Final Wednesday
Day 1
Chapter 19
- US Societal changes
- Early 1900s...
- "comfort"
- die of infection
- at home
- family caregiver
- death short and sudden
- Today...
- "cure/delay"
- die of chronic illness
- at institutions
- institution staff as caregiver, not always well-trained to do this (trained to cure)
- death prolonged
- What is death? (with medical advancements)
- Brain death
- All activity in brain/stem stopped
- irreversible
- Persistent vegetative state
- Activity in cerebral cortex stopped
- brain stem still active
- Concept of death
- Permanence
- Inevitability
- Cessation
- Applicability
- Causation
- Early childhood
- Don't completely understand permanence of death, universality, lack of functioning
- Facts that affect understanding:
- * Experience with death
- * Religious teachings
- Adolescence
- More experienced with death and grief
- More mature understanding of death
- * Problems applying idea to their lives
- - High-risk activities
- - View as abstract state
- Early adult
- * Avoidance
- * Death anxiety
- * Death considered distant
- Middle adulthood
- * Begin to think of death
- * Aware of limited time left to live
- * Focus on tasks to be completed
- Late adulthood
- * Think and talk more of death
- * Practical concern about how and when
- What results in less anxiety?
- * Goals fulfilled
- * Feel as if one has lived a long life
- * Have come to terms with finality
- * Prior experience with death
- Kubler-Ross Theory DABDA
- * Stages are not a fixed sequence
- * May cause insensitivity by caregivers
- * Best seen as coping strategies
- Seven Stages
- * Shock/disbelief
- * Denial
- * Anger
- * Bargaining
- * Guilt
- * Depression
- * Acceptance / hope
- Communicating with Dying People
- Be truthful (diagnosis, course of disease)
- Listen perceptively
- Acknowledge feelings
- Maintain realistic hope
- Assist final transition
Day 2
- Factors that influence thoughts about dying
- Cause of death (nature of disease)
- Personality
- Coping style
- Family members' behavior
- Health professionals' behavior
- Spirituality and religion
- Culture
- Traditional places of death
- Home
- * most preferred
- * Only 25% die at home
- * Need adequate caregiver support
- Hospital
- * Intensive care unit can be depersonalizing
- Nursing Home
- * Focus usually not on terminal care
- Hospice Approach
- Comprehensive support for dying and their families
- * family and patient as a unit
- * team care
- * palliative (comfort) care
- * home or homelike
- * bereavement help
- Advance Medical Directives
- * Written statement of desired medical treatment in case of incurable illness
- * Living Will: specifies desired treatments
- * Durable power of attorney
- - authorizes another person to make healthcare decision on one's behalf
- - more flexible than living will
- - can ensure partner's role in decision making even in relationships not sanctioned by law
- Difficult grief situations
- * Parents losing child
- * Children or adolescents losing a parent
- * Adults losing an intimate partner
- * Bereavement overload
- Bowlby 4 stages of grief
- *Numbness
- *Yearning
- *Disorganization and despair
- *Reorganization
- Resolving Grief
- * Give yourself permission to feel the loss
- * Accept social support
- * Be realistic about course of grieving
- * Remember the deceased
- * When ready, engage in new activities and relationships. Master tasks of daily living.
