, Illinois, The Research Press. pp. 227 -250. § Simpson, S. (1996) Journal of Therapeutic Horticulture, Gathersburg , MD. 3/19/2018 48

§ Sourby, Charles A. (2002), from: Flowers of the Bible and How to Grow Them, New York, Citadel Press. § Sourby, Charles A. (2003) from: Herbs of the Bible and How to Grow Them, New York, Citadel Press. § Sourby, Charles A. (1998), Barbara-Palliative Care, Journal of Therapeutic Horticulture. 3/19/2018 49

§ Swenson, Allan A. (1995) Plants of the Bible and How to Grow Them, Citadel Press. § Spacapan, S. & Oscamp, S. (1988) The social psychology of Health, Beverly Hills, California pp. 285 -193 § Steuer, F. B. (1994) The Psychological Development of Children. Pacific Grove, California. Brooks/Cole Publishing. 3/19/2018 50

§ Stjernsward, J. & Colleu. S. M. (1996) The W. H. O. cancer pain and palliative care program: past, Present, and Furture, New York, Journal of Pain and Symptom Management (Vol 12[2]), pp. 65 -66. § Strensrud, C. (1993) Quality of living until death: A fusion of death awareness into therapeutic recreation-leisure education, The Journal of Loss, Grief, & Care, New York, The Haworth Press. pp. 33 -37. 3/19/2018 51

§ Stoll, B. A. (1988) Coping with cancer stress, The Netherlands, Nijhoff Publishers, pp. 45, 86, 116, & 119. § Taylor, E. J. (1992). The search for meaning among persons living with recurrent cancer. University of Pennsylvania. PH. D. thesis, pp. 35. 3/19/2018 52

§ Turk , D. C. & Feldman C. S. (1992) Noninvasive approaches to pain control in terminal illness: The contribution of psychological variables, The Hospice Journal, (Vols. 8[1, 2]). § Willetts, H. C. & Sperling, A. (1983) The role of therapeutic recreationist in assisting the oncology patient to cope, New York, Futura Publications, pp 38 -54. 3/19/2018 53