End of Life Experience (ELE) Phenomena - Dreams

Significance and Implication to Nursing Practice

Harriet Yarmill RN

Outline

Introduction to ELE Phenomena Why the interest? Dreams Communication Barriers and Benefits Responding Therapeutically Summary Discussion

End of Life Experience (ELE)

Definition: any one of a wide range of pre-death phenomena which comfort or prepare the dying person spiritually for death.

Fenwick Lovelace & Braye, (2007)

End of Life Experiences (ELE)

Occur frequently and are varied Theorized to be part of the dying

process May occur hours, days, or weeks

before death.

Fenwick & Fenwick (2008), Muff (1996)

Categories of ELE’s

Transpersonal Final-Meaning

Brayne & Fenwick (2008)

4 types of ELE:

Deathbed visions Physical changes at time of death Deathbed coincidences Dreams

Fenwick, Lovelace & Brayne (2007)

The Story of Sarah

Dying woman’s personal account of her dream told to me approx 2 weeks before death

ELE dream gave meaning to her illness Sara profoundly affected Dramatic change in her coping, her

behaviour Family able to be more involved with her at

time of death because of this change

Hallucination or ELE Dream?

Effect on patient Viewed by patient Prelude to death Response to Medication

Types of Dreams

Everyday Dreams

- belonging to the “personal unconscious”

- mundane

- no special meaning

Archetypal dreams

- part of the “collective unconscious”

- certain dream types common to all mankind

- Universal stages of life

Archetypal Dream Themes

Creation Great passage or journey

Crossing over water or bridge

Reformation of person in a new body

Weighing or judging of the soul

Return to another realm of existence

Reincarnation, occasionally Adapted from von Franz, 1986

More Dream Types

Wake-up dreams Setting Things in Order dreams

Opposition & Conflict dreams

Alchemic Imagery dreams

Transformation dreams

Spiritual/Archetypal dreams

(Adapted from Muff, 1998)

Dream Analysis vs Dream Work Structured Invasive Specialized Time consuming Painful

Patient leads No attempt to

decipher by listener No special training

or experience Patient arrives at

own conclusion or not.

Dream Work Applications

Childhood trauma Vietnam veterans AIDS patients

Symbolism – the language of dreams

Unconscious expression is through use of symbolism

Metaphors are another way of saying one kind of thing in terms of another

one common metaphor re: existential matters is that “life is a journey”

Bulkeley and Bulkley (2005)

How to identify Symbolic Communication

Often occur when client is “actively” dying

no absolutely fixed meanings May not make sense to caregivers Caregiver response is important

Barriers to Verbalization

For Patients For Caregivers

Benefits of ELE Work

Patients & Families Caregivers Mutual benefits

Caregiver Challenges

Communication skills Training in “language” of death Team Support Training to deal with existential issues Discomfort with “new priesthood” aspect Environmental constraints

Brayne, Lovelace & Fenwick (2008)

What Can We Do to Help?

Be open; recognize. Empathize (put yourself in their position) Suspend judgement….Realize you don’t

have to agree, believe, understand ….just BE

Support for all (patients, families, co-workers)

Normalize the experience

In grateful Acknowledgement for the encouragement and support of :

Sue Brayne, MA and Dr. Peter Fenwick

Dr. Susan McClement

References

Brayne, S., Farnham, C., & Fenwick, P. (2006). Deathbed phenomena and their effect on a palliative care team: A pilot study. American Journal of Hospice & Palliative Medicine, 23(1), 17-24. Brayne, S., & Fenwick, P. (2008). The case for training to deal with end-of-life experiences. European Journal of Palliative Care, 15(3), 118-120. Brayne, S., & Fenwick, P. (2008). End-of-life experiences: A guide for carers of the dying. Available at: http://braynework.com/resources.aspx Retrieved: October 12, 2008.Brayne, S., Lovelace, H., & Fenwick, P. (2008). End-of-life experiences and the dying process

in a Gloucestershire nursing home as reported by nurses and care assistants. American Journal of Hospice & Palliative Medicine, 25(3), 195-206. Bulkeley, K., & Bulkley, P. (2005). Dreaming beyond death: A guide to pre-death dreams and

visions. Boston: Beacon Press. Dosa, D. (2007). A day in the life of Oscar the cat. New England Journal of Medicine, 357(4),

328-329. Fenwick, P., & Fenwick, E. (2008). The art of dying: A journey to elsewhere. New York: Continuum. Fenwick, P., Lovelace, H., & Brayne, S. (2007). End of life experiences and their implications

for palliative care. International Journal of Environmental Studies, 64(3), 315-323. Muff, J. (1996). From the wings of night: Dream work with people who have acquired immunodeficiency syndrome. Holistic Nursing Practice, 10(4), 69-87. O'Connor, D. (2003). Palliative care nurses' experiences of paranormal phenomena and their

influence on nursing practice. Presented at: 2nd Global Making Sense of Dying and Death Inter-Disciplinary Conference, Nov 21-23, 2003, Paris, France. Available at: http://www.inter-disciplinary.net/mso/dd/dd2/s9.htm Retrieved: October 11, 2008.