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

310 Pages·2001·7.87 MB·English

by  Rosalie Hudson, Jennifer Richmond

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
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KEEPING IN TOUCH
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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
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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 [phone].
Fax [phone].
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
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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
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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
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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
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