Care for the Dying and for Those Who Grieve

CHAPTER 32 Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Hospice and Palliative Care

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Dr. Elisabeth Kübler-Ross Goal is quality, compassionate care for people facing a life-limiting illness or injury Team-oriented approach to expert medical care, pain management, and emotional and spiritual support Tailored to patient’s needs and wishes Support to patient's loved ones included Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Hospice Care

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Available to everyone regardless of age, diagnosis, or the ability to pay

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Requires a physician’s best clinical judgment that the patient is terminally ill with a life expectancy of 6 months or less

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Patient chooses hospice care rather than curative treatment Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Nursing Goals in End-of-Life Care Practice the art of presence

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Assess for spiritual issues

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Provide palliative symptom management

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Become an effective communicator

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Counsel about anticipatory grieving

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Practice good self-care Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Nursing Goals in End-of-Life Care

Continued

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The Four Gifts of Resolving Relationships

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Forgiveness

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Love

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Gratitude

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Farewell Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Styles of Confronting the Prospect of Dying: Seven Motifs 5.

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7.

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3.

4.

Struggle – living and dying are a struggle Dissonance – dying is not living Endurance – triumph of inner strength Incorporation – belief system accommodates death Coping – working to find a new balance Quest – seeking meaning in dying Volatile – unresolved and unresigned Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Grief Reactions, Bereavement, and Mourning

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Grief – the reaction to loss

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Includes depressed mood, insomnia, anxiety, poor appetite, loss of interest, guilt, dreams about the deceased, poor concentration Bereavement – period of grieving following a death

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Mourning – things people do to cope with grief Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Dual-Process Model of Coping with Bereavement

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Loss-oriented stressors – concentrating on the loss experience, feeling the pain of grief, remembering, and longing

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Restoration-oriented stressors – overcoming loneliness, mastering skills and roles once performed by the deceased, finding a new identity, and facing practical details of life – Stroebe and Schut Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Four Tasks of Mourning

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Accept the reality of the loss

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Experience the pain of grief

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Adjust to an environment without the loved one

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Externally, internally, and spiritually

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Relocate and memorialize the loved one Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Maladaptive Grieving

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Chronic grief

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Delayed grief

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Exaggerated grief

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Masked grief reactions Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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Helping People Cope with Loss

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Four constructs that support personal growth

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Seeing some good resulting from the death

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Continuing the connection with the deceased

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Invoking intrinsic spirituality to understand the death and aftermath

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Going forward with life Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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