Chapter 13: Dying and Bereavement Flashcards
What are the common signs of near death
- sleeping most of the time
- disoriented
- irregular breathing
- visual and auditory hallucinations
- decline in vision
- decreases production of urine
- mottled skin, cool hands and feet and overly warm trunk
- excessive secretion of bodily fluids
- very weak
- may be in pain
- may not recognize family members
What is anorexia-cachexia Syndrome
- loss of appetite and muscle mass when dying
What are the positive aspects that may be experienced near death
- emotional and spiritual growth
What is Crude Mortality Rate
- the number of deaths divided by the population alive during the particular time period
(deaths / alive population)
What are Age-Specific Mortality Rates
- crude death rate for a specific group
What are Age-Standardized Mortality rates
- take into account differences in age structure between different time periods or different locations
First Nations in Canada Mortality Rates
- higher age standardized death rate
What are some factors of life expectancy
- income
- education
- marital status
- occupational staus
- eating habits, smoking, obesity
Causes of death
- changes over time
- influenza and pneumonia sticking around (still a significant factor in cause of death)
- some drastic change: Covid 19 and TB
What is Death ethos
- sociocultural perspective
- cultures prevailing philosophy of death can be inferred by:
- funeral rituals
- treatment of the dying
- belief in afterlife and ghosts
- social conventions in discussion
- representation in the arts
How has death ethos shifted over time
- invisible death (being in hospitals away from families and not in homes)
- medical advances have impacted the understanding of death (good death and death with dignity)
What is death with dignity
- the period of dying should not be subject the individual to extreme physical dependency or loss of control of bodily functions
- bring death back to home
- control and decision made by patient not doctor
what is good death
- the autonomy in making decisions about the type of care and duration of care received until death
What is the Kubler-Ross study
- studied people diagnosed with a terminal illness
What are Kubler-Ross 5 stages that people with terminal illness go through
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
- a lot of individual variability and not necessarily in order
What is Identity Assimilation in bereavement
- deny that death may be approaching
- want identity balance, accept and adjust
- the way you die may become part of your identity (eg: want to die in a composed manner)
What is the Legitimization of Biography
- give meaning to life through stories
- may or may not be in writing
What is Awareness of finitude
- recognition of own mortality
What is the Terror Management Theory
- thoughts of death activated (reminded), can lead to change of healthy behaviours
- religious involvement
End-of-life Advance Directives
- legal document
- make wishes known: unconscious or otherwise incapable of expressing them
- health care durable power of attorney: appoint someone to act on your behalf
- Do not resuscitate (DNR)
- Do not Hospitalize (DNH)
- over-treatment when orders not followed
- 8/10 Canadians havent heads to advance care planning
Medical Assistance in dying in Canada
- MAID become legal in canada in June of 2016
Medical Assistance in dying in Canada: 2 Options
- physician or nurse practitioner can directly administer a substance
- Physician or nurse practitioner can give or prescribe a substance that they can self-administer
- patients mist be capable for providing informed consent at the time that MAID is provided, this just be voluntary (no external pressures(
- NEW- allows eligible persons whose natural death is reasonably foreseeable and who have a set date to receive MAID, to waive final consent if they are at risk of losing capacity in the interim
Who is eligible for MAID in Canada
- must be 18+ and meet the following
- have a serious and incurable illness, disease or disability
- be in an advanced state that is irreversible decline in capability
- endure physical and psychological suffering that is intolerable to them
- their natural death has become reasonably forseeable
- temporarily excludes eligibility for individual suffering soley from mental illness for 24 months and requires the ministers of justice and health to initiate an expert review tasked with making recommendations within the next year on protocols, guidance and safegaurds for MAID for persons suffering from mental illness
MAID stats
- roughly 50% of people who get approved actually use it (cancer most common diagnosis seen)
challenge’s to MAID
- ambiguity (different points of view)
- ensuring providers do not feel pressure to provide
What is Hospice Palliative Care
- assisting dying people
- different from MAID
- emphasizes pain management , quality of life and death with dignity
- de-emphasis on prolonging life
- inpatient and outpatient services
- staff role- be with patients
- less than 30% of people have access
What is Hospice Care
- allows patient to have pain control and symptom management, avoid extended period of dying, achieve sense of personal control, reduce burden on other, strengthen ties with those close to them
- assist people dying
Improving end of life care
- research SUPPORT study to understand prognoses and preferences for outcome and risk of treatments
- training, educating and options
- cultural and language differences
- individual needs/ preferences
What is Bereavement
- process of coping with the death of another
What is Grief
- feelings after a loss, sorrow, hurt and anger ‘
What is mourning
- expressing our grief, cultural norms
Bereavement Biopsychosocial perspective
- biological: stress on body
- Psychological: range of negative emotions, impaired attention and memory
- Sociocultural: altered reposition in family and community, financial burden, change in support network (losing sense of community)
loss of a child is most distressing
What is the traditional view of Bereavement
- death should be worked through
- grief that goes on for more than a year is abnormal
What is the attachment view in Bereavement
- maintaining continuing bond with deceased
- keeping possessions is not abnormal
What is the dual Process model for Bereavement
- restorative: practical adaptations to loss
- loss: adjustment to the emotional consequences
- Adjustment : alternate between the two
- responses to loss may depend on attachment style
- flexible adaptation shows best outcomes
- repressive coping might be okay at times
Other factors related to dual process model for bereavement
- optimism
- capacity for positive emotions
- maintain sense of continuity
