Week 8

Final Wednesday

Day 1

Chapter 19

• US Societal changes
• Early 1900s...
•  "comfort"
• die of infection
• at home
• family caregiver
• death short and sudden 
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• 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
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• What is death? (with medical advancements)
• Brain death
• All activity in brain/stem stopped
• irreversible
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• Persistent vegetative state
• Activity in cerebral cortex stopped
• brain stem still active 
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• Concept of death
• Permanence
• Inevitability
• Cessation
• Applicability
• Causation 
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• Early childhood
• Don't completely understand permanence of death, universality, lack of functioning
• Facts that affect understanding:
• * Experience with death
• * Religious teachings
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• 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
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• 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 
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• 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
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• Kubler-Ross Theory DABDA
• * Stages are not a fixed sequence
• * May cause insensitivity by caregivers
• * Best seen as coping strategies
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• Seven Stages
• * Shock/disbelief
• * Denial
• * Anger
• * Bargaining
• * Guilt
• * Depression
• * Acceptance / hope 
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• Communicating with Dying People
• Be truthful (diagnosis, course of disease)
• Listen perceptively
• Acknowledge feelings
• Maintain realistic hope
• Assist final transition 
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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
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• 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
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• 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
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• 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
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• Difficult grief situations
• * Parents losing child
• * Children or adolescents losing a parent
• * Adults losing an intimate partner
• * Bereavement overload
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• Bowlby 4 stages of grief
• *Numbness
• *Yearning
• *Disorganization and despair
• *Reorganization
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• 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.
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