By Chandrika Puventhran
Perak Palliative Care Society
End of life care is care that specializes in providing comfort to ease physical, emotional and spiritual changes that are part of the dying process. No curative treatments are provided at this point and the focus of care is on comfort. Touch is a comfort therapy that is possible to provide ease to patient who might be experiencing distress towards end of life.
Just as in birth where touch is the first form of communication, in end of life too touch becomes one of the final ways to converse with a person who is dying. Through the act of compassionate touch, palliative massage therapy becomes instrumental in showing families that despite the decline in their loved ones body, it is not something to be afraid of. The body of someone in the last stage of life even though frail and dependent, is worthy of the same tenderness, care and unconditional love as that at birth.
Each person is different in the end of life phase. During this stage, a therapist will provide the utmost care support as best as possible to both patient and family to help make them both comfortable. When a person nears end of life, they experience increased fatigue along with other conditions. During this time massage in the form of the gentle touch will provide relief from increasing fatigue and support emotional well-being. This act of kindness is very soothing and able to make the patient feel connected to those who are involved in his or her care, especially the family members.
The choice of where a patient wishes to receive massage or comfort touch should be taken into consideration. Some patients may wish to lie on their bed or a massage bed / table to feel normal for as long as possible. Others might prefer a reclining chair. The sofa and wheel chair too are sometimes favoured.
During this phase, swelling known as lymphoedema and ascites is also common in the limbs and abdomen. Gentle comfortable strokes will make patient feel less distressed and help in their overall well-being. Family members are taught to give simple touch therapies. Involving family at this stage is very meaningful. Encouraging and teaching them to give comfortable touch to very cachexia patients empowers carers and family members to show their love during the end of life of a loved one.
Some basic strokes in caring touch will be resting your hand on the body, perhaps at a shoulder or elbow joint. Holding is applied by using both hands together at the same time, such as at the hand, elbow or knee. Gentle pressure at areas touched or held allows connection. Gentle sliding strokes with full hand contact can be applied to the arms or legs. Some lotion or massage oils will be helpful with the gentle strokes and glide on fragile skin. Small gentle circles around the joints or along the spine bring comfort to touch. Always touch with reverence to bring compassion and loving kindness into your heart and hands before beginning. Talk to your loved ones and ask how they feel. Listen to them and make adjustments as needed.
Safety will always be given priority and sessions should be adjusted according to the patient’s condition. Touch can be continued for as long as the patient is able to tolerate. This reassures the caregiver. When the end nears, loving gentle touch can be a form of spiritual nourishment that feeds caregivers and patients.
“Often, touching brings the greatness in comfort and is ultimately the healing needed for the heart for both the caregiver and care receiver.”
from The True Work of Dying
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