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Dealing with Death & Bereavement

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Chapter 19 Dealing with Death & Bereavement Cultural context Customs related to disposal and remembrance of the dead, transfer of possessions, expressions of grief ... – PowerPoint PPT presentation

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Title: Dealing with Death & Bereavement


1
Chapter 19
  • Dealing with Death Bereavement

2
  • Cultural context
  • Customs related to disposal and remembrance of
    the dead, transfer of possessions, expressions of
    grief care of toward the dying
  •  
  • Mortality
  • Top cause for death are diseases.

3
  • Care of the dying
  • Hospice care- personal, patient and family
    centered care for the terminally ill
  •  
  • Focus is on palliative care- relief of pain and
    suffering, control of symptoms, maintaining
    satisfactory quality of life, allowing patient to
    die in peace and dignity.

4
  • Psychological Issues
  • Confronting ones own death
  • In absence of identifiable illness, at 100, tend
    to suffer functional declines, lose interest in
    eating and drinking, and die a natural death

5
  • Terminal drop or terminal decline- widely
    observed decline in cognitive abilities shortly
    before death decline in verbal ability
    significant
  •  
  • Near death experiences sense of being out of
    body and visions of bright lights or mystical
    encounters
  •  
  • May result from physiological changes or
    psychological responses to threat of death

6
  • Kubler-Ross- Five Stages of coming to terms with
    death
  • Denial
  • Anger
  • Bargaining for more time
  • Depression
  • Acceptance
  •  
  • Not everyone will experience all five stages or
    in same sequences may bounce between or return
    to stages

7
  • Patterns of Grieving
  • Bereavement- the loss of someone close and
    process of adjusting to it.
  •  
  • Brings change in status and role
  •  
  • Grief- emotional response initially experienced

8
  • Grief work
  • Shock and disbelief- immediately following the
    death feel lost and confused awareness of loss
    sinks in, numbness then overwhelming feelings of
    sadness, crying, may last weeks
  •  
  • Preoccupation with memory of the dead person-
    may last 6 months to 2 years, attempts to come to
    terms, unable to do so. May relive death and not
    accept it may feel dead person is present
    relieves at anniversary
  •  Resolution- renews interests in everyday
    situations, memories of the dead person bring
    fond feelings with sadness.

9
  • Commonalities
  • Depression is not universal in its expression or
    experience
  • High distress at outset does not necessarily
    avert long-term problems
  • Not everyone needs to work through a loss
  • Returning to normal not on a schedule
  • Cannot always resolve their grief and accept
    their loss

10
  • Common grief- depression that sets in immediately
    after bereavement and subsides over time
  •  
  • No empirical support for absent or delayed grief,
    but rather resilience- a low and gradually
    diminishing level of distress. May accept death
    as natural process
  •  
  • Grief therapy
  • Helps the bereaved cope with their loss

11
  • Childhood and Adolescence
  • Ages 5-7, begins to understand death as
    irreversible
  • Also that it is universal (all things must die)
    and therefore inevitable and a dead person is
    nonfunctional (all life functions end at death)
  • Pre-5, difficult to grasp
  • Table 19-2 (page 721-722)

12
  • How children show grief depends on cognitive and
    emotional ability. Some express through anger,
    acting out, refusal to acknowledge death
  •  
  • Help children understand death and bereavement
    process make as few changes to routines,
    household as possible

13
  • Adulthood
  • May experience little or major problems with
    death.
  •  
  • Surviving Loss of Spouse
  • Women difficult when structured life pleasing or
    caring for husband not only loose companion but
    important, central role. Men may experience
    similar

14
  • Quality of marital relationship affects degree to
    which widowhood affects mental health
  •  
  • If have become high dependent on spouse, tended
    to become more anxious and more difficult time
    grieving- longer mourning

15
  • Men who lost their wives within 5 year period,
    21 died if not remarried women 10 more likely
    to die
  •  
  • Loss of spouse may be loss of the protective
    shield- the one who reminded to take pills, care
    for, etc
  •  
  • Practical problems of care, poverty

16
  • Women- can be catalyst for growth, discovering
    submerged aspects of self, learning to be more
    independent search for personal meaning
  •  
  • May seek new companion, some seek new marriage-
    though not necessary- only companionship

17
  • Losing parent in adulthood
  • Experience emotional distress.
  • Helps to force resolution of important
    developmental issues achieving stronger sense of
    self more realistic goals and awareness of own
    mortality greater responsibility, commitment,
    and attachment to others
  • May have to assume responsibility for surviving
    parent and in keeping family together

18
  • Losing a child
  • Unprepared comes as a cruel, unnatural shock an
    untimely event that should not have happened
  • Parents may blame themselves may hasten parents
    death
  • If terminally ill, parents who discuss openly the
    impending death tend to achieve a sense of
    closure that helps to cope with the loss

19
  • Mourning a miscarriage
  • Most end to avoid talking about it grief becomes
    more intense and wrenching without support
  •  
  • Often overcome with frustration and helplessness
    often found support by supporting spouse.

20
  • The Right to Die
  • Suicide- 20-60 had tried suicide before
    completing it
  • Many care accidents and drug overdoses are
    actually unidentified suicides
  • 10 who attempt suicide kill themselves within 10
    years
  • 60 of nonfatal self-inflicted injuries treated
    in emergency rooms among teenage girls and young
    women are probable suicide attempts

21
  • women attempt suicide more than men however, men
    are more likely to complete a suicide- using more
    lethal methods
  • men over 50- 30 of all suicides, risk rises for
    men 85 and older- more likely to be depressed and
    socially isolated.
  • Older people are more likely to be effective with
    suicide the first time.
  • Family history of suicide dramatically increases
    risk

22
  • Genetics- mood and impulse control problems,
    increases risk
  • 8/10 people who killed themselves gave warning
    signs (withdrawing talking about death or
    suicide giving away possessions abusing
    substances personality changes unusual anger,
    boredom, or apathy neglect self care and
    appearance, avoid usual activities, complain of
    physical problems that may have no medical basis
    eat/sleep too much or not at all depression
    hopelessness.

23
  • When finally make decision to kill self, often
    appear improved mood, happier, and this is
    misinterpreted as being less at risk when in fact
    it is the final acceptance to die.

24
  • Aid in dying
  • Active Euthanasia- mercy killings, action taken
    directly and deliberately to shorten a life in
    order to end suffering or allow a terminally ill
    person to die with dignity. Illegal.
  • Passive Euthanasia- withholding or discontinuing
    treatment that might help extend the life of a
    terminally ill patient medication, life-support
    systems, feeding tubes. Some circumstances is
    legal.
  • Must be voluntary of person dying.

25
  • Assisted suicide- physician or other helps a
    person bring about a self-inflicted death.
  • Advance directives
  • Constitutional right to refuse or discontinue
    life-sustaining treatment- to request passive
    euthanasia. Must be mentally competent. This is a
    written document contains instructions. Living
    will is one type. 
  • Durable power of attorney- appoints someone to
    make decisions when person unable to make their
    own decisions

26
  • Assisted suicide- physician or other helps a
    person bring about a self-inflicted death.
  • Advance directives
  • Constitutional right to refuse or discontinue
    life-sustaining treatment- to request passive
    euthanasia. Must be mentally competent. This is a
    written document contains instructions. Living
    will is one type. 
  • Durable power of attorney- appoints someone to
    make decisions when person unable to make their
    own decisions
  • Ethical arguments for and against assisted
    suicides.
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