Advance Directives
a legal document that states the person's wishes for medical treatment in the event that he or she cannot make these decisions
Anticipatory grief
a reaction to an expected loss; may allow family members to express feelings, complete with unfinished business with the dying person and begin to deal with the loss
Bereavement
having a sustained loss
Cheyne-Stokes respirations
irregular respiratory rates with periods of apnea
Do Not Resuscitate (DNR)
an order that guides healthcare workers with regard to wishes of patients should they go into cardiac or respiratory distress
Durable power of attorney for health care
appoints someone to make the individuals wishes known and to carry out some decisions regarding their medical care in the event that they can no longer express themselves
Euthanasia
deliberate ending of one's life as well as the withholding of treatment
Grief
the feeling tone or the outward expression in response to a loss; considered healthy
Hospice care
a healthcare organization under Medicare and Medicaid and other third-party insurers that provides for the care of terminally ill persons in the comfort of their home; the focus of the treatment is comfort not curative
Living will
a form of Advance Directive that states the wishes of person regarding life sustaining treatment in case of serious illness (each state may have a different format)
Loss
an encounter that one faces during the course of his or her life
Maladaptive grief
an exaggerated, lengthy, unpredictable courses that results in unresolved conflicts
Mourning
the natural process that one goes through following a major loss
Patient Self-Determination Act (PSDA)
1991; a patient has the right to have advance directives in place
Palliative care
helping to relieve the suffering of terminally ill persons
What are Kubler-Ross's stages of death and dying?
Stage 1: Denial- when an individual believes that the information is not true and death will not occur
Stage 2: Anger- when the individual internalizes the truth about the impending death and maybe turned inward or displaced on another individual
Stage 3:
What are John Bowlby's stages of separation?
1. Numbing Stage- a protective mechanism for the individual allowing them time to mobilize their strength to deal with the loss
2. Painful Stage- the individual faces the magnitude of the loss
3. Disorganization and Despair Stage- the individual feels ang
What are the 3 main types of losses?
physical losses, symbolic losses, facing one's own death
What are physical losses and the different types?
Physical losses are those that are readily evident. Types: loss of a spouse, loss of a parent, loss of a child, loss of an unborn child, loss of a sibling
Loss of a spouse
studies demonstrate that there is a greater risk of death in the remaining spouse especially within 2 years following the death; men tend to feel alone and like they lost apart of themselves and women tend to feel abandoned
Loss of a parent
the meaning of this depends on the age of the child:
Children- encourage expression of feelings; for younger children this may occur during play, reassure the child, answer questions at their age level and honestly
Adult- remains extremely painful
Loss of a child
thought to be one of the most difficult experiences to comprehend and accept; often use blame and anger
Loss of an unborn child
causes an enormous sense of loss and disappointment; allowing parents to hold their baby may be good for the grieving process
Loss of a sibling
great pain at any stage of life; reorganization of the family is required-- children often blame themselves; still have to deal with parental grief; adults feel that the loss causes a void
What are symbolic losses?
those that are less apparent and include loss of work or status or a change in roles
What is the type of loss: facing one's own death?
affected by age, religion, culture, support of family/friends, and personal beliefs; should encourage end-of-life discussions
The development of the concept of death at various ages:
Infant- no concept of death
Toddlers- more concerned with separation; death means "less alive"
Preschool age- see death on tv or may have experienced it in their family; they become frightened
School age- have the capacity to understand the finality of de
What are some signs of approaching death?
withdrawal, decrease in sense, quiet, restless, agitated, breathing patterns change (respiratory rates become irregular with periods of apnea), vital signs change (BP drops, pulse slows), bowel and bladder weaken, decreased alertness, loss of heat, spirit
What are some considerations regarding end-of-life issues and decisions?
*advanced directive, Patient Self-Determination Act (PSDA), living will, Durable power of attorney, DNR
*Ethical issues: euthanasia, right to die, palliative care, hospice care
Right to Die
individuals have the right to refuse medical treatment even though it may result in death