Adulthood: Grief, Death & Dying Flashcards
The absolute cessation of vital functions
Death
Study of the experiences of dying and bereavement
Thanatology
The process of losing these functions
Dying
Dying, and the individual’s awareness of it, imbues humans with values, passions, wishes and the impetus to make the most of time.
Death
Characterized by needless suffering, a dishonoring of patient or family wishes or values, and a sense among participants or observers that norms of decency have been offended.
Bad death
One that is free from avoidable distress and suffering for patients, families and caregivers and is reasonably consistent with clinical, cultural and ethical standards.
Good death
Reactions to Death
Untimely, Subintentional, Unintentional, Intentional & Timely. “USUIT”
DABDA(impending death) formulated by whom
Elisabeth Kubler-Ross
Stages of Grieving
Denial, Anger, Bargaining, Depression & Acceptance “DABDA”
Reaction to death: outcry, denial & intrusion, working through and completion. By whom?
Mardi Horowitz
Reaction to death: 6Rs recognize the loss, react, recollect & re experience, relinquish, readjust & reinvest. By whom?
Therese Rando
Jean Piaget: a temporary absence, incomplete and reversible like departure or sleep. _______ from primary caregiver is main fear. What stage of cognitive functioning?
Preschool (<5y/o). Separation. Perioperational stage
Jean Piaget: inevitable human mortality. Death is a final reality that happens to old people not children. Usually have active fantasies _______ & _______ dominates by themes of death and killing. What stage of cognitive functioning?
5-10y/o. Violence & aggression. Concrete operational thinking.
Jean Piaget: death is inevitable and final but may not accept possibility of their own death. Great potential for ________ & ________. What stage of cognitive functioning?
Adolescents. Isolation & withdrawal. Formal concrete operations.
Universal, Inevitable & Irreversible.
Puberty
Attitude towards death across the life cycle: Protest, Despair & Detachment. By whom?
John bowlby
Erick Erickson: frustrated in their plans to enjoy hard earned pleasure.
Middle age
Erick Ericskson: focus on missing the chance to marry.
Young adults
Erick Ericskson: confront increasing reality of their own mortality; integrity vs despair
Older age
Among the most stressful of all life experiences. Older adults have more favorable outcome. Depressive symptoms peak within the first few months but decline significantly within a year.
Spousal Bereavement
Emotional &/or psychological reaction to any loss, not limited to death.
Grief
Process by which grief is resolved. Societal expression of post bereavement behavior and practices.
Mourning
Wake, internment. Rituals for disposing the body. Rituals for invocation of religious ceremonies. Rituals for periodic official membranes.
Rituals for mourning
Prevailing display of bereavement
Funeral
State of being deprived of someone by death and being in the state of mourning.
Bereavement
Stages of Bereavement according to Clayton
Numbness, Depression & Recovery “NDR”
Stage of Bereavement according to Clayton: insomnia, restlessness & irritability. Mostly reduced over time but may be reactivated on holidays, anniversaries, birthdays & at times of other personally meaningful events. Last a few ___ to a ___.
Depression. Weeks to year.
Stage of Bereavement according to Clayton: dazed, functioning almost automatically(doing what needs to be done w/out much awareness) forgetful of what’s been done. Usually lasts for a few ____ to ___. Seldom ____.
Numbness. Hours to days. Weeks.
Stage of Bereavement according to Clayton: acceptance of loss. Return to pre-morbid level functioning. Seek out new relationships & roles; return to roles before death. Varies by age, gender, health of survivor. Within _____ of loss.
Recovery. 6mos.
Stages of Bereavement according to Bowlby
Early phase of acute despair, Phase of intense yearning and searching, Phase of disorganization and despair & Phase of reorganization. “AID R”
Symptoms indicating major depressive disorder exceeding usual bereavement.
Guilt & Preoccupation
Can be influenced by his/her age, personality, developmental stage, earlier experiences with death, his or her relationship with the deceased.
Child’s grief
Bereavement in children: loss of speech diffuse distress.
Younger than 2y/o
Bereavement in children: phobic, hypochondriacal, withdrawn, pseudomature, school performance suffers.
School aged
Bereavement in children: eating, bowel and bladder dysfunctions, strong feelings of sadness, fear & anxiety.
Younger than 5y/o
Bereavement in children: behavioral problems, somatic symptoms erratic moods to stoicism
Adolescents
Duration of grief
Cultural, Loneliness, In chidren depends on support system & Dictated by society “CLID”
Identifying with the deceased taking on traits/possessions.
Normal grief
Believes he is the dead person or dying of the same disease.
Pathological grief
Persistent, intrusive complex auditory hallucinations
Pathological grief
Hear fleeting, transient voice.
Normal grief
Dead person still alive
Pathological grief
Denial of certain aspects of the deceased
Normal grief
Disbelief, denial & shock. Sense of unreality withdrawal.
Normal grief
Depression impaired self esteem suicidal & denial delayed or absent grief
Pathological grief
Progressive social isolation & hostility paranoid reactions.
Pathologic grief
Profound sadness survival guilt intact self esteem. Anger and irritability.
Normal grief
Mood fluctuations. Waves, washes over and time limited.
Grief
Mood disturbance is pervasive, unremitting & hopeless.
Depression
A normal albeit, intensely painful state that is responsive to support, empathy and passage time.
Grief
Potentially a medical emergency that requires immediate intervention to forestall a complication like suicide
Major Depressive Disorder
Disruption of biological rhythms. Impaired immune functioning. Decreased lymphocyte proliferation. Impaired functioning of natural killer cells.
Acute grief
Acute grief: _____ appear to be at risk longer than widows.
Widowers
Physician responses: often reflect underlying attitude towards _____. Death as a ________ to personal immortality.
Death. Personal failure/threat.
Physician responses: medical training focuses almost entirely on the ________ & ________ of disease at the expense of care and comfort of the person with the disease.
Control and eradication.
Physician responses: ______ of own attitudes toward death and dying. Unconscious feeling of ______ and power of preventing death.
Awareness. Omnipotence.
Hallmarks of appropriate care: visiting patient regularly, eye contact, touching, listening & respect.
Compassionate care
_______ the family for the probability that a loved one will die. ______ the family’s ventilation of feelings.
Preparing. Encourage.
Regularly scheduled sessions where grieving people are encouraged to talk about feelings of loss and about a person who has died.
Grief therapy
Provides temporary support until a sense of confidence about the future develops.
Attachment to the therapist
Most are practiced to protect the living. Appease the spirits thought to have caused the person’s death.
Ghost protection rituals
Death & Burial Customs: _____ the eyes of the dead person. Covering the _____ of the dead. Carry the dead out of the house ____ first. _____ were covered. Family photographs turned _______.
Shutting. Face. Feet. Mirrors. Face down.
Tombstones to weigh down the dead. Mazes the entrance of ancient tombs. Beating on the grave, firing of guns, funeral bells & wailing chants. Bodies lie w/ their heads to the west and their feet to the East.
Cemeteries
House, funeral parlor & church. Usually lasts for 5-7 days or longer. 24 hrs. Novena, mass & prayer. Nearest kin sits beside the coffin.
The wake/vigil
Walk behind the funeral car, stopbat the church after mass relative will make a speech, grave site, house of the family, children are passed over the coffin & 40days.
Requiem mass/ Funeral
