The Miami Valley Hospital (MVH) Palliative Care Department offers a variety of services to ensure the comfort of terminally ill and chronically sick patients and to help their families with any major health decisions.
Six Services That MVH Palliative Care Provides
- Educates and aids with advanced directives, living wills, health care powers of attorney, and Ohio State Do Not Resuscitate Comfort Care Identification
- Offers do-not-resuscitate discussion, support, follow-up, and physician conferences
- Offers end-of-life support for a patient dying in the hospital
- Coordinates the goals of care support for the seriously ill or those with life-limiting illnesses, especially when multiple consultants, multiple providers, or a large family is involved
- Educates about hospice care by providing information and dispelling myths
- Supports the staff and family through the process of life support withdrawal, symptom management, pain, shortness of breath, nausea, and constipation
The Goal of Palliative Care
Once it has been determined that comfort is the goal for the patient, MVH Palliative Care follows these four guidelines:
- Give care in accordance with advanced directives or patient and family wishes
- Provide an environment where feelings of grief can be expressed with sensitivity to cultural, spiritual, and personality traits of the patient and family
- Tend to physical comfort and dignity by making every effort to meet patient and family requests, no matter how out of the ordinary they may be
- Assess for children who may be involved and address their needs
Comfort, Dignity, and Individualized Care
The MVH Palliative Care staff focuses on a patient’s needs, which become especially important when a cure is not possible and end-of-life care becomes the concern. In addition to arranging a private room, the Palliative Care team encourages many opportunities for individualizing care for the patient. The family is asked to bring in items that make the patient feel comfortable and at home, like a CD player, pajamas, and other items that will make the space at the hospital remind them of their own home. Special arrangements are made on behalf of family and patient for whatever brings them comfort. Palliative patients have had string quintets perform in their rooms. Some have had academic degrees deferred at bedside. Arrangements that are out of the ordinary are often just part of the plan for palliative patients.
Special Help for Children to Cope
Being a Level I Trauma Center, MVH is often faced with sudden death. When a child has experienced the loss of a parent or loved one, helping them cope is a priority. The first step is usually discussions with the child and trained Palliative Care staff and psychologists. Often school guidance counselors, teachers, or those close to an adolescent are briefed or involved. There are special pamphlets available to help explain what’s happening in a language children can understand. Remembrance activities often help them with closure. A few popular ones are hand molds of the parent, with thumbprints or fingerprints made into jewelry that can be worn for constant remembrance.
The MVH Palliative Care team includes a Program Manager, physicians who specialize in the treatment of the terminally ill, nurses with specialty Palliative Care leadership training, a Social Worker, a Chaplain, and a Psychologist. The interdisciplinary team meets weekly to discuss the cases of individual patients and monthly for process improvement. There are also four physician champions in the program. Typically, interdisciplinary teams work to set goals for patient improvement. With dying patients, the Palliative Care team sets comfort goals as a patient’s condition worsens.
Focus on Comfort and Easing Symptoms
Since most palliative patients seek care for very serious illnesses, comfort becomes the goal for their care. The care process starts by making sure the patient thoroughly understands what is happening to them. Patients get a realistic picture of their chances of recovery and an explanation of what happens if their condition deteriorates. This information is relayed by their doctor, and then the patients’ wishes are relayed to the Palliative Care team. Wishes include how they expect to be treated, if they want to be revived, etc.
Symptom management and maximizing the patient’s quality of life are the goals of the hospital treatment. Commonly the Palliative Care team is focused on relieving pain, maximizing breathing ability, and controlling nausea, vomiting, and constipation.
MVH developed a pilot program using music for Palliative Care patients. Nurses work with music therapy students from the University of Dayton. Research shows that music can reduce blood pressure, reduce heart and respiration rates, decrease perceived pain, positively affect the immune system, and reduce fear and anxiety related to the patient’s condition and surroundings.
Each quarter two senior music therapy students from UD come in twice a week. With the help of the nursing staff, they offer a variety of options for patients at many different participation levels. Patients interested in musical therapy are given a menu that includes:
- Music on cassette for relaxing or energizing the body
- Music before, during, or after surgery or a painful procedure
- Musical sessions during family visits
- Developing musical skills on simple instruments
- Music composition to reflect a patient’s thoughts
- Requests for songs performed live by musical therapists
Most participants reported that the music therapy reduced anxiety and increased overall comfort.
MVH Palliative Care has been using pet therapy since the program’s inception. The Pet Therapy Program started at MVH in 1999. Dogs visit regularly, and patients who are interested often find comfort and pain relief in interaction with the pets. Pet Therapy pets are screened and specially trained. All dogs are certified as Therapy Dogs through the Delta Society®, where the dog and handler complete an eight-week, 20-hour course in working with patients. The dogs also pass a physical every six months and are bathed before each visit.
“About How You Live” Class
The “About How You Live” class is open to the community at convenient locations. The program teaches the public about the importance of advance directives, living wills, health care powers of attorney, and Do Not Resuscitate (DNR) orders. Education follows a national curriculum set by the National Hospice and Palliative Care Organization.
Thumbies and Loving Touch
Thumbies and Loving Touch are companies that create keepsake jewelry from a fingerprint or thumbprint. These give survivors a very personal memory of a loved one. An impression or print can be taken before or after death. Some companies offer price breaks for MVH. Ask your Palliative Care team member for more information.
When Life Ends
Withdrawal of life-sustaining treatment happens when the patient has prearranged it or when a decision has been made by family. The state of Ohio and MVH have policies for implementing this over a two-day period. The Palliative Care team is present when a patient is permanently removed from an intravenous drip or a ventilator.