New Conversations: Death over Dinner

DRAFT

New Conversations:Death over Dinner

This is an invitation to dinner.

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In Praise of the Slippery Slope: The Hazards of Research Design for Provider Ratings

DRAFT                            In Praise of the Slippery Slope:                        test1              

The Hazards of Research Design for Provider Rating

ABSTRACT:  This article is intended to give a light touch to a serious topic--the use of customer satisfaction surveys in healthcare.  While the motives may be honorable:  to improve patient care and conserve expensive resources, depending upon surveys to rate and reward outstanding providers may lead to inadequate data, misleading analysis, and ultimately misinformed action.  The consequences may be devastating to the genuine need for better healthcare.  A familiar image used in the field of ethics, the slippery slope, is useful in this discussion because it suggests both risk and danger with the promise of desirable change from challenging and transforming the status quo.  Engaging a slippery slope is most often discouraged since it leads toward one kind of disaster or another.   We engage it here for many reasons.  Personally, in my work in bioethics and information ethics, I've always been attracted to the slippery slope partially because it makes many ethicists uncomfortable.   In addition, the slippery slope can lead us from academic arguments toward  real world problems and rapid change.  In the case of healthcare, the stakes are so high that I am eager to face criticism and the uncertainty of unleashing our imaginations.   

Quantitative vs. Qualitative Research

Talking about research design in relation to quality ratings for healthcare providers makes me very uncomfortable.  Those of us who favor qualitative over quantitative research live lives of quiet desperation in defending our research our theories and methods.  Early on in our careers we learned that we would be disrespected in the competition for funding and journal placement.  But we persevere, devoted to our belief that our methods come closer to bringing understanding more applicable to decision-making than approaches that measure undefinable variables that only seem to be meaningful for making comparisons.  We have long ago let go of the notion that human experience can be explained and predictable.  We know that to evaluate quality of care and provider impact is a very messy business.  

Now pardon me if I'm overly sensitive, but it's hard to muck around in the swamps and deserts of human interactions and not be appreciated by peers and institutional authorities.  


Social construction of reality

Social theory

Grounded theory

Hermeneutics

Hermeneutic of messinesss.  

Hermeneutic of compassion

Dancing the Pain Away

Dancing the Pain Away:

Mourning the Death of Nelson Mandela

Introduction to the Tree of Remembrance spiritual message, December 8, 2013The Rev. Dr. Martha M. Smith

Today I want to invite you to take this time we have together to remember and celebrate the memories of all of the loved ones we have lost both in this past year, in recent years, and  those who died years and years ago.  My parents have been gone now for over twenty years but at this time of the year I think about them making the fancy pink and green candy we called "divinity"  and the nutty, brown sugar bars we called "chewies."  Most of the chewies were mailed to friends far away, so I never got to eat enough of those.  I have so many good memories of them, and the older I get the more I realize how much my life stands on the foundations they built.   

So many of our memories in our families focus on food, so I suppose it's very proper that we celebrate with lots of goodies today.  Food means love, and at feast times we are knit together with our food traditions.  So I bet we have on our table today many of your favorites, at least I hope some of my favorites are there.  So let me add my thanks to those who have provided such a spread.  Now I'm one of those people who prefer cornbread dressing, but I have come to love some of the stuffings and filling from this part of the world.  But we can talk about that later.  For now, let me share a few thoughts.    

Spiritual Reflection

We've seen a very different style of grief expression this week with the death of Nelson Mandela.  

The pictures and videos say it best:  Singing and dancing in South Africa mark the memorial expressions to Nelson Mandela.  While his political impact was great, his personal courage and his leadership toward reconciliation of his country has left an even more enduring legacy.  In the face of opposition, he was able to mix patience and forceful action. 

The larger than life icon who emerged from prison after twenty seven years went on to become President of South Africa and making real the end of the formal divisions between the races. Mandela and his followers, very much like Gandhi in India, defied those who would have made him a king and left the Presidency, like our own George Washington, after his term ended.  He was able to lead and then able to walk away from the trappings of formal power, trusting that others could carry on what he had started.  

Those of us old enough to remember the world before the campaign against apartheid may be able to grasp the significance of the change that came about in South Africa.  But the impact went far beyond.

For me this week, I was most captivated by the joyful spirit of celebration that arose out of the cries and tears.  Watching the news coverage around the home where Mandela had died just hours before, I was startled by the show of deep emotion.  Women and men and even little children were wailing and weeping and then would break into the songs of liberation.    For the last several days the sadness of grief has been mixed with the joyful sounds of triumph --for a life and for a death that places Mandela among the ancestors.  Much of the world, I've learned, find our quiet and somber funeral customs to be very strange.  Those of us who have spent time with loved ones who are dying, when they died, and after the death and through the grieving rituals know how hard it is for many people to deal with these times.  

When we exercise our grief muscles and our capacity for deep mourning, we are able to make a transition in our minds, in our bodies, and throughout the everyday reality of our lives to a reinvigorated level of living.  Now all of this is not a smooth and easy process, but the effort is worth it.  So may I wish for you a time this season to share your memories and find ways to celebrate in joy and hope.  

Finally, here is a poem that sustained Mandela during his twenty seven years and beyond.  What songs, poems, movies, and books help you remember your loved one.

Invictus

BY WILLIAM ERNEST HENLEY

Out of the night that covers me,

      Black as the pit from pole to pole,

I thank whatever gods may be

      For my unconquerable soul.

In the fell clutch of circumstance

      I have not winced nor cried aloud.

Under the bludgeonings of chance

      My head is bloody, but unbowed.

Beyond this place of wrath and tears

      Looms but the Horror of the shade,

And yet the menace of the years

      Finds and shall find me unafraid.

It matters not how strait the gate,

      How charged with punishments the scroll,

I am the master of my fate,

      I am the captain of my soul.  

Parking Lot Philanthropy: Giving Thanks by Giving Back

Parking Lot Philanthropy: 

Giving Thanks by Giving Back

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As we get close to Thanksgiving and begin the seasons of shopping for gifts, I'd like to share my own version of philathropy.  Of course, we may tell ourselves that we should be less materialistic and more centered on doing good, using our time and treasure to make the world a better place, but most of us can not resist the pull of the purse.  Maybe love does make the world go 'round but having some money to spend sure generates a lot of excitement if not love.   

For some years now, I've practiced what I call "Parking Lot Philanthropy."  It's a level of giving that fits someone who has been a single parent, a librarian, a minister, and in my early years, mostly a student working part-time.  It's very simple, I save change, keep it in baggies, and when I'm out and about I drop some of it in parking lots.  These days as a member of the hospice traveling staff, I have ample opportunities to visit parking lots--Wawa, Turkey Hill, hospital parking lots, nursing home parking lots, and the usual grocery stories, etc.  I save my pennies for the stories that share pennies.  It might be too disappointing to pick up pennies in the parking lot.  Feel free to try it out for yourself. 

Other Ways to Give at the Holidays

Wanting to set a good example for my daughter (To be continued.)

 

Getting Ready for the Holidays: Relaxing

Feel Good for the Holidays:

Tips from Alternative Medicine—

  Healing Touch, Yoga, Massage, Reike, Acupuncture, and Sound Therapies

This time of year there are all kinds of tips to help us get through the holidays with less stress and more joy.  For many of us, there is so much to do that stress seems much inevitable.  With shopping lists and meals to plan, with work and relatives and traveling, we may want to give up before we even begin.  Wait--before you surrender, consider these tips from the vast world of alternative therapies including practices related to reike and healing touch, yoga and massage, and many others, to help you uncover your joys and dodge the strains and stresses.  If you can take the time and spend a little money ($60-$80 and up), I would recommend a full-body massage for detoxing the body and total relaxation.  Even a quickie shoulder massage at the shopping center can feel great.  Other treatments like reike, acupuncture, or reflexology may involve finding someone to fit your wants and needs, so you may want to explore them in the New Year.  For many people, getting a mani and a pedi can be enough of a break.  

Alternative Medicine: Vibrations, Energy Fields, and More--   The insights of alternative medicine have had mixed reviews in healthcare circles.  Although main stream Western medicine does not accept much of the formal evidence involving energy fields, healing/therapeutic touch, Ayurvedic nutrition, and related approaches, many medical centers are beginning to include alternative practitioners among their offerings.  For most of us, evidence is not as important as our own experiences and how we feel afterward.  In our hospice team, we have tried out some relaxation techniques from the traditions of energy medicine, visualization, and yoga.

Simple and easy is the key.  Ten Deep Breaths: Sitting comfortably, upright in a chair, take ten slow breaths in and out, eyes about half-open or completely closed, to restore your energy and send you back into your day with more hop in your step.  Take ten more and then sit for five minutes to listen to your heart beat.      

When relaxing, if something hurts, don’t do it.  Remember the goal is to let go and release tension and not to tighten up.  Soften your muscles; ease your mind. 

Listen to Your Own Vibrations.  Another of my favorite exercises is best done standing up.  You can bring energy to the body by using gently closed hands to pound lightly starting with the collar bones and moving slowly down the front and sides to your knees or feet.  If bending over is difficult, then pause at your waist or knees and go back up to the top.  You can also use your finger tips to press the tender spots on your face and head, chest, around the waist, and down over the hips.  Make a humming sound to hear your own vibration, or sing a silly song like Happy Birthday or Three Blind Mice to yourself or out loud.  Your own healing touch and movement will renew you.  Remember at busy times, take time to relax so you can enjoy the best of the holidays—the hugs and kisses of family and friends.   Nothing replaces the best of love and caring. 

 

 

 

Perspectives on Bereavement: Marti Smith and the Hospice Team

Here are a few excerpts from a recent article for one of our newsletters.  Along with pictures of some of us in the hospice team, there will be an article about hospice services and our director, Gretchen White-Streuli.  Enjoy.

 

What goes on in spiritual and bereavement services?

Hospice is a team effort, and Marti’s role focuses on the emotional and spiritual needs of patients and families from admission to years after the death of the loved one. Hospice traditions from its beginnings and today Medicare regulations require attention to the whole person and family, not just the physical problems. Official requirements also include support for professional team members’ emotional and spiritual wellbeing. As a society with deep fears of illness and death, all of us are vulnerable, and experience teaches that preparation is the key to helping others and ourselves navigate the challenges of sickness, dying, death, and grieving.

Every situation brings its own challenges.

In her duties in spiritual and bereavement services, Marti listens to team members to assess each family’s situation to customize appropriate services. Every case is different, from the great, great grandmother with congestive heart failure to the young father with brain cancer. In each case, individuals are coping with unfamiliar demands and feelings, and each person’s experience is different. With hospice medical social workers, Marti helps families connect to their support systems, to friends, faith traditions, community agencies. In the Reading area, often a mom or dad has moved away from a home church, so, as needed, Marti arranges for local pastors to provide ministerial support. Fortunately, in Berks and Pottstown, there is wonderful community cooperation from a wide variety of faiths. Our families, often multi-generational, may have a mix of affiliations and religious preferences. Marti helps families to find common ground to guide them before and after the loved one’s death. She is available to assist with planning memorial services or funerals in accordance with the wishes of the family and conducts services when requested.

Care Long After Your Loved One Dies

Personalized attention to mourning families continues with a set of services that Marti coordinates. She started as a hospice volunteer and now enjoys a large team of volunteers who make calls, send regular letters and uplifting reading, and keep all of the records for an operation that most years serves around 400 bereaved. Twice a year, Marti participates in the agency-wide memorials with the Tree of Remembrance and the Butterfly Release. She says that she especially enjoys sharing the volunteer created knitted shawls, hats, booties, gowns, and other special items. On being a member of the hospice team, Marti says she is blessed to share times when the earthly and the spiritual seem to come together around a patient’s bedside or in the weekly moments when those who have passed are honored.

Personal Details

Marti has been an ordained minister since 1971, in the United Church of Christ since 1983. She was born and grew up in Jacksonville, Florida and went to Duke University, Duke Divinity School, and received graduate degrees from both Duke and the University of North Carolina at Chapel Hill. She worked in colleges and universities both teaching and in libraries. An early tech enthusiast, she taught online at several places, first starting a blog while at Drexel in the School of Information in 2005. She now has a blog Compassion Comes Home linked to the VNA website (http://compassioncomeshome.blogspot.com ). She is a member of Immanuel United Church of Christ, Shillington, PA, and enjoys guest preaching and speaking in local churches and civic organizations. While teaching world religions early in her career, Marti came to appreciate the importance of spiritual expression to people in both life and death. She is grateful to work as part of a healthcare organization devoted to respecting all perspectives as patients and families face difficult challenges.

When the Sun Sets Earlier: Do You Need a Happy Light?

When the Sun Sets Earlier:

Do You Need a Happy Light?

A full- spectrum light may help some people with Seasonal Affective Disorder (SAD), but if something is making you feel sad, make sure you find some way to find help in understanding your feelings. Many people suffer needlessly and may even feel suicidal in the wintertime when the weather is colder and the sun shines less and less.   

 

In Winter and always, take good care of yourself. 

 

When I was growing up in Florida, it never occurred to me that I might live in a place without sunshine.  Even when it was raining, I always knew the sun was not far away.  In the summertime, the sun would be shining when the rain was pouring down.  At the lake, the rain would stream across slowly enough for us to jump into the water and swim around before the rain would hit our dock.  All the while the sun would keep shining.

When I moved to Northern Indiana, the sun seemed to have stayed in Florida.  The summers were short and the winters were very, very long.  From October to almost June, there was snow on the ground, and it never went away.  I always thought snow melted.  But I had never encountered temperatures so low.  My groceries froze in the car.  My sodas were solid.   

 

Snow, snow, snow--how could there be that much snow?  Even in North Carolina where I had lived for decades, there was sunshine most of the year.  My first winter in Northern Indiana, not far from Chicago, I began to sink into a funk early in November and was very depressed by January.  I knew what I felt was nothing normal.  I could barely get out of bed.  Food tasted strange, and my energy was gone.  A kind doctor suggested a temporary medication and a full-spectrum light.  What a difference both made.  Now I wouldn't do without my light.  While I've had different models over the years, they have all helped to fight off what I learned was Seasonal Affected Disorder or SAD.  Maybe I was more prone to SAD because I came from the South where I had lived for over forty years by the time I loved to the Midwest.  I don't know, but I am so glad that I found something that helped me so much. 

Now that I live in Pennsylvania I enjoy more sun year round than I did in Indiana.  But I still depend upon my happy light to keep my mood up in the fall and winter.  I get it out around the end of September and turn it on as I wake up.  Experts suggest ten to thirty minutes each morning.  No need to look at it directly.  I turn it on before I get out of bed and it makes the morning brighter.  Sometimes I turn it on for a little longer in the late afternoon as the sun begins to set earlier.  Might a full-spectrum light help you if you are feeling sad this time of year? Whatever you need to help you cope with the winter or with a time of loss or grief or with a hard time, seek out help.  Take good care of yourself.  You are worth it.