death, dying and breavement Flashcards
desribe the epidemiologal shift
improvments in tremnt and heathcare
what can be the effect of illness *
shock to security and self image
makes you feel vulnerable and aware of life’s uncertainty
therefiore adjusting to life with an illness may require a lot of effort
what are the challenges with adjusting tio illness *
adjusting to symptoms and disability - physical and psychological challenges
maintaining a reasonable emotional balance
preserving a satisfactory self image and sense of competence
learning about symptoms, treatments and self-management
sustaining relationships
forming and maintaining relationships with healthcare professionals
preparing for an uncertain future - some conditions dont have a certain diagnosis
changes in behaviour - stopping health comprimising behaviour and taking up health beneficial bahvaiour
describe the self regulatory model *
stage 1 interpretation - what do the symptoms indicate
- representation of health threat - existing ideas about what symptoms indicate - identity, cause, consequence, time line, care/control
- emotional response to health threat - how does it impact my life and do i need to take it seriously - fear, anxiety and depression
stage 2- coping
stage 3 - appraisal of the coping effects
what are the psychological impacts of long term conditions *
2-3x more likely to get depression
people with 3 or more are 7x more likely to get depression
having a mental health problem increases risk of physical health
adults with physical and mental health problems are less likely to be in employment
people with schizophrenia or bipolar disorder are likely to die 16-25 years younger
a lot of people have both physical and mental health problems
describe positive adaption to long term health conditions *
psychologiccal stress is not inevitable
some pts report positive changes and growth ie less destress and better physical and mental health
these people have a different psychological make up to those who get mental health problems
describe the narratives of illness *
the events surrounding chronic illness and the positive/negative changes become part of people’s stories
people can be influenced by narratives that have come across in media - eg Philidelphia which presented a person with HIV changed people’s perspective of HIV
people’s preconcieved ideas of what disease means to them may have come from the media
the narratives:
transform events and construct meaning from the illness
help people to reconstruct their history to incorporate their illness to get a sense of self worth - eg some people with cancer go on to raise money, others see this and feel stressed that they dont have this drive
help people to explain and understand their illness
relate the illness to their values and life priorities
make illness a collective experience
what is narrative based medicine *
listening to people’s narratives and using these to improve clinical care
list and explain some of the psychological issues for people with chronic conditions *
depression and anxiety - they label the symptoms but dont give an explanation
motivational - adherence to treatment and self management
adjustment and adaption
confidence and self esteem - body image
poor coping
stress and health behaviour change
trauma
sexual issues
existential issues - death and dying
loss of identity - this us a key psychological variable - lose physical function, hopes and goals, relationships, activities that you used to enjoy
example of how someone copes with COPD *
problem is there is no definite prognosis - makes life uncertain
the concerns are buffered by having a good support network - this impacts people’s ability to adapt
why is it important to talk about death *
we’ve forgotton what dying is like
think it is all dramatic like ion the films - actually people just get tireder and slip away - they become deeply comatosed and breath bubbles
we put people with non-preventable deaths in hospital even though nothing could be done - so we need to work to plan peoples deaths because they dont need to be in hospital
there is a death cafe movement that where people go to talk about death
describe the healthcare perspective of where people die *
57% people die in hospital
only 3% people say they would want to
many would prefer home or hospice
medicine is focused on how best to treat disease and cheat death- but just because you can doesnt mean that you should
describe palliative care *
provides care for the terminally ill
addresses the medical, psychological, social and spiritual aspects of dying
relieving/managing symptoms rather than curing disease
it is a collaberative approach with honest communication
control, choice and empowerment is important
more about the biography and less about the biology
but there is tension regarding the ethical, moral and legal opposition to euthanasia
what did Higginson et al discover about people’s priorities for end of life care *
respondants were asked if faced with a serious condition like cancer with limited time to live - what would your priorities be
most prioritised improving quality of life and only 2% thought extending their life was important
describe what Gomes et al found about dying at home *
the effectiveness and cost effectiveness of dying at home
the systematic review investigated the difference home palliative care services made to people’s chance of sying at home, also issues for pt at end of life eg pain and family distress
having access to home palliative care doubles chance of dying at home, reduces the symptom burden, doesnt increase grief for family/care givers after death; there is no increase to cost
therefore the recommendation is that patients who want to die at home should be offered home palliative care
what do etkind et al predict about palliative care *
that the need is going to increase - there will be a 25% increase in deaths by 2040
therefore systems must adapt, boosting palliative care
currently only half of health and wellbeing strategies in england and wales mention end of life care, few prioritise it and none cite evidene for effective interventions
what are the 5 general reactions when people are dying *
denial
anger
bargaining
depression
acceptance
describe denial *
the person may think that it isnt really happening
they might lie about the situation and say it is only temporary
it is used as a psychological defence in attempt to cushion the impact of the source of grief
descrive anger *
people might think - why me, or how could god do this to me
feel generalised rage at the world
the feel isolated and furious
they think it is unfair and that they have been betrayed
outbursts of anger in unrelated situations can occur
describe bargaining *
think - if i do this i can fix it
feel guilt and responsibility to fix the problem
attempt to strike bargains with god and heathcare professionals - if i am a good person now will i get better
describe depression *
people think my heart feels broken, or the loss is really going to happen and it is sad
the person is absorbed in their intense emotional pain that they feel from heaving their world come apart
overwhelmed by helplessness and sadness
anticipatory grief
describe acceptance *
teh 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
work on alternatives to minimise and cope with the loss
how are the stage theories western *
there is a linear progression - gives sense of a conceptual order to a complex process - providing a degree of predictability and control
an overwhelming desire to make sense of the uncertain - but for some chronic conditions this is not possible - therefore utility of stages is questioned
they were developed at a time when limited literature on death and dying existed
what are the weaknesses of the stage theories *
they are prescriptive and place pt in a passive role
do not account for the fact that people deal with things differently
focus on emotion and neglect behaviour
dont consider social, env and cultural factors - eg a pt in a supportive env will exhibit differet stages to those not
pathologies the people who do not pass through the stages - if people dont pass through make them feel like their psychology is wrong, even though sometimes it is impossible to pass through the stages
what is the problem with pathologising with the stage theories *
distress or depression is not inevitable - many people report significant and valuble changes from the illnes som eeven report benefits
acceptance might not be achieved - reaching a state of resolution may not be possible for some, complex cognitive and emotional responses may continue to be present
good patients vs bad patients??
what is the ripple effect of death *
death effects family, commuinity nad health care professionals
describe the bereavement perspective *
death doesnt occur in isolaton - it affects the friends, family and community
bereavement refers to the situation of a person of a person who has recently experienced the loss of someone significant in their lives through that person’s grief
grief is a normal BPS reaction to loss eg sleep, anger, walk
how we grieve is strong influnenced by cultural custums and norms - differences seen in many cultures
range of establised theoretical approaches that consider responses to bereavement
perspectives include general stress and trauma theories of grief and models of coping which are specific to bereavement
what are the stress theories about bereavement
emphasise stress and coping with bereavement as a dynamic process
involves change in orientation towards loss or restoration
orientation to loss:
- preoccupation
- think and yearn for the person lost
- seeking out places as reminders or searching for the person
orientation to restoration
- adjustments to lifestyle
- coping with day-day life
- building a new identity
- distracting away from painful thoughts
what is the dual process of coping with bereavement *
every day experience oscillates between loss orientated and restoration orientated
what might responses to bereavement vary on *
the duration and severity of a person’s grief may depend on:
how attached they were to the deceased person
the circumstances of the death and situation of loss
how much time they had to work through anticipatory mourning
85% people have adjusted by 2nd year of bereavement
what are the responses to bereavement *
minimal grief in 1st year leads to minimal grief in second year
common grief in 1st year (cognitive disorientation, dysphoria, health deficits, disrupted social and occupational functioning and positive experiences) can lead to minimal grief by 2nd year or chronic grief (major depression, generalised anxiety, PTSD symptoms)
describe chronic grief *
can be associated with worsening mental health eg depression/anxiety
more likely to occur if the deatrh was sudden, teh deceased was a child, there was a high level of dependancy in the relationship, the bereaved person has a history of psychological problems, poor support and additional stresses eg financial
what is the treatment for chronic grief *
psychological interventions - this has little effect on mood, grief or physical symptoms, but has some impact in high risk individuals with mental health problems
support helps bereaved people generally, but doesnt buffer them against the grief
what were Dame Cicely Saunders and Elisabeth Kubler ross involved in
shifting the narrative of us telling patients how they would die, to pts being involved in the end of life care
Sauders - did hospices
kuber-ross - did stages of grief model
