The Landscapes of Our Patients' Journeys

What do you say that is helpful to those at the end of life? Are you an end of life caregiver and want to be more certain your interactions are helpful and relevent to those you care for? This book overs a science based method of understanding what people and their families at the end of life are experiencing. It offers an approach to caregiving that individualizes care so those at the end of life know they are not alone and that the caregiver understands what is being felt and thought.

Those who work with the dying have informal understandings of the ideational worlds in which their patients and families live. We know those who have a fervent belief in a life to come and rely upon that for comfort and sustenance in their transition and we know those who are more matter of fact about death being a part of life.

Formalizing these understandings can give us a more exact picture of the ideational and emotional landscapes our patients are traveling through. This assists caregivers in more precisely targeting their interactions and interventions in ways that help the patient know they are not alone and their journey is understood. Caregivers are then equipped to use the patient’s own resources and ideations to assist them in their journey and transition.

This book uses a psychological assessment tool, Death Attitude Profile-Revised, to understand these distinctive landscapes and offers resources to creatively individualize care in each of the five specific death "domains."

Robert Kastenbaum in, "The Psychology of Death," has noted that post mortem case studies have indicated that knowing the patient a little better would have resulted in better care. This book offers a way to know the patient and this/her worldview and self-concepts vis a vis death and dying better so that they will know we are accompanying them on their journey and they are not alone.

The five death domains, Approach Acceptance, Escape Acceptance, Neutral Acceptance, Fear of Death and Death Avoidance are explained and explored. A heuristic is offered, based on how closely the statements that comprise each domain are related, that makes this easy to use in clinical practice. Prayers, hymns, scriptures, readings and songs are suggested for each "landscape" aka domain.

With quality indicators being increasingly used by the Center for Medicaid and Medicare Services, this book offers a way to marry narrative with data. Each patient's landscape can be assessed at admission and, through interviews with family and loved ones, after death, a post mortem assessment can be devised which uses both numerical and narrative information.

Keith A. Rasey, M.Div., LNHA, is a graduate of Eastern Michigan University, Yale Divinity School and Kent State University. He has over 25 years of experience in working with patients and their loved ones at the end of life.