Lecture 9.6.16 - Death and Dying

Question 1

What are some symptoms of distress?

Answer 1

Depression, anxiety, hopelessness and despair, shock, guilt, loss of meaning, feeling like a burden to family

Question 2

Developmental tasks of dying patients include developing a renewed sense of ___, bringing closure to personal and community ___, bringing closure to worldly ___, and accepting the finality of life and surrendering to the ___.

Answer 2

Meaning; relationships; affairs; transcendent

Question 3

What are the 5 stages of grief according to Kubler-Ross?

Answer 3

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 4

What are the four tasks of grief for those who experience loss?

Answer 4

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.

Question 5

What are the four types of complicated grief?

Answer 5

1. Chronic grief
2. Delayed grief
3. Masked grief
4. Exaggerated grief

Question 6

What is the continuation of grief symptoms more than six months after the death?

Answer 6

Chronic grief

Question 7

What is bereavement occurring years or decades after a loss?

Answer 7

Delayed grief

Question 8

What type of grief involves symptoms of grief that may be absent or appear unrelated to the loss?

Answer 8

Masked grief

Question 9

What is grief characterized by excessive or disabling symptoms that may worsen with time?

Answer 9

Exaggerated grief

Question 10

What are the risk factors for complicated grief?

Answer 10

Specifics of the loss/who died, Nature of the attachment, mode of loss, historical antecedents and personality variables, social factors, and concurrent stressors

Question 11

What do patients want when they are dying?

Answer 11

Pain and symptom control, avoid inappropriate prolongation of the dying process, achieve a sense of control, relieve burdens on the family, and strengthen relationships with loved ones.

Question 12

___% of conscious patients who died in the hospital had moderate to severe pain over 50% of the time during the last three days of life.

Answer 12

50%

Question 13

True or false - it is common for patients to prefer CPR to be withheld, but physicians do not know this.

Answer 13

True

Question 14

What do families of dying patients want?

Answer 14

High quality medical care - providing dying persons with desired physical comfort, helping dying persons control decisions about medical care and daily routines, relieving family members of the burden of being present at all times, educating family members so they can care for their loved ones at home, providing family members with emotional support before and after the patient’s death

Question 15

What are some of the consequences to family members?

Answer 15

Increased risk of MI or cardiac death, increased risk of death, 5 times more PTSD, 8.8 times more prolonged grief disorder

Question 16

What is the RULE principle of motivational interviewing?

Answer 16

Resist the “right”-ing reflex
Understand the patient’s motivation
Listen to the patient
Empower the patient

Question 17

What is the NURSE principle of motivational interviewing?

Answer 17

Name the problem or emotion
Understand
respect
Support
Explore

Question 18

What is the SPIKES principle of motivational interviewing?

Answer 18

Setting up the interview
Assessing the patient's Perception
Obtaining the patient's Invitation
Give the Knowledge to the patient
Addressing the patient's Emotions with Empathetic responses
Summarize and provide strategy

Question 19

What are risk factors for burnout?

Answer 19

Not being able to maintain a work-life balance, not being able to say “no,” organizational and financial pressures, lack of social or spiritual support, taking work home, younger age, difficulty expressing emotions

Question 20

What are signs and symptoms of burnout

Answer 20

Tiredness out of proportion to work being done, low morale, avoidance of patients, easily irritable or getting angry, errors in judgment, depression or grief, difficulties at home