Exit interviews are a legal requirement to occur in some businesses, such as hazardous waste spills or plane crashes. If you know you’re going to meet an exit interview, you generally have time to prepare for the questions. If you know a patient is going to have an exit interview, that gives you time to brace yourself for difficult and unpleasant questions, such as “Doesn’t it bother you that I’m here with a terminal illness?” Keep a three-ring binder at bedside to jot notes down so you don’t forget. If you’re leaving a job, write out standard form responses to frequent questions, such as, “Why are you leaving?” early on in your job and have them handy.
Know when to drag or terminate
The word “drag” means to continue a futile, undesirable repetitive task and/or to discontinue a non-fruitful, unprofitable cluster of actions. When tasks have stepped out of focus, don’t spend time pursuing strategies that aren’t essential. These tasks typically begin with “effect” because progress has been previously made, but they may not be clearly useful and may not be benefiting the patient. As you “drag” certain clusters of actions, ratchet back others to patient benefit.
SCVEs: The dragging of tasks, should be avoided. When they are being dragged, it is better to terminate other tasks rather than maintaining positions and thinking alternatives (p.25)
Endings, like beginnings, stir up emotions. Watch for clues your loved one can’t cope, such as saying, “Things never change, do they?” and withdrawing. If you see those signs, avoid arguments and lengthy discussions about matters outside your immediate task at hand, because you may end up in the middle of a conversation and wonder why you started it in the first place. Stay focused on what you can do now.
You’ve made effort after effort and it’s still not turning for the best. Why drag it out? At what point does this lack of progress make it pointless? By the end of life, symptoms usually have ceased being totally unpredictable. Things aren’t going to change. You won’t be able to change the diagnosis.
Make a list of things patients want to accomplish, those they are doing, those they are painfully unable to do, and those they would like to start and never get to in their life.
Explain that “hindrances” mean conditions or causes that prevent something from happening. Who or what factors are preventing them from achieving their goal?
Clarify realistic choices.
SCIENCE The choices involved with dying are then debated and described: Should I discuss these choices with my doctor? Yes. Discuss everything with your doctor. What do I want in December or January? You know, the choices to end my life in a peaceful way—do I want to choose them? Or do I want to go on like this? Or do I want to stop? That’s natural for me. I don’t understand why everyone says I don’t have a choice. I have several choices. Do I wish to choose them? (p.26)
Discuss feelings and responsibilities.
What do you feel your responsibilities are to me? The last worry is how to be responsible to your spouse and children.
Consent ahead of time
Before essential decisions become explosive and painful, ask what your patient would like to do with respect to obtaining bioethics consultation (i.e., withdrawing/resuscitating). Keep this question as unemotional as possible.
Goodbyes tend to be rushed. Make sure to say “I love you” even if it feels a bit impersonal after all these years. Dr. George notes the common pitfall of ignoring the present; hold them close and don’t talk about what you once talked about. Be together. Be content.
Discussion question: What would a nursing hour look like for “letting go?”
How about an exit interview with yourself?
Take time for yourself to slow down, re-group, and mourn before caring for another patient. It is difficult to go back to work after a difficult death. End on a high note, so that you return to caregiving with engaged, positive energy.
Keep talking with loved ones, friends, and stuffed-animal-clubing therapy dogs. Sometimes, more importantly, knowing who went before you helps you to accept your own life and death. Weighed down with work, try to make time to revisit imagery that keeps you connected to death and the dying patient.
Need Some Closure? Dr. George Gero and John Grosh, who recently performed a literal final farewell over the body of a loved one, have started keeping a blog that explores dying, death, faith, and grief in long-term care facilities (Blog). They remind all of us “Regardless of our convictions about what happens, there are choices ahead at the end of life.”
American Nurses Association. (2012). Scope and standards for long-term nursing care . [Retrieved from http://www.nursingworld.org/MainFolder/policy/practice-guidelines.html?NavItemNumber=4040] Burlington, MA: Author.
Kuhn, C. T. (2009). The gift of hope (pp. 114-116). Cambridge: The Good Book Company.
Kuhn, C. T. (2011). Manual of basic counselling skills (p. 114). [Cambridge: The Good Book Company].
Kuhn, C. T. (2011). Manual of basic counselling skills (p. 116). [Cambridge: The Good Book Company].
Grandt R (2011). How nursing can demonstrate compassion to people and their families. Retrieved from http://aging.advanceweb.com/article/889-how-nursing-can-demonstrate-compassion-to-people-and-their-families
Beck JB and Beck MD (2011). Do the right thing! The family caregiver-employer contract and organizational survival. IJGN, 24 (6): 460-6.
© Patricia A. Powell, PhD and The Long Term Care Planning and Consulting Group™, 2013
You should write at least 350 words but no more than 700 words.
OSCE level: Intermediate
Use complete sentences.
You are allowed to use a dictionary and reference books to check facts.
Write your name after the title.
The Forgotten Coast of Eastern Georgia, U.S.A.
The beach is the most visited location of any summer vacation. It is the main destination for adults and children alike. In the U.S.A one of the most visited places on any coast is the Eastern coastal region called “The Forgotten Coast” of Georgia. Not much has changed since it’s exploration and founding during Colonial times. Pine trees still stand tall at Pinestar pine Preserve. Rivers still sparkle through the coastal scenery. Families still entertain guests from all around by sharing in their local culture. Farms, entertainment and local culture are what make this region most appealing. It is this formula which will continue for many to come.
The Forgotten Coast does in fact have much history behind it and quite some very important events. The discovery and founding of the Town of St. Joseph/Berkeley was part of one of the most significant events of Georgia’s early history. Founded by 18th-century settlers, it was founded by Captain Briarly and a group of people enjoying a ride up the St. Mary’s River on a Spanish ship. This stop was caused because the Spanish forces were making their way to St. Augustine, Florida, and were asked to sail up the river. At that time formal documents were signed which, after a world of fighting, at last gave the Spanish territory, including the entire Georgia coast. Besides the unusual architecture of the historic and elegant buildings in historic areas along the coast of St. Joseph/Berkeley, such as headstones and poles in Moultrie Cemetery, there is still another unusual phenomenon. A band of wandering palmetto trees covers nearly all of St. Joseph’s pedestrian area, engraving its outlines onto a town relishing in its rich history and extraordinary secluded life.
St. Mary’s Street is one of the most popular sites of the Cross-Timbers, from which it gets its name, is a landscaping design of heritage pure culture and rural lifestyle. Hundreds of century-old live oaks shades St. Mary’s Street for practically its entire distance, still there today, the very heart of downtown. Tourist attractions:
St. Joseph’s Living Ship attraction is the Maritime Heritage Center of East Florida. It is one of the five maritime museums in the counties of Northeastern Florida. In 2005 St. Joseph’s became an active participant in the Black Loyalist Heritage Project of Nova Scotia, Canada. This is a very worthy effort being responsible for the restoration and preservation of the two known extant figureheads of black loyalists. It has also impressive working maritime vessels and audio guides presentations of trade and commerce.
Cap’l Jak’s Charters Marine Museum is one of Hidden Americas’ National Treasures. It is the destination of marine attractions, history, educational programs and events, fun and recreation. It has located in the historic village of Crisp, Georgia. This historic village was so named a century ago from Galphin’s Landing and Crawiff’s Mill where a halwa, a ferry service and commercial lead to the mill. The museum is worth practicing because of the specially designed educational fishing. It is a museum of importance to providing: locally grown seafood, maritime heritage of the region and fishing opportunities.
Also, St. Joseph and Berkeley Island is a favorite destination for turtle nesting. It was declared a species-specific protected area. People believe that she carries the soul of her mother onto the island. She is protected and saved whenever there is harm in the area.
Horse Creek is a water body of significance. It drains St. Marys and is important because of its geographical centrality in the network of thousands of miles of channels, transits, sloughs and tributaries within the rivers and marshes of Saint Marys. Several parts of the Horse Creek’s channel system are “bottom” maintained and plowed along by University of Georgia Water Resources Research. This facility benefits water management and helps to work towards conservation of water resources and the wildlife in the deep water estuary. Every year on Horse Creek the recreational and educational benefits that it provides are made available to the visitor, which includes aquaculture, college-level marine research for marine ecology, fisheries, and saltwater ecology.
The attractions on the Forgotten Coast feature a rich aquatic life, more demonstrations of the area’s deep-water estuary, beaches and nature programs such as, yoga, barbeques along with enticing marinas, nature walking trails and restaurants. A trail near the beach is where they come and tour. This enables people to visit museums and attend much known events as art festivals, historic home tours and pop festivals of many flavors like on Bay Street or other places such as conventions, festivals or concert events. Savannah is less than an hour’s drive to the downtown area of the Forgotten Coast for the spectacular, fun and great food of the Original Downtown Tattoo Festival and is close to St. Simons Island, Jekyll and all of the islands of Georgia. Savannah, is an 1890 Spanish revival architectural gem that was visited and designed by Estey organ. more than a hundred and twenty intricate and detailed water related architectural details. Each picture tells a story and proves Savannah is an ideal place for parents and children to spend birthday parties together, family occasions and to enjoy nature. Evening: picture night life with cool music at Amici Ercolano and visit the Savannah Qube, to enjoy the bands, fun and dancing. Tourists can also find the Savannah Historical Swamp Garden, the Old Town Trolley, and plenty of shops, upscale and historic offers with leisure seekers, who enjoy browsing the many locations and outings.
While the Forgotten Coast site of St. Joseph/Berkeley may be considered as the ”poor brother” of Telfair County’s historical sites; its history has had an enormous impact on the region. It boasts the first Catholic mass held in Georgia by Saint-Malouais at the entrance to the Flint River. St. Joseph/Berkeley was founded by the Franciscan Father James O’Hearne in the heart of some Georgia’s oldest buildings and cultural values conveyed by Civil War Era. The Father O’Hearne was the son of a rural Irish family whom worked hard for his own clerical formation at Kilkenny’s Irish College in Paris. It was here at English College in Paris on May 7, 1765 that Pope Porphyrogencych had founded the Franciscan Order of the Franciscan Recollect Order of Florida. Father O ‘Hearne inspired to serve the poor and natives of his adopted country. His original Spanish mission remained the site of later Spanish military stockade with a Gothic chapel named the Chapel of San Jose. These current draws on structure is an example of the French and Spanish Architecture. It can inspire people to feel the real sense of Christ’s mission to me. Also, Father O’Hearne lies in the midst of a Confederate army main camp until well after breakfast. After breakfast, Union soldiers trade razors and money. There are also ephemera of the coastal beaches and campuses, secret society support local cemetery with large red brick wall still stand beachside. In front entrance to the park people can still see the stones of a distinctive culture found inland sea.
At the Lost Footprints of the Sacred Flint Hills of Flint, Georgia the mission of San Jose became a place of Mexican Santeria and the adopted home of their Grey Condor. It was a place for many peoples growth, empowerment and success. These values are taught as prayers, eating and sharing food with your family, community and the land.
Sports and recreation
Berkeley Beach being a beach community people from all walks of life enjoy relaxing. With fishing boats, water skiers and sailboats people become a guide during high and low tides at certain hours during the day. Volunteers make it a point to keep the beaches clean of the litter in the area. There are also pier fishing in Dewey St. John park on the north side of “The Forgotten Coast.” On the southern part visitors can improve their fishing by casting in the area and wait patiently at the coast near Dolphin Point. Bird watching and sightseeing can be appreciated by a novice. One can see exotic and native birds, rookeries and wildlife such as deer, raccoons, osprey, alligators, tree frogs and snakes.
Music, sports and recreation are important for growing community by preserving and blending greater arts into its bustling coastal region, including a world-class pediatric therapy program at Mary Ross Center, environmental medicine at EastCoast Wellness and more. As the Arts and recreation draw more visitors, visitors can enjoy all it has to offer and you will find a spiritually rewarding experience among a friendly population. Getting there: The Forgotten Coast is easily accessible by puddle-jumper plane from the Cross-Island airport (30min) in St. Marys, but is more commonly accessed from Georgia State Highway 273/84/163: Interstate 95 (Appriorate span of 4 Hours) and Interstate 10 (approrpriate span of 4 Hours). Locally the area may be reached by car or boat.