Death and Dying Flashcards
Symptoms of distress
Depression, anxiety, hopelessness, despair, shock, guilt, loss of meaning, and feeling like a burden to family
Developmental tasks of dying patients
Develop a renewed sense of meaning, bring closure to personal and community relationships, bring closure to worldly affairs, and accept the finality of life and surrender to the transcendent
Providers must foster hope
Providers should develop caring relationships, provide comfort and relieve suffering, set attainable goals that involve the pts in the decision making, support the pt’s spirituality, use light hearted humor when appropriate, and reminisce about life and emphasize uplifting memories
Stages of grief
Denial, anger, bargaining, depression, and acceptance
Tasks of grief for those who experience loss
Accept the reality of the loss, experience the pain of the loss, adjust to an environment without the deceased, and emotionally relocate the deceased and move on with life
Types of grief
Chronic grief, delayed grief, masked grief, and exaggerated grief
Chronic grief
Continuation of grief symptoms for more than 6 months after death
Delayed grief
Bereavement occurring years or decades after a loss
Masked grief
Symptoms of grief may be absent or appear unrelated to the loss
Exaggerated grief
Grief characterized by excessive or disabling symptoms that may worsen with time
Risk factors for complicated grief
The specifics of the loss and who deceased (loss of a child, spouse); nature of the attachment (dependent partner); mode of loss/death (sudden death); historical antecedents and personality variables (psychiatric illness, several losses); social factors (estrangement and geographical separation); and concurrent stressors (economic reversals)
Patients want relief of suffering and open communication
Pain and symptom control, avoiding inappropriate prolongation of the dying process, achieve a sense of control, relieve burden on the family, and strengthen relationships with loved ones
Families of patients want high quality healthcare
Education about the illness and how to cope, provide the dying person with desired physical comfort, provide family members with emotional support before/after patient’s death
Barriers of communication - Pt/Family
Cultural beliefs on disclosure of information, unrealistic expectations of the healthcare system (especially in terms of death), societal values on the dying process, trust, and lack of advanced directives and burden of decision making on families
Barriers of communication - Physician
Failure of active listening, uncertainty of prognostication and unrealistic physician expectations, discomfort with expressing emotions or dealing with emotional issues, lack of time/space
Principles of Motivational Interviewing - RULE
- Resist the “righting” reflex
- Understand the pt’s motivation
- Listen to the pt
- Empower the pt
Emotional Component and NURSE
- Naming (the problem or emotion)
- Understanding (where are they coming from and what are their feelings)
- Respecting (show it verbally and nonverbally)
- Support (give them credence and express your concern)
- Explore (tell me more, dwell in depth on their concerns)
SPIKES 6 Step Approach
- Setting up the interview
- Assessing the pt’s perception
- Obtaining the pt’s invitation
- Give the knowledge to the pt
- Addressing the pt’s emotions with empathetic responses
- Summarize and provide strategy
Signs and symptoms of burnout
Tiredness, low morale, avoidance of patients, easily irritable or angry, errors in judgement, depression or grief, difficulties at home
Risk factors for burnout
Not being able to maintain a work/life balance, not being able to say no, organizational and financial pressure, lack of social/spiritual support, younger age, and difficulty expressing one’s own emotions
