week 12- end of life Flashcards
factors that affect transitions
personal meaning, expectations, knowledge, planning, SES, emotional/physical reserves, societal conditions, culture, gender
gerotranscendence theory
- experience growing old with a positive outlook
- developmental process and the final developmental stage
- fear of death is lessened, mystery of life is accepted
- redefinition of self and of relationships
- new understanding of fundamental existential issues
nursing interventions to promote gerotrascendence
- presenting a specific topic related to old age and having open conversations
- discussing spiritual factors through a life map, art work, sharing dreams, reminiscence, tai chi
- increases level of satisfaction, decreases depression
end of life care models
- universal access to psychosocial, spiritual and physical care for all dying people
- care coordination case manager
- palliative and hospice care
- EOL care in all settings
living-dying interval
period made up of acute, chronic (slow decline) and terminal phases
signs of imminent death
progressive weakness, bedbound state, sleeping most of the day, decreased food intake, dark/decreased urine output, difficulty swallowing, delirium, decreased LOC, noisy respiration, change in breathing pattern, mottling
needs of the dying patient- physical
nutrition, hygiene, rest, elimination, relief of pain/symptoms, mouth/skin care, positioning
needs of the dying patient- psychological/spiritual care
- search for meaning and purpose in life and suffering
- sense of forgiveness
- acceptance of unfulfilled expectations
- compassionate presence
- privacy offered
- participation in decision-making and care
caregiving assessment
- context (home vs hospital)
- perception of health and illness
- preparedness for caregiving
- quality of care able to provide
- caregiver health
- use, desire for and ability to access supportive services
- awareness of wished for care and SDM
caregiving interventions
- support, listening
- respite
- education, resources and referrals
- psychotherapy
six C’s approach to dying
care (empathy) , control (enable self-determination), composure (enable expression), communication, continuity (enable legacy and transcendence), closure (goodbyes)
loss
generic term that signifies absence of an object, position, ability or attribute
grief
lifelong experience that has components of suffering but also aspects of celebration and continuing, evolving connection
dimensions of grief reactions
a) affective: depression, anxiety, anger, guilt
b) cognitive: preoccupation, helplessness, hopelessness
c) behavioural: agitation, fatigue, weeping
d) physiological-somatic: loss of appetite, exhaustion, susceptible to illness
e) existential: meaning of death, question spiritual beliefs
successful adaptation
generates a new positive equilibrium
unsuccessful adaptation
anger, hopelessness, substance misuse, depression
acute grief
4-6 weeks
persistent grief
more than 3 years
disenfranchised grief
an experience of the person whose loss cannot be openly acknowledged or publicly mourned
anticipatory grief
response to a real or perceived loss before that loss occurs
grieving models
a) freud: melancholia is a condition unable to break emotional bonds
b) lindemann: studied traits of grievers (unsuccessful vs successful adaptation)
c) kubler ross: stages of dying include denial, anger, bargaining, depression and acceptance
d) bowlby: grief process includes shock, searching/yearning, despair and reorganization
e) worden: grief experience includes numbness, pining, disorganization, despair
f) jett: grief as experience
jett loss response model
- impact of a death leads to functional disruption (disequilibrium)
- as they inform other family members, the loss becomes more real and new emotions may surface
- loss often comes with reorganization of family structure
- in order to regain equilibrium, the family must reframe their memories to accept that the future will look different
seven stages of grief
shock, denial, anger, bargaining, depression, testing and acceptance
