Advance Healthcare article about expressive puppetry
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(Please note that the print article incorrectly lists Marge
Schneider’s name as Marge Tolland.)
Expressive Puppetry in Hospice
May 31, 2004
Creative approach to breaking down barriers in treatment
By Nicky McHugh
Making a caring connection with patients in hospice care is not always easy, especially when they have dementia or are terminally ill. “When you meet people at the end of life, there is a certain nobility to that. Many of us who work in hospice find that inspiring,” observed Timothy Boon, vice president of Hospice and Palliative Care of Connecticut VNA, an affiliate of Masonicare, a not-for-profit elderly care organization.
The hospice division of Masonicare, located in Wallingford, CT, has had a great deal of success using non-traditional therapies to treat patients who are terminally ill. Among its creative approaches is expressive puppetry, a unique therapy used to connect with hospice patients on a deeply personal level.
Originally, hospice programs were established to care for patients who were terminally ill with cancer. Many professionals in the medical community still think of hospice as an oncology program. However, recent trends suggest that hospice care is changing. While 76 percent of all new hospice enrollees had a diagnosis of cancer in 1992, that percentage dropped to 57 percent in 1998, according to the U.S. General Accounting Office.
Today, the hospice program at Masonicare treats patients with cancer, Alzheimer’s disease, Parkinson’s disease and heart disease, as well as those with neurological conditions such as multiple sclerosis and dementia. In addition to providing symptom management and personal care for patients, hospice clinicians provide support to their families.
Traditionally, expressive therapies like massage, guided imagery, and art and music therapy have been an important component of hospice care, providing an opportunity for expression, communication, relaxation, stimulation and pain relief.
However, the hospice teams at Masonicare discovered that while psychosocial services offer great comfort to caregivers and loved ones, they frequently did not penetrate patients’ thick barriers of severe dementia and depression to improve their emotional and spiritual quality of life.
“We needed to find a way to truly reach those patients,” said Boon. “We were open to trying new techniques, and this led us to develop a program of expressive puppetry.”
As a modality, expressive puppetry is the purposeful, skillful use of specific puppets that are meaningful to the patient in some way. The approach is particularly useful for individuals who are unable to engage due to cognitive limitations.
The puppetry program provides a different approach to help patients explore emotions that can be too painful or overwhelming to talk about openly.
Expressive puppetry is effective because it is not threatening to the patient, explained Patti Granzen, RN, who leads the VNA Hospice team in Shelton, CT. It also provides avenues for communication that traditional expressive therapies cannot.
“Even for patients with severe dementia, we find the puppets can break through,” she said. “Puppets offer unconditional love and tap into people’s roots at a very fundamental level, so people begin to share stories. Sometimes the puppets are just very nurturing.”
Marge Schneider, an educator by profession, helped Masonicare initiate the expressive puppetry program. She recounted an early success story.
“Two years ago I had a patient who was severely depressed,” she recalled. “Every week for a year I would try different methodologies to try to reach her; but she was bed-ridden, losing weight and nonverbal. I almost took myself off the case because I felt I was unable to reach her. One day I tried my black lab puppy puppet, and for the first time I noticed a flicker in her eyes. I moved in closer with the puppy and nuzzled her face. During the next few weeks, she started opening up; and we were able to talk—patient to puppet.”
Schneider learned the patient had had a black lab puppy when she was a child. By remembering those good times, she was able to feel safe and begin to open up.
“That’s how the puppets work,” Schneider said. “They tap into a past joy and fill a void. The puppet allowed the patient to share her story, and in sharing her story she shared her grief. This helped her heal.”
The success of the expressive puppetry program is due in large part to the teamwork of the various professionals caring for the patient, Boon said. “We recognized that the reason clinicians enter this profession is to make a difference, to help people, and to make a positive impact on individuals and their community in some way.”
Masonicare developed a team-based approach that focuses on treating the individual instead of the disease.
“Treatments are aimed at providing comfort, rather than prolonging life,” Boon said. “It’s often very difficult to talk about end-of-life issues, and many people don’t get the chance to discuss them honestly.”
The VNA hospice program deploys teams of nurses, home health aides, social workers, spiritual counselors, bereavement counselors, dietitians, pharmacists and other professionals to help patients have a meaningful experience at the end of their life.
“Hospice is really about living, not dying,” noted Boon. “Our goal in establishing expressive puppetry as one of our practices was to help the patient and caregiver work through the pain and anguish to acknowledge and embrace the physical, emotional and spiritual issues associated with death. In working through this process, you can bring about peace.”
Nicky McHugh is a freelance writer from Connecticut.