A quiet evolution is taking place in how we care for our patients in Hospice Care of Nantucket. Fully committed to a holistic approach to care, in the truest sense of this often inappropriately used word, we have recognized that caring for the person means attending to body/mind/spirit. For years, we, at Hospice, have hoped to integrate high quality conventional medical treatment for pain and other physical and psychosocial symptoms with complementary modalities, such as, massage, meditation, yoga, etc. Two and a half years ago, we found the right person to add to our staff to help us expand our abilities to do so.

By hiring Nan Strelnitski, R.N., M.A., M.S., with her background in psychiatric & mental health nursing, combined with her skills as a yoga instructor and her personal characteristics of gentleness, compassion, and commitment to service, we have been able to add a dimension of care that profoundly nurtures our clients, at a level that is much deeper than that achieved by most systems of health care. Moving beyond medications and talk therapy, offering a manner of compassion, calmness, and unconditional personal presence, combined with gentle touch or body movement, creates a connection with people at a core level, rather than just engaging their intellect. This allows for a deep sense of peacefulness and emotional healing, facilitating a reconnection with our deepest selves, the source of well being. This is very spiritual work, meant in the broadest sense of that word, “tending to the spirit,“ and we have seen remarkable benefits for our patients who’ve accessed this service, patients from all walks of life and with a variety of symptoms.

 In an effort to explain the impact of this work for our readers, I’ve asked Nan to share some of her experiences and observations. Her words follow. Charlene Thurston, R.N., A.N.P., Director of Hospice

Nan’s words:

I am grateful to Charlene for her vision to integrate complementary modalities into the scope of Hospice services. For me, it has been an opportunity to bring principles and values held personally into my work life. It has provided a way to integrate my experience in psychotherapy with other complementary health care related practices, yoga and bodywork, thus blending a contemporary model of treatment with those possessing ancient wisdom.

Initially, although I believed in and had experienced the beneficial effects of body movement, soothing music and gentle touch, I was not certain if people would be open to participate and receive such healing modalities, and to become partners in a healing energy exchange. I did not know how these desired outcomes would become apparent; I only knew that it was my intention to bring comfort by applying these ancient healing techniques.

Our work occurs during vulnerable and frightening times in the lives of those we serve. People can be overwhelmed and unprepared whether living with a life threatening illness, caring for a loved one, or having lost someone precious to them. It is a time which can also be deeply poignant and transformational. This work offers an opportunity to refresh a person’s sense of stability and create an oasis from complex care decisions, difficult emotional issues and spiritual distress, by providing occasion for a momentary “letting go” and coming into inner balance, a peaceful state with a renewed perspective. It is essential in this work to be flexible, “fluid”, to modify the treatment modalities in response to the evolving needs of the person. Not being restricted by a certain model of care allows being present and supportive to people as they experience what they are enduring, without the need to put it all into words.

In our “Time Out” group, stressed and tired caregivers are finding relief of tension through gentle yoga and therapeutic touch, with mental focus on the breath. Attention to the breath is fundamental. It creates a discrete single focus for the mind, which helps to quiet stressful thoughts and elicit the relaxation response, characterized by a sense of well-being or equanimity. Often people express relief and amazement as they realize they have been totally “present” during the meeting time, and they describe a feeling of “lightness.”

In individual support sessions, which are available to patients, caregivers, and bereaved clients, we offer whatever support modalities that are most comforting to the person. This might include conversation, gentle movement, massage, meditation, etc. What follows are a few examples of how people have responded to these treatments. This feedback has been heartwarming and encouraging.

– My first patient had been sick for a long time with widespread cancer. She was highly anxious, very frightened, and short of breath. From the first session, her muscle tension released, and she began to breathe deeply and slowly. Although she said she wished I could see her every day, she was able to remember and use the relaxation breath between sessions. Over time, simply a light touch elicited relaxation and her tense elevated shoulders would relax and drop. Eventually, she began to notice when she had returned to her habitual tense state, and was able to relax on her own and breathe more easily.

– Given differences in personality, determining what will most effectively comfort a person can take some time. After several months of visiting and talking with one very dignified and reserved woman, who also was living with widespread cancer, I offered to massage her temples and scalp in order to soothe the pain and itching following shingles. She experienced great relief, and then teasingly scolded me saying “You knew how to do this all this time?” This led to weekly stress reduction bodywork sessions, during which she was able to relax fully. She truly looked forward to these interludes of peace and relaxation during this very stressful time in her life.

– A middle-aged man who had been the primary caregiver for his father for the past 6 months, came to the Hospice office for ”Time Out”. I could actually feel the areas where there was release of muscle tension as I administered a gentle massage technique to his feet and upper body. “Thank you”, he said, a little tearfully, as our session was ending, “You have no idea how badly I needed that. It’s really helped. I was so tied up in knots.”

– One elderly woman, who was no longer mobile, and whom I visited at home, had stress and anxiety which were increasing every day and were contributing to gastrointestinal and breathing problems. “Would you be interested in exploring some gentle seated yoga breaths and movements?” I asked. “Isn’t that just voodoo?” she answered. We both had a laugh over that. “No, it’s not voodoo. It’s a practice which has existed for over 4000 years. One of the first things one learns in Yoga is how to breathe.” “I’ve known how to breathe since I took my first breath!” she said. “Yes, but then we often change the “natural” way we first breathed, which was full and deep. I’d like to teach you how to breathe in a relaxed, stress-reducing manner.” Once a week for several months thereafter, we practiced Yoga relaxation breathing techniques together. Then one day, she said, “This has been such a great help. I feel so much calmer now, and can really breathe and let go.”

How all of this works is still not precisely known, but the response to focused breathing and comforting touch therapies seems to be remarkably powerful in reducing tension and bringing forth a state of well – being. Whatever the mystery, it is a great privilege to transmit the healing benefits of these techniques, validated by centuries of practice.  Nan Strelnitski, R.N., M.A., M.S.

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

A Partnership in Caring

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