death and dying

Question 1

thanatology

Answer 1

the study of death and dying

Question 2

psychological death

Answer 2

• begins when the person is told they have a terminal illness
• start the grieving process (crying, mourning, disbelief, sadness)

Question 3

physiological death

Answer 3

• starts when the body processes decline in function
• cessation of breathing and heartbeat do not necessarily constitute death (they can be restored through resuscitation)

Question 4

brain death

Answer 4

• irreversible cessation of all activity in the brain and the brain stem
• Used in the US to define death
• Brain stem for reflexive actions such as heartbeat and breathing

Question 5

persistent vegetative state

Answer 5

• cerebral cortex no longer working, but brain stem is.
• cerebral cortex responsible for higher level of function — thinking, personality

Question 6

physical decline during death

Answer 6

• less interest in communicating, eating, drinking, moving
• body temp declines
• blood flow to extremities declines
• blood pressure starts to go down
• extremities becomes cool and take on a duller hue
• decreased urine output

Question 7

transition from life to death: final three phases

Answer 7

• Agonal phase: struggle to breath, lung congestion
• Clinical death: heartbeat, circulation, breathing stops but resuscitation may still be possible
• Mortality: Passage to permanent death

Question 8

“death with dignity”

Answer 8

• quick, agony free end during sleep
• clear-minded to say farewell and review their life

Question 9

dignity of death: compassionate care

Answer 9

• care and treatment with respect
• address the patient’s greatest concerns

Question 10

dignity of death: communication

Answer 10

• Candid approach about the certainty about death
• This allows for end-of-life planning and decision
  making
• Allows the person to make reasoned decisions and choices

Question 11

attitude toward death

Answer 11

• death avoidant society
• reluctant to talk about it
• death anxiety: fear and apprehension of death (lowers as we age)

Question 12

Kubler-Ross: 5 Stages (Reactions) to Death

Answer 12

• denial: Refusing to accept the diagnosis and avoiding discussion about it. Trying to escape the
  prospects of death
• anger: Resentment and fury that time is short and their goals will be left unattained. Unfairness of death
• bargaining: Striking bargains with anyone (and God) for more time
• depression: Realization of the inevitability of death. Despondency about impending loss of life
• acceptance: Reaching a state of peace. Disengaging from most except for a few close family members or friends

Question 13

what influences dying and death?

Answer 13

• the nature of the disease affects the context of dying
  > the course of illness affects the person
  > the toll of the disease often results in
  depression
• Personality and Coping Style of the Individual affects the context of dying
  > How individuals have coped with prior stress
  > How they have viewed prior life events
  > Poorly adjusted individuals and many life
  disappointments are usually more distressed

Question 14

the home

Answer 14

• 80% prefer to die in the home
• Offers an atmosphere of intimacy
• Feel less abandoned or humiliated by the loss of dignity with dying
• Only 1 in 4 die in home
• Not necessarily easy on the family physically or emotionally

Question 15

the hospital

Answer 15

• 40% of deaths occur in the hospital
• Nearly 30% of those over 65 will die in the ICU
• Hospital not equipped to handle the emotions
• Hospital environment is impersonal—in the hospital, death is often seen as failure.
• Nurses and doctors are not always trained in management of chronically ill and my engage in life prolonging procedures

Question 16

nursing homes

Answer 16

• About 20% will die in a long term care facility
• Little research available about what it is like to die there.
• Inattention to spiritual and emotional needs and
  untreated pain often occur

Question 17

hospice – comprehensive program of support services for terminally ill

Answer 17

• Not a place, a philosophy
• Focus on quality of life
• Provides emotional, spiritual, physical care
• Focus on palliative care (reduces pain and suffering)
• Interdisciplinary team that provides 24 hour support and family services after the death
• Most insurances cover as well as Medicare and Medicaid.
• No curative goals

Question 18

palliative care

Answer 18

• have some medications focused on cure
• Approach that improves quality of life in those facing a life-threatening illness
• Prevention and relief of suffering
• Addresses the person as a whole.
• Can be accessed at any point in the illness continuum
• During treatment as well as end of life
• Focuses on physical symptoms, emotional and spiritual needs and assistance for caregivers.
• Goal: best quality of life

Question 19

hospice care

Answer 19

• palliative care but with no curative goals and patients do not seek curative treatments
• comfort for family/patient

Question 20

voluntary euthanasia

Answer 20

• At a patient’s request, a doctor actively takes the patient’s life in a painless way for the purpose of relieving suffering.
• This is a criminal offense in all states and most countries
• Opponents stress there is a moral difference between letting someone die and purposefully ending their life early.

Question 21

helpful communication

Answer 21

• “Tell me how you are feeling”
• “It is ok to cry”
• “I am here if you want to talk”
• Silence is fine
• Warm touch, presence
• “I am sorry for your loss”
• “Would you like to talk?”
• “Tell me about……”

Question 22

not helpful communication

Answer 22

• “You need to be strong for your family”
• “Don’t cry”
• “It is God’s Will”
• “You will be out of pain soon”
• “Was she in a lot of pain?”
• “Where you expecting him to die”

Question 23

the right to die

Answer 23

• 70% of adults/95% of physicians support the right of patients or family members to end treatment
• The AMA endorses withdrawing treatment from those who are terminally ill
  or those in permanent vegetative state.
• Religious and cultural views may play a role in these decisions

Question 24

Advanced Directives

Answer 24

• Durable Power of Attorney–Assign someone to make decisions should you
  not be able to
• Living Will–You identify what treatments you would want and not want
• Do Not Resuscitate Order

Question 25

medical aid in dying

Answer 25

• at an incurably ill patient’s request the HCP provides a prescription for lethal dose of medication
• The patient then self administers this to themselves
• 2 doctors need to agree
• there is a waiting period for the prescription
• very controversial

Question 26

bereavement

Answer 26

• Involves grief and mourning
• Experience of losing a loved one by death

Question 27

grief

Answer 27

• Emotional response to loss
• Intense physical and psychological distress

Question 28

mourning

Answer 28

• Outward expression of grief
• Culturally specified expression of the thoughts
  and feelings.

Question 29

anticipatory grief

Answer 29

grief that occurs before the loss is known

Question 30

delayed grief

Answer 30

• when emotions are postponed
• may be triggered later by another life event

Question 31

how much experience moderate distress, depression and difficulty in functioning over the next year?

Answer 31

15-25%

Question 32

how much experience severe, prolonged distress,
depression and lack of acceptance for years?

Answer 32

5-15%

Question 33

infants and toddlers view on death

Answer 33

• Do not understand death
• React to changes in the family routine when someone dies
• Do not understand implications of their own death

Question 34

preschoolers view on death

Answer 34

• Do not understand the permanence of death
• Magical thinking. May think they are “asleep”
• May continue to ask about the person
• Do not really understand much about their own death

Question 35

school age view on death

Answer 35

• Understand the finality of death
• Understands death is forever, they are not coming back
• May be interested and curious about the rituals related to death

Question 36

adolescents view on death

Answer 36

• Understand death in abstract manner
• Adult view and understanding of death of themselves and others.

Question 37

health care providers

Answer 37

• Increase understanding of physical and psychological changes that accompany dying
• Enhancing awareness of end-of-life options, funeral services, memorial rituals
• Promoting understanding of advance directives, living wills, euthanasia, organ donation
• Improving student’s ability to communicate effectively about death and dying
• Helping prepare for the professional role in caring for the dying
• Fostering appreciation of lifespan development and how that interacts with death and dying
• Communication is key

Question 38

personal and situation variations of grieving

Answer 38

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