Slide 1 - Hospice of Spokane

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					            Trajectory #2:
Combat Trauma APPARENTLY Integrated:
          (Subclinical PTSD)




     Outward Landscape     Inward Landscape
                                              1
Delayed-Onset PTSD




                2
    WOMEN are Veterans Too!
                             -Sexual Assault
                             -Combat




Marie Bainbridge RN
 Vietnam Veteran
Bronze Star Recipient
                                               3
Bay Pines VA Hospice Nurse
Interventions: All VETERANS
        -Intake Assessment:
           Have you served in the military (not “ Veteran”)?
           If so, Have you served in a Dangerous Duty assignment?
          (not “Combat veteran”)? If so, encourage stories…

        •Veteran-veteran volunteers
        •Transport to Morgue/Funeral Home under Flag

        •Affirm the FEELING aspect of the death experience,
            especially the tears and fears (which the military
            culture taught them to disdain).
        Anticipate that they might UNDERREPORT
             physical and emotional pain.
        Anticipate that they might UNDERREPORT fear.

        Thank them for serving your country
          and giving you your freedom.
        Post a certificate of appreciation.
        Pin an American flag on them with a personal message.
        Acknowledge sacrifices the family made.
        Provide to NH veterans.

        Educate them about their hospice benefit.
                                                                 4
        Educate them about burial benefit (spouses too).
 INTERVENTIONS: Combat Vets



                                                    Behold
                                                    and feel
                                                   Beholden!




(Title: “Loss of Innocence: Artist: Tommy Bills)         5
(“Burning Vision”. Artist: Tommy Bills)

                                          6
  Interventions: Trajectory #1
(Successfully Integrated Trauma)




                                   7
Interventions: Trajectory #3
         Emotional Pain Scale
         (0=Serenity/10=Turmoil)

         Understand and accept their
         pain, anger, shame, fear,
         helplessness.




                                   8
                                   Distinguish between PTSD and
                                   “Terminal Restlessness” or Delirium.
                                    Benzodiazepines may be helpful with
                                   the latter but may produce a
                                   paradoxical reaction with the former.

                                   7P Assessment: Pain, Pee, Poop,
                                   PTSD, Pulse Ox, Polypharmacy,
                                   Pre-hospice (terminal restlessness)

                                   Enter metaphor with them.
                                   (Battle metaphors are common)

                                   Put mattress on floor if
                                   enemy soldiers are under bed.

                                   No restraints (especially POWs)
                                   or bed alarms (PTSD).

                                   Don’t touch without calling out their
                                   name or letting them see you first.
Interventions should be geared toward helping the patient feel safe.
                                                                      9
   Interventions (Con’t)

Be aware that Asian Ancestry in
the healthcare provider may be a
trigger for WWII (Pacific theatre),
Korean, and Vietnam vets. Don’t
take this personally.

No substitute for good basic
 medical and nursing care.

If Vietnam or Korean vet speaks
about how Americans treated them,
apologize. If Vietnam vet speaks
about never being welcomed home,
welcome him.


                                  10
                              HEALING
FORGIVIENESS! FORGIVENESS!
  FORGIVENESS!
  Much to be forgiven for:
   * Self (Killing, etc.)
   * Self (not killing, not dying,
    “friendly fire”)
   * ENEMY****
   * Government
     (using/betraying them in
      Vietnam)
   * The World (for being like
    it is)
   * God (for allowing the
     world to be like it is)

   Assess guilt. DON’T dismiss
    it with platitudes.
   What is needed is healing of
    the heart.
                                        11
Forgiveness at the Wall




                          12
It is not too late to
Heal our Nation!
(and we do it one dying soldier at a time).




          VA Mission:
 “To care for him who shall
 have borne the battle and
 for his widow and his orphan.”
        Abraham Lincoln



                                        13
      Let’s not allow the soldier
          dying in our midst
      be unknown any longer…




Let us BEHOLD and FEEL BEHOLDEN!    14

				
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