1 of 18

Supportive End of Life Therapies

Faith Bishop, Tess McAndrew, Alexis Parker, Brianna Scanga, Lauren Teresi

2 of 18

What is Hospice Care?

Hospice Care focuses on the care, comfort, and quality of life for a person with a serious illness who is approaching end of life (<6 months), and chooses to not continue with life-saving treatment.

3 of 18

What is Palliative Care?

Palliative Care is a specialized medical care for those living with serious illness focused on providing stress and symptom relief to improve quality of life.

4 of 18

Types of

Supportive Therapies

5 of 18

Therapeutic Massage

Includes using gentle pressure or rubbing by using different pressure and movements on different areas of the body.
Relieves pain

6 of 18

Art Therapy

Used to facilitate self-expression and reflection to stimulate the body and mind through artistic creativity.

Improves psychological symptoms of anxiety and depression.

7 of 18

Music Therapy

Live music either sung or instrumental

Recorded Music

Music Composed with other modalities

8 of 18

Aromatherapy

A form of herbal medicine that uses specific traditional plant extracts (essential oils) to support the health and well-being of the person through the use of powerful scents.

Examples:

For Nausea

A mix of CO2 ginger extract, lemon, mandarin, and peppermint oils

For Insomnia

A mix of lavender, mandarin, and vetiver

For muscle spasms/pain

Copaiba, black pepper, sweet marjoram, ginger, and geranium.

9 of 18

MEDITATION & PRAYER

Meditation

Mindfulness meditation
Body scan
Walking
Loving kindness
Transcendental

Prayer

Conversational
Meditative Prayer
Ritual
Intercessonary

Lauren

Different types of meditation have been shown to result in psychological and biological changes that are actually or potentially associated with improved health.

Mindfulness meditation: Basic act of being aware (or mindful) of what you are doing in the PRESENT moment

Meaning you are 100% involved in the activity you are doing
Not thinking about any distractions, stress, or worrying about the future.

Body Scan: Focus in consciously relaxing different parts of the body

Ex: focus your feet on how they feel on the floor, then go up from there with all the body parts.
Great way to relieve tight muscles or a tense neck which results from stress or anxiety.

Walking Meditation: Encourages you to focus on each footstep in order to be fully present. This cultivates a sense of mind-body awareness by focusing on the body’s physical sensations as it moves.

This is helpful when you find it difficult to sit still.

Loving Kindness: Form of meditation geared towards cultivating compassion for yourself and others.

Can direct phrases of goodwill and a positive intention to yourself, loved ones, difficult people in your life, and even complete strangers.
Repeat the words, “May I be happy. May I be healthy. May I be safe.”

Then you can change the I and put a person's name to direct it to someone else.

Transcendental: Focusing on a specific mantra or phrase by repeating it during meditation. The mantra acts as the object of awareness for the person during meditation.

Can be something simple including saying “Om” or a phrase such as “I am worthy”

https://www.insider.com/types-of-meditation

Many people use prayer, and some studies have shown a positive association between prayer and improved health outcomes

conversational prayer: A person engages in an informal conversation with God about day-to-day matters, seeking guidance and counsel, or expressing gratitude for life and wellbeing
meditative prayer: A person contemplates spiritual themes and the relationship of the divine to mankind
ritual prayer: Which takes the form of reciting or reading well known prayers such as the Lord’s Prayer
intercessory prayer: characterised by petitions on behalf of others for their health and wellbeing.

https://www.mja.com.au/journal/2007/186/10/prayer-medicine-how-much-have-we-learned

10 of 18

Relaxation Techniques

Guided Imagery

Biofeedback

Hypnosis

Breathing Techniques

Harmony between mind and body
Calm
Peaceful
Mental Escape

Change the way their bodies function
Measure body’s function

Trance-like state in which heightens focus and concentration
Calm and relaxed

Powerful tool to ease stress and feel less anxious.
Deep breathing and Breath Focus

Lauren

Some examples of relaxation techniques we found include:

1. Guided imagery: Create harmony between mind and body. Focuses imagination to create calm, peaceful images to provide a mental escape

https://my.clevelandclinic.org/departments/wellness/integrative/treatments-services/guided-imagery

2. Biofeedback: Alternative medicine approach that teaches people to change the way their bodies function.

It is mind-body therapy the may improve your physical and mental health
Monitoring equipment and instruments to measure your body’s function
Then you can see how you can create physiologic changes.
Eventually you can perform these changes without the monitoring
Helps to relieve issues such as anxiety, PTSD, ADD, asthma, and insomnia. Also works for Diabetes, Epilepsy, and HTN.

https://my.clevelandclinic.org/health/treatments/13354-biofeedback

3. Hypnosis: Also known as hypnotherapy or hypnotic suggestion. Is like a trance-like state in which you have heightened focus and concentration.

Usually done with a therapist using verbal repetition and mental images
During this, you feel calm and relaxed.
Effective method for coping with stress and anxiety. This can also help with pain control, mental health, and other conditions that are common with older adults.

https://www.mayoclinic.org/tests-procedures/hypnosis/about/pac-20394405

4. Breathing Techniques:

Your breath is a powerful tool to ease stress and make you feel less anxious.
Deep breathing- most people take short shallow breaths that could make you feel anxious and zap energy. With deep breathing, you will learn how to take bigger breaths and can create more calmness.
Breath Focus- Use a picture in your mind and a word or phrase to help feel more relaxed.
These can make a big difference if you make them part of your routine.

https://www.webmd.com/balance/stress-management/stress-relief-breathing-techniques

11 of 18

“Universal Life Force Energy”
Used to help balance a person’s energy, remove blockages, and release negative energy

Relieves:

Pain
Stress
Anxiety

Improves spiritual and mental state

Reiki

12 of 18

Acupuncture/ Acupressure

Complementary medical modality used to promote relaxation and comfort at end-of life care.

Acupuncture

Inserting very thin needles in the skin at certain points in the body

Acupressure

Putting pressure on certain places of the body

13 of 18

Pet Therapy

The first use of pets in a therapeutic setting was by Florence Nightingale in the 1800’s for children and adults in psychiatric wards. When given the companionship of small animals, they experienced greatly reduced levels of anxiety and stress.

14 of 18

NURSING IMPLICATIONS

15 of 18

Advocacy

Role in being a member of the Interprofessional team

Striving to achieve the highest quality supportive care

16 of 18

Cultural Considerations

Ask the patient and family if they have special rituals or alternative therapies they like to perform during end of life care.

Encourage the family to take an active part in their loved one’s care.

17 of 18

References

Bradt, J., & Dileo, C. (2014). Music therapy for end-of-life care. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd007169.pub3

Collette, N., Güell, E., Fariñas, O., & Pascual, A. (2021). Art Therapy in a Palliative Care Unit: Symptom Relief and Perceived Helpfulness in Patients and Their Relatives [Abstract]. Journal of Pain and Symptom Management, 61(1), 103-111. doi:10.1016/j.jpainsymman.2020.07.027

Crossroads Hospice Charitable Foundation. (2015, October 31). What Is Hospice Pet Therapy? Retrieved December 7, 2021, from https://crhcf.org/insights/what-is-hospice-pet-therapy/

Fowler, P. (2020, January 19). Deep Breathing Exercises & Techniques for Stress Management and Relief. Retrieved December 7, 2021, from https://www.webmd.com/balance/stress-management/stress-relief-breathing-techniques

Guided Imagery. (n.d.). Retrieved December 7, 2021, from https://my.clevelandclinic.org/departments/wellness/integrative/treatments-services/guided-imagery

Jantos, M., & Kiat, H. (2007). Prayer as medicine: How much have we learned? Medical Journal of Australia, 186(S10). doi:10.5694/j.1326-5377.2007.tb01041.x

November 22, 2. (2019, December 02). Aromatherapy Supports Holistic Well-Being in Hospice Patients. Retrieved from https://www.compassus.com/blogs/everyday-compassion-blog/posts/749-aromatherapy-supports-holistic-well-being-in-hospice-patients

18 of 18

References

Professional, C. C. (2020, December 21). Biofeedback: What Is It & Procedure Details. Retrieved December 7, 2021, from https://my.clevelandclinic.org/health/treatments/13354-biofeedback

Reiki . (2021). Retrieved December 7, 2021, from https://www.hopeinstilled.org/

Shah, S., & Merrill, D. (2020, December 11). The 5 most common types of meditation - and how to choose the best type for you. Retrieved from https://www.insider.com/types-of-meditation

Shaw, G. (2019, August 19). Beyond Drugs: Nonpharmacologic Ways to Manage Pain. Retrieved December 7, 2021, from https://www.webmd.com/palliative-care/managing-pain-beyond-drugs

Staff, M. C. (2020, November 14). Hypnosis. Retrieved December 7, 2021, from https://www.mayoclinic.org/tests-procedures/hypnosis/about/pac-20394405

Stuart, A. (2020, September 10). Massage Therapy: Styles of Massage and Their Health Benefits. Retrieved December 7, 2021, from https://www.webmd.com/balance/guide/massage-therapy-styles-and-health-benefits

What Are Palliative Care and Hospice Care? (n.d.). Retrieved December 7, 2021, from https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care

What is Palliative Care?: Definition of Palliative Care. (n.d.). Retrieved December 7, 2021, from https://getpalliativecare.org/whatis/