8: Death, Dying, Bereavement Flashcards
What are the main challanges in chronic illness?
E.g.
- Adjusting to symptoms and disability
- Maintaining a reasonable emotional balance
- Preserving a satisfactory self-image and sense of competence
- Learning about symptoms, treatment procedures and self-management
- Sustaining relationships with family and friends
- Forming and maintaining relationships with healthcare providers
- Preparing for an uncertain future
Explain the Self Regulatory Model
((Leventhal)
- Interpretation of situation (e.g. all the symptoms)
- Coping (what am I doing with it? How am I going to cope with it?)
- Appraisal
All bidirectuaonally are influenced by
- Emotional response to health threat
- fear
- anxiety
- depression
- Representation of health threat
- identity
- cause
- consequnece
- timeline
- cure and control
What are the psychological impact of long term conditions?
What is the relationship between mental and physical illness?
- With mental illness: More likely to develop depression
- 1 chrnoic illness: 3x more likely
- >3 conditions: 7x more likely
- mental health conditions increases the risk of physical illness
- people with severe mental health problems die younger
What are the possible positive adaptations and psychological growth in chronic illness?
What are the effects of that?
- Chronic illness can induce post-traumatic growth
- 60-90% of people with HIV and cancer experience positive growth
Growt might lead to
- less distress short term and better mental and physical health overall
What is meant by the phrase “Narratives in Medicine”?
What is its role?
All the canges (positive and negative) around a chronic condition become part of peoples Story and are somethimes made publlic
These stories might
- transform the perception and concept of illness
- might help people to reconstruct identitiy etc.
- help to understand their illness
- make it a collective experience
What is meant by the term narrative based medicine?
emphasis is on listening to people’s narratives and using these to improve clinical care
What are the main psychological factors of palliative care?
- Founded on providing terminally ill people with compassionate care
- Addressing medical, psychological, social and spiritual aspects of dying
- Relieving/ managing symptoms (e.g.,pain, breathlessness) rather than curing disease
- Collaborative approach with honest communication
- Empowerment – control and choice is paramount
–> Improve quality of life during the time left and prepare for death
Explain 5 phases of dealing with death according to Elisabeth Kübler-Ross
- Denial
- this does not happen to me –> defence mechanism, often includes lies to oneself etc.
- Anger
- why does this happen to me?
- generalised rage at the world –> feel isolated and furious, feel its unfair and betrayed
- Bargaining
- I’ll be a good person, if I get another chance, If I do this, I can make it better
- Depression
- absorbed in the intense emotional pain
- feeling helpless and sadness
- Acceptance
- The loss is accepted and we work on alternatives to coping with the loss and to minimise the loss
What are the advantages/ reasons for development of stage theories (5 phases by Kübler Ross) in death?
- Linear progression – gives a sense of conceptual order to a complex process – proving a degree of predictability & control
- An overwhelming cultural desire to “make sense” of the uncertain
- Developed at a time when limited literature on death & dying existed
- Applied to a number of different situations (including bereavement)
What are the weaknesses of stage theories in the concept of coping with death?
(Wortman & Silver)
- They place patients in passive roles
- don’t account for variability in patinets
- Focus on emotional responses and neglect cognitions and behaviour
- Fail to consider social, environmental or cultural factors
- Pathologise people who do not pass through stages
What is the problem with pathologising patients that don’t fit into the stage theories of coping with death?
-
Distress or depression is not inevitable:
- Many people report significant and valuable changes from the experience of the illness (Weinman et al., 1999)
- Some even report benefits (e.g., “Posttraumatic Growth” Tedeshi & Calhoun)
-
Acceptance” might not be achieved
- Reaching a state of resolution may not be possible for some
- Complex cognitive and emotional responses may continue to be present
Forms categories of “Good” patients vs “Bad” patients (not true)!
Explain stress theories of bereavement
Emphasise stress and coping with bereavement as a dynamic process
- Involves 2 changes with bouncing between them
- orientation toward loss
- orientation towards restoration
- Orientation toward loss:
- Preoccupation
- Think and yearn for the person lost
- Seeking out places as reminders or searching for the person
- Orientation toward restoration:
- Adjustments to lifestyle
- Coping with day-to-day life
- Building a new identity
- – Distracting away from painful thoughts
How lond does bereavement last for most people?
Which factors can influence this?
Can be influenced by:
- How attached they were to the deceased person
- The circumstances of death and the situation of loss
- How much time they had to work through anticipatory mourning
85% will normally have adjusted by the 2nd year of bereavement
