death, dying and bereavement Flashcards
challenges
• Adjusting to symptoms and disability • Maintaining a reasonable emotional balance • Preserving a satisfactory self-image and sense of competence • Learning about symptoms, treatment procedures and selfmanagement • Sustaining relationships with family and friends • Forming and maintaining relationships with healthcare providers • Preparing for an uncertain future
self regulatory model
draw
psychological impact of long-term conditions
● People with one LTC are two to three times more likely to develop depression than the rest of the population.
● People with three or more conditions are seven times more likely to have depression
illness narratives
• Transform events and construct meaning from the illness • Help people to reconstruct their Hx to incorporate the illness and reconstruct their identity to retain a sense of self-worth in the face of illness • Help people explain and understand their illness • Relate the illness to their values and life priorities • Make illness a collective experience
palliative care
• Founded on providing terminally ill people with compassionate care • Addressing medical, psychological, social and spiritual aspects of dying • Relieving/managing symptoms (e.g., pain, breathlessness) rather than curing disease
outlook on palliative care
Gomes et al., 2013 The majority of people prefer to die at home
home palliative care:
• Doubles their chances of dying at home • Helps to reduce the symptom burden • Does not increase grief for family/caregivers after death • Above benefits does not raise cost
5 reactions to dying
- Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
define denial
● The person may think “This isn’t really happening” ● They may lie about the situation and tell themselves that this is just temporary and everything will be back to normal soon ● It is often used as a psychological defence in an attempt to cushion the impact of the source of grief
define anger
● The person may think “why me?” or “how could God do this to me?” ● The person feels generalised rage at the World for allowing something like this to happen ● They feel isolated and furious that this is happening to them ● They think it’s unfair and may feel betrayed ● Outbursts of anger in unrelated situations can occur
define bargaining
● The person thinks “If I do this, I can make it better, I can fix things.“ ● One may feel guilt and feel it is their responsibility to fix the problems ● They make an attempt to strike bargains with God, spouses, HCPs e.g. “I’ll be a good person, if I get another chance
define depression
● The person thinks “my heart feels broken” or “this loss is really going to happen and it’s really sad” ● At this stage, the person is absorbed in the intense emotional pain that they feel from having their world come apart ● They can be overwhelmed with feelings of helplessness and sadness ● “Anticipatory grief
define acceptance
● The person thinks “this did occur, but I have great memories” or “it is sad but I have so much to live for and so many to love” ● The loss is accepted and we work on alternatives to coping with the loss and to minimise the loss
The embedded nature of Stage Theories in Western culture
Theories in Western culture
● Linear progression – gives a sense of conceptual order to a complex process – proving a degree of predictability & control ● An overwhelming cultural desire to “make sense” of the uncertain ● Developed at a time when limited literature on death & dying existed ● Applied to a number of different situations (including bereavement
Weaknesses of Stage Theories
● Stages are prescriptive and place patients in a passive role ● Do not account for variability in response (e.g., “people deal with things differently”) ● Focus on emotional responses and neglect cognitions and behaviour ● Fail to consider social, environmental or cultural factors (e.g., a patient in a positive and supportive environment is likely to exhibit very different stages than those who are not) ● Pathologise people who do not pass through stage
stage theories and the problem of pathologizing
distress or depression is not inevitable
acceptance might not be achieved
good patients vs bad patients
“Bereavement” refers to
to the situation of a person who has recently experienced the loss of someone significant in their lives through that person’s death
stress theories of bereavement
Emphasise stress and coping with bereavement as a dynamic process ● Involves changes in orientation toward loss or restoration
Orientation toward loss:
– Preoccupation – Think and yearn for the person lost – Seeking out places as reminders or searching for the perso
Orientation toward restoration
– Adjustments to lifestyle – Coping with day-to-day life – Building a new identity – Distracting away from painful thought
dual process model of coping with bereavement
model
-includes loss oriented and restoration oriented
The duration and severity of a person’s grief may depend on:
– How attached they were to the deceased person – The circumstances of death and the situation of loss – How much time they had to work through anticipatory mourning
Responses to bereavement (Bonanno & Kaltman, 2001)
model
chronic grief more likely to occur if:
More likely to occur if: – The death was sudden or unexpected – The deceased was a child – There was a high level of dependency in the relationship – The bereaved person has a history of psychological problems, poor support and additional stresses (e.g., financial)
psychological interventions with chronic grief
Psychological interventions: – Little effect on mood, grief or physical symptoms – Some impact in high risk individuals such as those with existing mental health problems (Jordan & Neimeyer, 2003)
advancing of understanding of grief and grieving:
suggestion
– Further development of cross-cultural theoretical approaches – Sound empirical testing – More focussed efforts to better understand those who suffer extremely – Continued development of effective psychological interventions to help support those who experience chronic grief
