Chapter Twelve: Psychological Issues in Advancing and Terminal Illness Flashcards
Causes of death in infancy & childhood:
Lack of free or low cost maternal care programs
Congenital abnormalities
Sudden Infant Death Syndrome (SIDS)
Def: Sudden Infant Death Syndrome (SIDS)
Condition where an infant stops breathing
More likely to occur in lower-class urban environments (if mom smoked while pregnant, if baby is put to sleep on its stomach or side)
Main causes of death among kids under the age of 15:
Accidents
Cancer
Kids understanding of death at around age 5:
Thinks of death as permanent sleep
Curious about what death is
Kids understanding of death between the ages of 5 & 9:
Idea that death is final
No biological understanding of death
Kids understanding of death of ages 9&10:
Moderate understanding of the processes involved in death
Realize that the person who had died will not return
Causes of death in adolescence & young adulthood:
Unintentional injury
Homicide
Suicide
Cancer
Heart disease
AIDS
Young adults facing a terminal illness:
Feel shock, outrage, & an acute sense of injustice
Might face a long & drawn out period of dying
Death in middle age becomes more realistic bc…
It’s more common
Chronic health issues leading to death can develop
Premature death
Def: Premature death
Occurs before the projected age of 79
Mainly caused by heart attack or stroke
Most ppl prefer a sudden death bc:
It facilitates a more graceful departure
Their families don’t have to witness their worsening condition
Finances & other resources aren’t as severely taxed
_____ is a strong determinant of age of death.
SES
Death in old age:
The elderly are more prepared to face death bc they have experienced seeing friends & other relatives die & they thought abt their own death while making some preparations for their departure.
Cause of death in old age:
Degenerative diseases
Physical decline that predisposes them to infectious diseases or organ failure.
Factors that predict mortality in the elderly:
New illnesses & the worsening of preexisting conditions
Poor mental health & reduced satisfaction with life
Women live ______ than men.
longer
Def: The Patient Self-Determination Act
Requires health facilities to have policies concerning patients’ wishes for life-prolonging therapy.
Def: Right to die movement
Maintains that dying is more a matter of personal choice & personal control.
Def: Do Not Resuscitate (DNR) order
when patients might choose to sign or not in order to provide explicit guidance regarding their preferences for medical responses to cardiopulmonary arrest
Def: euthanasia
ending the life of a person who is suffering from a painful terminal illness
Def: Living Will
instructions & legal protection for the physician.
To ensure that life-prolonging interventions will not be indefinitely undertaken
Doesn’t always ensure that the patient’s requests are met.
Many physicians fail to follow the wishes of their dying patines & will prolong the patient’s pain & suffering.
The living will & related tools aren’t completely _________ in allowing patients to fully express their wants & to ______ that they are met.
successful, ensure
Psychological & social issues related to dying:
Changes in the patient’s self-concept. This is bc the patient can have more difficulty presenting themselves efficiently.
Issues of social interaction
Communication issues
Reasons why ppl fall prey to dubious remedies:
Hope for a miracle cure
Deteriorating relationship with the formal health care system
Desire for a more humanistic care
Kübler-Ross’s Stages of Dying:
Denial
Anger
Bargaining
Depression
Acceptance
Def: Denial
Patient’s initial reaction on learning the diagnosis
Defense mechanism by which ppl avoid the implications of an illness
May act as if the illness isn’t severe
Causes them to deny said illness
Could be caused by one’s subconscious blocking out the full realization of the implications of the disease
Def: Anger
Hard response for family & friends to deal with
Patient isn’t angry with them but at fate itself or a higher power.
Why me?
May show resentment to others who are in good health
Def: Bargaining
Trading good behavior for good health.
Might try to make a pact with a higher being
May become more charitable
Def: Depression
Time for anticipatory grief
Patient mourns the prospect of their death
Realization of their inevitable death has set in
May feel nauseated, breathless, & tired
This is referred to as “anticipatory grief.”
Def: Acceptance
A tired, peaceful calm descends
Patients decide to divide up their possessions & say goodbye to loved ones.
Might be too weak to be angry
Makes preparations for post-mortem
Evaluation of Kübler-Ross’s Theory:
Patient’s don’t go thru the stages in order, it’s personalized
Theory doesn’t fully acknowledge the importance of anxiety.
Anxiety is one of the most common responses
Significance of Hospital Staff to the Patient:
Provides physical assistance
Helps reduce pain
See patients on a regular basis
Are the only source of realistic info
Are privy to one of the patient’s most personal acts, the act of dying.
Visitors might be limited which will reduce the availability of social support from family
Def: Terminal Care
physical care that is palliative rather than curative.
Def: Palliative Care
designed to make the patient feel comfortable.
Def: Curative Care
designed to cure the patient’s disease
Staff might ________ from watching patients after they die.
burn out
Physicians spend less time with terminally ill patients to dedicate their time for those who can ______ profit from it.
Patients sometimes can interpret this as ______________
most, abandonment
Achieving an appropriate death:
Informed Consent
Safe Conduct
Significant Survival
Anticipatory Grief
Timely & Appropriate Death
Def: Informed Consent
Patients should be told the nature of their condition & treatment and might be involved in their own treatment.
Def: Safe Conduct
The physician or other staff should be helpful for the patient thru this new & frightening stage.
Def: Significant Survival
The physician and staff need to help the patient use their remaining time as well as possible.
Def: Anticipatory Grief
Both the patient & their family members should be aided in working thru their anticipatory sense of loss & depression.
Def: Timely & Appropriate Death
The patient should be allowed to die when & how they want to as much as possible. The patient should achieve death with dignity.
Therapy with the terminally ill:
Short term
Nature & timing of visits depend on the patient’s desires & their energy level.
Visits varies & isn’t fixed like normal therapy
Def: Thanatologists
studies death & dying
Believes that CBTs can be constructively employed with dying patients.
Children learn abt their condition by taking causes from:
Their treatments
Ppl around them
Counseling of terminal illness in kids:
Therapist stake cues abt what to discuss from the kid.
Helps parents to cope with the impending death
Restores balance in a family with other kids
Provides supportive mental health services to parents who exhibit symptoms of PTSD.
Def: Hospice Care
First place that provided care & comfort for travelers in medieval Europe
Painful or invasive therapies are discontinued
Oriented toward improving one’s social support system.
Currently provides palliative care & emotional support to dying patients & their loved ones
Def: Home Care
Taking care of the patient at home
Very popular & economically feasible
Provides psychological advantages for the patient
Stressful for the family bc if the nurse isn’t there, the family has to take that place.
Def: Greif
feeling the hollowness marked by:
Preoccupation with the image of the deceases
Expressions of hostility towards others
Guilt over the death
Grief response is more aggravated in:
Men
Caregivers
Ppl whose loss was sudden & unexpected
___________ adults who ruminate on their death are less likely to get _________ social support, and are ______ likely to be depressed.
Sorrowful, good, more
Biggest Burden for survivors:
Women: financial strain
Men: strains of managing a household
Death of a __________ raises complications for child survivors.
sibling
Kids should be prepared for the death:
Questions should be answered honestly
Info should be provide at the right time
Developing realistic expectations abt:
What modern medicine can achieve
The kind of care the dying want & need
Colleges have developed courses on dying:
Volunteer work with dying patients
Potential issues - unintended encouragement from self-destructive leanings.
