G & D Ch. 17

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Death, Dying, and Grieving

Death, Dying, and Grieving

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  • 1. CHAPTER 17 Death, Dying, & Grieving
  • 2. Definitions & Legal Issues
    • Sociocultural Definitions
    • Grief expressed differently in different cultures
    • Death viewed in 10 main ways:
    • 1. As an image or object
    • Sympathy cards, tombstones, color black (in the West)
    • 2. As a statistic
    • Mortality rates, patients who die from a certain disease, murder suicide rates, life expectancy tables
    • 3. As an event
    • Funeral, memorial service
    • 4. As a boundary
    • Questioning self, family, outcome
    • 5. As a state of being
    • What happens?
    • 6. As a thief of meaning
    • Takes you with more to do
    • 7. As an analogy
    • Dead as a doornail, dead wrong, dead heat
    • 8. As fear & anxiety
    • How will it happen? What about others?
    • 9. As a mystery
    • What’s it like, what happens after death?
    • 10. As a reward or punishment
    • Everyone meets justice
  • 3. Legal & Medical Definitions
    • Clinical Death:
    • Lack of heartbeat & respiration
    • Brain Death:
    • 1. No spontaneous movement in response to stimuli
    • 2. No spontaneous respirations for at least 1 hour
    • 3. Total lack of response to painful stimuli
    • 4. No eye movements, blinking, or pupil responses
    • 5. No postural activity, swallowing, yawning, or vocalizing
    • 6. No motor reflexes
    • 7. A flat EEG for at least 10 minutes
    • 8. No change in any of these in 24 hours
    • To be declared brain dead all 8 must be met
    • Lack of brain activity must occur in both the brain stem & cortex
    • Persistent vegetative state:
    • Cortical functioning ceases while brainstem activity continues
    • No recovery from this
  • 4. Ethical Issues
    • Euthanasia:
    • Ending of a life for reasons of mercy
    • Moral dilemma in decision of circumstances
    • Active Euthanasia
    • Deliberately ending someone’s life based on a clear statement of the person’s wishes or a decision made by someone else who has legal authority
    • Usually when one is in a persistent vegetative state or suffering at the end of a terminal illness
    • Passive Euthanasia
    • Allowing a person to die by withholding available treatment
  • 5. Making intentions known
    • Legality of Euthanasia
    • In many areas, euthanasia is legal only when person has made wishes known
    • 2 ways to make wishes known:
    • 1. Living will
    • States wishes about life support & other treatments
    • 2. Durable power of attorney
    • Make wishes known & names a legal authority to speak for the person
  • 6. The Hospice
    • Assisting Dying People
    • Emphasizes pain management, or palliative care, & death with dignity
    • Concern is making the person as peaceful & comfortable as possible, not to delay death
    • Primarily aimed at controlling pain & restoring normal functioning
    • Hospice services requested only after person or physician believes no treatment or cure possible
  • 7. The Hospice
    • 2 Types
    • 1. Inpatient provides all care for client
    • 2. Outpatient provides a nurse to visit the client at home
    • Not a hospital
    • Role of staff is to be with client, not treat the client
    • Often attention is paid to personal appearance & grooming
    • Hospice clients more mobile, less anxious, & less depressed
    • Quality of personal care is higher & quality of life better in hospice
    • Considerations:
    • 1. Is person completely informed re: nature & prognosis of condition?
    • 2. What options are available in the progress of the disease?
    • 3. What are the person’s expectations, fears, & hopes?
    • 4. How well do the people in the person’s social network communicate with each other?
    • 5. Are family members available to participate in terminal care?
    • 6. Is a high-quality hospice care program available?
  • 8. Dealing with One’s Own Death
    • Kubler-Ross’s theory
    • 5 Emotional States Dealing with Terminal Patients
    • Denial, Anger, Bargaining, Depression, Acceptance
    • Emotions can overlap & experienced in different order
    • Not everyone progresses through the stages at the same rate or in the same order
    • Emphasis is on differences between the various stages
    • Duration of stage or specific phase varies widely from person to person
  • 9. A Final Scenario
    • Making Choices
    • About how one wants & does not want their life to end
    • End-of-life Issues
    • Management of the final phase of life, after-death disposition of the body & memorial services, & distribution of assets
    • Deciding how the end of life should be handled helps people take control of their dying
  • 10. Grieving
    • Bereavement:
    • State or condition caused by loss through death
    • Grief:
    • Sorrow, hurt, anger, guilt, confusion, & other feelings that arise after suffering a loss
    • Mourning:
    • The ways in which grief is expressed
  • 11. The Grief Process
    • Grieving
    • A complicated process
    • Does not have clearly marked stages
    • When someone dies, must reorganize life establishing new patterns of behavior, & redefine friendships with family & friends
  • 12. Processes in Grief
    • Processes:
    • 1. Acknowledging the reality of the loss
    • 2. Working though the emotional turmoil
    • 3. Adjusting to the environment where the deceased is absent
    • 4. Loosen ties to the deceased
    • Mistakes to Avoid:
    • What works for one person may not work for another
    • Don’t underestimate the amount of time needed to deal with various issues
    • Takes at least 2 years to begin recovery
    • There is no recovery, it is living with the loss
  • 13. Risk Factors in Grief
    • Most Important Factors are:
    • Mode of death, personal factors (e.g. personality, religiosity, age, gender), & interpersonal context (social support, kinship relationship)
    • Greater the attachment, greater the grief
    • Church attendance helps some deal with bereavement
    • This is due more to social support
    • Social support helps buffer the effects of bereavement for older rather than middle age adults
  • 14. Normal Grief Reactions
    • Grief Work
    • The psychological side of coming to terms with bereavement
    • Coping
    • What people do to deal with their loss in terms of what helps them
    • Affect
    • People’s emotional reactions to the death of their loved one
    • Change
    • Ways in which survivors’ lives change as a result of the loss
    • Narrative
    • The stories survivors tell about the deceased
    • Relationship
    • Reflects who the deceased person was & the nature of the ties between that person & the survivor
  • 15. Grief Over Time
    • Grief Counseling
    • Reports of better outcomes when religious or spiritual issues are included in the therapeutic process
  • 16. Coping with Grief
    • 4 Components to Grief:
    • 1. Context of the loss
    • 2. The continuation of subjective meaning associated with the loss
    • 3. The changing representations of the lost relationship over time
    • 4. The role of coping & emotion-regulation processes
    • Dealing with Grief
    • Complex & only understood as a complex outcome that unfolds over time
    • Dual Process Model:
    • Defines 2 broad stressors
    • 1. Loss-oriented stressors
    • Those having to do with the loss itself
    • 2. Restoration-oriented stressors
    • Relating to adapting to the survivor’s new life situation
  • 17. Traumatic Grief Reactions
    • Not Everyone can Cope Well & Begin Rebuilding a Life
    • Traumatic Grief Involves:
    • 1. Symptoms of separation distress
    • 2. Preoccupation with the deceased to the point of interference with everyday functioning
    • 3. Symptoms of traumatic distress
    • 4. Feelings of disbelief about the death, mistrust, anger, & detachment from others as a result of the death, feeling shocked by the death, & the experience of somatic symptoms of the deceased
    • Grief can be still quite strong 10 years after the loss
  • 18. Bereavement Across the Life-Span : Childhood
    • Preschool
    • Death is temporary & magical
    • Not until around 5 – 7 do they realize it is permanent
    • 3 Areas of Change
    • Affect their understanding of death
    • 1. Cognitive-language ability
    • 2. Psychosocial development
    • 3. Coping skills
    • Children’s feelings of loss of a loved one vary with age
    • In middle childhood, child may feel responsible
  • 19. Bereavement Across the Life-Span : Childhood
    • Limited Ability to Cope
    • Typical reactions in early childhood:
    • Regression, guilt for causing the death, denial, displacement, repression, & wishful thinking
    • Reactions in later childhood:
    • Problems in school, anger, & physical ailments
    • With maturity, coping skills improve
    • Some they get from observing adults
    • Bereavement During Childhood
    • No long-lasting effects unless child does not get adequate care following the death
    • Understanding death can be difficult for children if adults aren’t open & honest about the meaning of death
    • Explain death to them in their own terms & that whatever they feel is okay
    • Mostly, provide loving support
  • 20. Bereavement Across the Life-Span : Adolescence
    • More Experience with Death & Grief than Many Realize
    • May have trouble making sense of death of someone close
    • Effects can be severe, & unresolved grief has been linked to agitated depression, chronic illness, enduring guilt, low self-esteem, poorer performance in school & on the job, & problems in interpersonal relationships
    • Reluctant to Discuss Grief with Loss of Sibling
    • Don’t want to appear different from their peers
    • Become vulnerable to psychosomatic symptoms
    • Headaches & stomach pains
    • With loss of parent, many show similar behaviors as loss of sibling
    • Family dynamics change with loss
    • With loss of peer comes survivor guilt
  • 21. Bereavement Across the Life-Span : Adulthood
    • Reactions
    • Natural consequence of forming attachments & losing them
    • Loss of partner is usually unexpected & traumatic
    • With young widows, level of grief does not diminish significantly until 5 – 10 years after the loss
    • Maintains strong attachment to deceased
    • In midlife, survivor challenges basic assumptions about self, relationships, & life options
  • 22. Death of a Child in Young & Middle Adulthood
    • With SIDS, Anxiety is High
    • Very negative view of world & guilt
    • Attachment to child begins before birth, esp. for mothers
    • Parents experiencing miscarriage, still-born, or neonatal death expected to recover quickly
    • Many report deep sense of loss
  • 23. Death of Parent
    • Loss of a Parent
    • Loss of key relationship & psychological buffer between one’s self & death
    • Feelings of loss reflect a sense of letting go, loss of a buffer, acceptance of one’s own eventual death, & sense of relief that parent’s suffering is over
  • 24. Late Adulthood
    • Death of Child or Grandchild
    • Reevaluation loss shortly after and years later
    • Many years later can feel sense of loss & continued difficulty coming to terms with it
    • Loss of a grandchild is similar
    • Family dynamics must be restructured
    • Death of One’s Partner
    • Deep personal loss
    • Social support significant in outcome of grieving process during 1st 2 years after death
    • Quality of support important
    • Bereaved spouse’s ratings of marriage
    • The more depressed the spouse, the more positive the marriage’s rating
    • Depressed nonbereaved spouses gave marriage negative ratings
    • Some widows “sanctify” their husbands
    • Cognitive-behavioral therapy is especially effective intervention to help make sense of loss & deal with other thoughts & feelings
  • 25. Widowhood
    • Death of Spouse Usually Follows Period of Caregiving
    • Widows & widowers not only lose spouse but friends & family who feel uncomfortable including a single person rather than a couple in social functions
    • Men & Women React Differently to Widowhood
    • Widowers higher risk of dying soon after spouse either by suicide or natural causes
    • For many women, widowhood means poverty
    • Older widowers less likely to form new, close friendships
    • Widowers 5 times more likely to remarry