Chapter 14 (15 in slides)

Question 1

Instead of Terminally Ill

Answer 1

life-limiting illness

Question 2

general ideas about what a “good death” means

Answer 2

adequate pain management, being with loved ones and having time to say one’s good-byes, not leaving financial burdens or the burden of difficult decisions regarding life-sustaining treatments and exercising choice over where to die.

Question 3

No universal legal definition of death

Answer 3

brain death is most common

Question 4

In many parts of Western culture, the treatment of the dead body

Answer 4

is one expression of a need to deny death its power.

Question 5

The highly popular novels, television shows, and films about the “undead”—that is, vampires and zombies

Answer 5

are another indication of the fascination mainstream American culture holds with death and its denial.

Question 6

Common Stresssors dying

Anticipation or Fear of Future Isolation

Answer 6

The fear of separation from the familiarity of home and routine as a way of ordering one’s life becomes a reality for many. Treat with your own preseance.

Question 7

Common stressors dying

Prospect of Pain and Other Symptoms

Answer 7

holistic approach to the physical pain of dying, though it is still a challenge in some settings to get positive pain relief.

Question 8

Common stressors dying

Resistance to Dependence

Answer 8

“outer limits” of what one could bear: loss of bowel and bladder control; sexual impotence; inability to feed oneself, to communicate verbally, or to think straight; unconsciousness; or other loss - after acceptence people get used to it.

Question 9

Reckoning With What Death Might Mean

Answer 9

• Individual and culture dependent
• Range of beliefs and traditions related to the transition from life to death
• Religious beliefs and philosophical considerations
• Separation of soul and body
• Before talking with your patients regarding this topic think about your own beliefs regarding
  dying: Do you believe in mortality? The afterlife?
• If you were facing a terminal diagnosis, what would be your response?

Question 10

Coping Responses in the
Dying Patient

Answer 10

First response is acute shock or disbelief. Coping also may take many other forms, such as periods of depression, anger, and hostility, bargaining behavior, or acceptance.

Question 11

Coping Responses by the Patient’s Family

Answer 11

great majority of families are brought closer together by an end-of-life experience

Families cope with uncertainty, stress, and anxiety

Question 12

Coping Responses by Health Professionals

Answer 12

strive for effective communication especially with the interprofessional team, learn from experience in dealing with dying patients including collaborating with patients and families to reduce the moral burden of decision-making regarding care, share experiences and emotions with colleagues, and take breaks from intensive care delivery when possible

Question 13

Coping Responses of the
Patient’s Family -PP

Answer 13

• Pull back from patient to create distance
• Become more involved in patient’s care
• Try to control care and decisions
• Hold an overly optimistic view
• Experience anticipatory grief

Question 14

Priorities for Respectful Interaction - dying

Answer 14

• Attentive, Open Communication
• Responding caringly (to both patient and
  family)
• Maintaining hope:
  
  • Hope for meaningful activities
  • Less focus on cure, more focus on what is
    possible
  • Palliative care/Hospice
  • Comfort and relief of suffering
  • Meaningful and peaceful transitions