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PHTY2230 > L5: Grief and Loss > Flashcards

L5: Grief and Loss Flashcards

1
Q

___ and _____ are pervasive themes in health-care settings as patients adjust to disease and disability

A

Grief; mourning

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2
Q

Distress ___ (increases/decreases) as disease progresses

A

increases

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3
Q

Patients with advanced cancer report feeling socially _____, and that there is a distance between them and health professionals

A

isolated

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4
Q

What are 2 features of improved survival with facing incurable illnesses?

A
  1. Repeated crises leading to exhaustion of family members
  2. Difficulty pacing oneself - like running a marathon without a defined course
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5
Q

What are 7 factors which increase WTHD (high desire to die)?

A
  1. Higher level of depressive symptoms Treating the depression reduced the wish to hasten death
  2. Being admitted to in-patient hospice setting
  3. Greater perception of being a burden on others
  4. Lower family cohesion
  5. Lower levels of social support
  6. Higher levels of anxiety
  7. Greater impact of physical symptoms
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6
Q

What are 6 associations with the desire for death?

A
  1. Higher depression scores
  2. Lower physical functioning
  3. Perceived absence of social support
  4. Lower peace/meaning
  5. Lower religious faith
  6. Greater pain interference
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7
Q

In Pain and Palliative Care Services, _____ had no wish for hastened death

A

2/3

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8
Q

What are 8 common problems when patients are dying?

A
  1. Differences about goals of treatment
  2. Lack of communication between team members
  3. Angry/dysfunctional families
  4. Projection/displacement/splitting
  5. Difficulty for some staff to “let go”
  6. Challenge to sense of professional integrity
  7. Feelings of sadness, and the burden of being “immersed in suffering”
  8. Avoidance of patients/refusal to “talk the talk”
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9
Q

What are 3 effects on patients when the clinical has the fear of “taking away hope”?

A
  1. Pursuit of aggressive and futile treatments
  2. Failure to support patients and families
  3. Longer-term regret, and impact on family adjustment
    • “We thought we had more time” -
    • No one was brave enough to tell family about EOL
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10
Q

Hope is not about survival. It is about being treated with ______ and ____. Care for people when goal of treatment is not a ____ rather the goal is living as best as possible

A

dignity; respect; cure

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11
Q

What are 5 ways to promote hope in palliative care?

A
  1. Discussion about what can be done e.g. control of physical symptoms
  2. Treatment with care and dignity
  3. Practical support
  4. Exploration of realistic goals
  5. Discussion of day-to-day living:
    • Taking a day at a time
    • Focusing on the present
    • Knowing there will be good days and bad days
    • Trying to continue “living” because life does not stop when you are dying
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12
Q

What are 6 characteristics of grief?

A
  1. Grief is a universal human response
  2. First response to loss is shock, numbness, and disbelief
  3. Sense of unreality/nightmare
  4. “Frozen in time”
  5. The wish to avoid, but need to hear the words of death
  6. Anxiety and panic
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13
Q

What are 8 physical symptoms of grief?

A
  1. Restlessness
  2. Yearning
  3. Scanning the environment
  4. Waves of somatic distress
  5. Sighing respirations
  6. Palpitations
  7. Deep inner pain
  8. Choking sensation
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14
Q

___ and aggression are common with grief.

A

Anger

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15
Q

Intensity of feelings may be overwhelming, perceived as ______, and may be displaced onto others

A

irrational

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16
Q

The bereaved person feels ____ by the deceased whose absence causes this ___>

A

deserted; pain

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17
Q

Rites of passage (eg. funerals) are _____ of reality.

A

Consolidation

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18
Q

What is the practical function of a funeral?

A

Disposal of the dead body

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19
Q

What are the 3 symbolic functions of funerals?

A
  1. Separation of the dead from the living
  2. Opportunity for farewells
  3. Opportunity for re-establishment of the social group,
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20
Q

The bereaved are often “protected” from viewing the dead body, but this is often an important part of _____.

A

adjustment

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21
Q

What are the 4 theoretical perspectives on the tasks of mourning?

A
  1. Accept reality of the death
  2. Awareness and processing of the feelings In the early stage (grief and loss hurts) -> do not shut down emotions (negative effect long term)
  3. Negotiating a world without the deceased
  4. Constructing an ongoing representation of the deceased
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22
Q

What are 4 reasons why we mourn?

A
  1. When someone close to us dies, an attachment bond is broken
  2. Attachment refers to the propensity of humans to form affectional bonds
  3. Instinctively we resist disruption to these bonds – infants separated from their mother demonstrate protest, despair and detachment
  4. Many of the most intense emotions arise in the “formation, maintenance, disruption and renewal” of attachment bonds
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23
Q

Attachment bonds are an ___ response so we can not help mourning if bonds break.

A

innate

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24
Q

The must intense feelings we ever have are when we ___ or _____ attachment bonds.

A

form; break

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25
Q

Bereavement “invalidates a host of assumptions about the world - plans, thoughts, habits, ways of coping all have to be _____”. Adjustment is inhibited by censure about expression of ____.

A

re-learned; emotion

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26
Q

Why is it harder to let go of deaths now?

A

Average life expectancy has significantly improved - Death is less familiar Eg. 1881-1890 the average death for males is 47.2 yrs old and now it is 79.9yrs old.

27
Q

What are 4 sanitised responses to death?

A
  1. The entire population is:
    • Much-loved
    • Cherished
    • A devoted mother/father/aunt/uncle etc.
  2. All deaths are:
    • Peaceful
    • In the presence of loving family
  3. Occurring after:
    • A courageous fight against cancer
    • A brave struggle
  4. All deceased will be:
    • Sadly missed
    • Forever in our hearts
28
Q

Why are sanitised responses to death a problem?

A

Unable to share true feelings

  • ” I wish I had done this..etc”
29
Q

What are 7 reasons why health professionals often feel unprepared for the intense feelings of the grief of others engenders in them?

A
  1. Reminder of our own mortality
  2. Education focuses on cure as the desirable outcome and death is seen as failure
  3. The pain of others resonates with our own (often unexpressed) experiences of loss and grief o But there is powerful socialisation in health care:
  4. To be “in control”
  5. To “not get involved or show feelings”
  6. To fix things!
  7. To compare ourselves with others whom we perceive to be coping`
30
Q

What are ways to incorporate humour into serious content?

A
31
Q

What are 3 key components in complicated mourning?

A
  1. Sense of disbelief about the death
  2. Anger and bitterness about the death
  3. Recurrent pangs of painful emotion:
    • Intense yearning and longing for the deceased
    • Preoccupation with thoughts of the deceased
    • Often including distressing thoughts about the death
32
Q

What are the 4 risk factors for poor outcome?

A
  1. Type of death
  2. Relationship
  3. Characteristics of the surviour
  4. Social circumstances
33
Q

What are 3 types of deaths which are risk factors for poor outcomes?

A
  1. Blame
  2. Sudden
  3. Horrifying/mismanaged
34
Q

What are 3 relationships which are risk factors for poor outcomes?

A
  1. Dependent
  2. Ambivalent
  3. Spouse/child < 2 years
35
Q

What are 6 characteristics of the survivor which are risk factors for poor outcomes?

A
  1. Grief-prone
  2. Insecure
  3. Previous mental illness
  4. Excessively angry or self-reproachful
  5. Previous unresolved losses
  6. Inability to express feelings
36
Q

What are 6 social circumstances which are risk factors for poor outcomes?

A
  1. Intimate relationship
  2. Cultural/religious isolation
  3. Unemployed
  4. Dependent children
  5. Low socio-economic status
  6. Multiple losses
37
Q

What are 6 ways to help with poor outcomes?

A
  1. Giving bad news sensitively, in privacy and honestly
  2. Acknowledging the emotional impact
  3. Not exhorting the person to be brave
  4. The opportunity to talk and share painful feelings and memories including guilt
  5. Offering increased support for the person who is at risk of an adverse outcome
  6. Seeing when the person is “stuck” or depressed and initiating appropriate interventions
38
Q

What are 6 effects of grief in response to loss?

A
  1. Bodily parts (Guilt/blame Shame Anger Threat to life)
  2. Diagnosis of serious/life-threatening disease
  3. Survival does not necessarily mean “good as new”
  4. Functional limitations e.g. rheumatoid arthritis
  5. Sexual or reproductive function
  6. Ageing
39
Q

What are 5 physical losses of ageing?

A
  1. Visual acuity
  2. Hearing - anger, denial, projection
  3. Sexual function
  4. Fertility
  5. Bodily control:
    • Bladder
    • Balance
      • Falls are a high risk for death in older persons
    • Exercise tolerance
40
Q

What are 5 psychosocial losses of ageing?

A
  1. General health, well-being and mental agility
  2. Retirement - financial loss
  3. Loss of status and “value”
  4. Relationships:
    • “Empty nest”
    • Disengagement
    • Deaths
41
Q

What are 7 losses due to Lymphoedema?

A
  1. Diagnosis often delayed
  2. Impact on body image and sexuality
  3. Practical issues - clothing, pressure garments
  4. Lifestyle limitations
  5. Changes in relationships and roles
  6. Financial strain/employment
  7. Adjustment undermined by social pressure to be positive
42
Q

What are 2 reactions of others to loss?

A
  1. May not tell the truth to protect oneself from curiosity and protect others from being embarrassed
  2. Medical practitioners may downplay (“Compared with cancer it’s nothing.”)
43
Q

What are 2 examples of asking for help?

A
  1. “Why can’t they see I can’t do it? Why must I ask for help?”
  2. “I’ve always been the kind never to ask for help. I really hate having to ask …… it feels like a big defeat. Yes, I felt like a strong woman before and I feel like a weak person now.”
44
Q

What are 2 examples of the impact of loss (eg. Lymphoedema) on body image?

A
  1. Compression sleeve experienced as “ugly, terrible, unfeminine and warm”
  2. “So I stood in front of the mirror and started crying. The sleeve was so un-feminine. It was just awful.”
45
Q

What is an example of acknowledging chronicity (eg. Lymphoedema)?

A

“But, later, it became a problem. I wasn’t prepared for having it for the rest of my life. I thought it would pass. I didn’t realize that I might have to wear the sleeve for the rest of my life.”

Need to live with this for the rest of life - Loss not just about death but about the meaning to the individual and the ripple effect to various parts of their life

46
Q

____ are a leading cause of death and disability

A

Burns

47
Q

Estimated that up to 1/3 of burns victims have pre-existing _____ or ___ disorders, including alcohol dependence.

A

physical; psychiatric

48
Q

What is the problem with having a re-existing physical or psychiatric disorders in burns patients.

A

 These patients are likely to experience more difficulty adjusting to their injury  They are more likely to pose challenges in management

49
Q

What are the 3 adaptational stages of a burn?

A
  1. Resuscitation
  2. Restorative care
  3. Social/rehabilitative phase
50
Q

What are 5 characteristics of resuscitation (stage 1 in burns)?

A
  1. Physical survival
  2. Resuscitation - airway, fluids, wound care
  3. Pain and discomfort
  4. Attention to sleep and trauma of ICU
  5. Shock and distress of family
51
Q

What are 4 causes of delirium with patients in burns unit?

A
  1. Burn itself
  2. Infection
  3. Electrolyte imbalance
  4. Pharmacotherapy
52
Q

What is delirium? What does it mean?

A

Acute confusion stage - This body is sick (brain telling body)

53
Q

What are 3 post-traumatic stress symptoms?

A
  1. Intrusive thoughts and images/ “flashbacks”
  2. Disturbed sleep/nightmares
  3. Heightened physiological arousal
54
Q

What are 9 risks for developing PTSD?

A
  1. Increased risk for females
  2. ? Increased risk with higher TBSA
  3. Blame of others
  4. Risk of disfigurement (interaction with type of burn)
  5. Acute stress response
  6. Avoidant coping style
  7. High levels of neuroticism
  8. Perceived threat to life, level of control
  9. Attribution of responsibility
55
Q

What are 7 characteristics of the acute phase (2nd stage of burns)?

A
  1. Focus on restorative care
  2. Ongoing painful procedures Increased awareness and taking stock of the situation
  3. Disbelief, anger blame
  4. Survivor guilt
  5. Reappraisal of identity, roles and relationships (challenge to assumptive world)
  6. May prove overwhelming and lead to regression, aggression, and depression
56
Q

What are 3 risk factors for the prevalence of depression?

A
  1. Past history of depression
  2. Female
  3. Facial disfigurement
57
Q

What are 6 characteristics in the social/rehabilitation phase (3rd stage of burns)?

A
  1. Meaning of the injury to the survivor
  2. Compensation issues
  3. Review of pain suffered and the treatment experience
  4. Regaining functional ability
  5. Integrating a new sense of self and body image
  6. Coping with social engagement
58
Q

Increasing burn depth associated with ____ (more/less) body image disturbance for males and females

A

more

59
Q

Upper body and facial burns associated with greater interpersonal distress for ____ (women/men)

A

women

60
Q

Difficulties with sexuality, body image and psychosocial aspects of QoL occur regardless of improvements in _________.

A

physical functioning

61
Q

What are 4 issues for health professionals?

A
  1. Dependency of patients may lead to frustration
  2. Slow recovery may lead to disappointment, resentment or punitive attitudes
  3. Anger and grief may be displaced onto other staff or patients
  4. Risk of over-involvement
    • I can be the “hero”
    • I can fix this
62
Q

_____ is very important (face and hands) affects function, appearance and social relationships

A

Physical appearance

63
Q

What are 8 outcomes of burns on patients?

A
  1. 50 – 60% require some job change
  2. TBSA influences time from sustaining the burn to returning to work
  3. Conflicting data about marital breakdown
  4. Self-esteem lower amongst females
  5. Improvement in body image after about 12 months
  6. Concept of post-traumatic growth
  7. Size of burn alone does not determine outcome:
    • Burns on face and hands associated with increased difficulties in self-concept and social reintegration
    • Functional limitation a key issue
  8. Other factors affecting adjustment
    • Social support from family and friends
    • Past history of:
      • Personal difficulties
      • Depression
      • Unemployment
      • Alcohol dependence
64
Q

What are 6 management strategies for burns?

A
  1. Analgesia
  2. Detection and treatment of delirium
  3. Encouragement/honesty of staff and promotion of realistic optimism, whilst acknowledging the grief and loss
  4. Facilitating support
  5. Recognition and treatment of psychiatric complications such as PTSD, depression
  6. Staff communication, training and supervision

PHTY2230 (24 decks)

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