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Death, Dying, and Bereavement

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Chapter 19: Death, Dying, and Bereavement Traumatic death often followed by physical or mental problems including post-traumatic stress disorder Grief therapy with ... – PowerPoint PPT presentation

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Title: Death, Dying, and Bereavement


1
Chapter 19
  • Death, Dying, and Bereavement

2
In This Chapter
3
The Experience of Death Death Itself
  • Characteristics
  • Clinical death
  • Brain death
  • Social death

4
The Experience of Death Where Death Occurs
  • Hospitals in the U.S. (45)
  • Decedents home (25)
  • Long-term Care (22)
  • Hospice (14)
  • Other (6)

5
The Experience of Death Hospice Care
  • Philosophy
  • Death viewed as normal
  • Families and the patient encouraged to prepare
    for death
  • Family are involved in patients care
  • Control of care is in the hands of the patient
    and family
  • Medical care is palliative rather than curative

6
Hospice Care Types of Hospice Care
  • Home-based programs
  • Hospital-based programs
  • Special hospice centers
  • Hospice

7
Hospice Hospital-based and Home-based Care
Comparison
Hospital-Based Care Home-Based Care
Patient Pain Same Same
Length of Survival Same Same
Patient Satisfaction with Care Same Same
Family Satisfaction with Care Higher Lower
Family Sense of Burden Higher Lower

Lets take a minute to review some of these
comparisons.
8
Dying, Death, and Bereavement Hospice Care
  • Hospice Care
  • Pros
  • Reduced cost of death
  • Less burden on central caregiver
  • Cons
  • Increased family worry about pain management

9
Developmental Understanding of Death
10
The Meaning of Death for Adults Death as Loss
Age
  • Age differences
  • Young adults Loss of opportunity to experience
    things loss of family relationships
  • Older adults Loss of time to complete inner work

11
The Meaning of Death for Adults Death as Loss
Ethnic Differences
  • Ethnic differences
  • Mexican Americans Increase time spent with
    family or loved ones
  • White and African-Americans Would not change
    their lifestyle
  • See Table 19.2 for responses to hypothetical
    impending death

12
Stop and Think!
  • At what age do you think people are most fearful
    of death?
  • What prompted your answer?

13
Fear of Death
  • Middle-aged adults most fearful of death
  • Sense of unique invulnerability prevents intense
    fear of death in young adults
  • Older adults think and talk more about death than
    anyone else

14
Fear of Death Religious beliefs
  • Religious beliefs and fear of death
  • Very religious adults less afraid of death
  • Those totally irreligious may also fear death less

15
Figure 19.1 Age, Ethnicity and Fear of Death
16
Fear of Death Personal Worth
  • Fear of death reduced
  • Adults accomplish goals or believe they have
    become the person they set out to be
  • Belief that life has purpose or meaning
  • How is this related to Eriksons stage of
    integrity versus despair?

17
?
?
Questions To Ponder
  • Your loved one is dying of a terminal illness.
    Would you use a hospice center? Why or why not?
  • If you were told that you had a terminal disease
    and only 6 months to live, how would you want to
    spend your time until you died?
  • On a scale of 1 5, with 5 being high, how much
    do you fear death?

18
The Process of Dying Preparation for Death
  • Kinds of preparations
  • Practical preparations
  • Deeper preparations
  • Older adults more likely to have made these
    arrangements

19
The Process of Dying Preparation for Death
  • Final preparations
  • Unconscious changes just before death
  • Terminal drop for psychological health

20
Theoretical Perspectives on Dying Elisabeth
Kubler-Rosss Stages of Dying
21
Theoretical Perspectives on Dying Criticisms of
Kubler-Rosss Theory
  • Methodological problems
  • Cultural specificity
  • Stage concept unsupported

22
Theoretical Perspectives on Dying Alternate Views
  • Two additional views
  • Shneidman Dying process has many themes
  • Corr Coping with death involves taking care of
    specific tasks

23
Theoretical Perspectives on Dying Responses to
Impending Death
  • Greer Attitudes and behavioral choices can
    influence course of terminal disease
  • Five groups/stages
  • Denial (positive avoidance)
  • Fighting spirit
  • Stoic acceptance
  • Helplessness/hopelessness
  • Anxious preoccupation

24
Theoretical Perspectives on Dying Responses to
Impending Death
  • Greer concluded that the message may be
  • Those who struggle the most, fight the hardest,
    express their anger and hostility openly, and who
    find some sources of joy in their lives live
    longer.

25
Theoretical Perspectives on Dying Psychoanalytic
Theory
  • Traumatic death often followed by physical or
    mental problems
  • Grief therapy with children makes use of defense
    mechanisms (sublimation, identification)

26
Theoretical Perspectives on Grieving
  • Freud Death of a loved one is an emotional
    trauma
  • Ego tries to insulate itself from unpleasant
    emotions through defense mechanisms such as
    denial
  • BUT
  • Defense mechanisms provide only temporary relief
  • How do people grieve in healthy ways?

27
Theoretical Perspectives on Grieving Attachment
Theory
  • Bowlby
  • Intense grief likely to occur at loss of any
    attachment figure
  • Quality of attachment related to grief

28
Theoretical Perspectives on Grieving Attachment
Theory
  • Bowlby Four stages of grief

29
Theoretical Perspectives on Grieving Attachment
Theory
  • Sanders five stages of grief comparable to
    Bowlby
  • Shock
  • Awareness
  • Conservation/withdrawal
  • Healing
  • Renewal

30
Theoretical Perspectives on Grieving Attachment
Theory
  • Revisionist Views
  • Avoiding expressions of grief neither prolongs
    grief nor inevitably creates mental health
    problems
  • Grieving does not occur in fixed stages
  • Many themes present simultaneously but one or
    another may dominate at one point in time
  • Adults develop different patterns of grieving

31
Figure 19.2 Jacobss Model of Grieving
32
Theoretical Perspectives on Grieving Patterns of
Grieving
  • Wortman and Silver
  • Normal
  • Chronic
  • Delayed
  • Absent

33
Theoretical Perspectives on Grieving
Dual-Process Model
  • Alternates between

34
Theoretical Perspectives on Grieving The
Experience of Grieving Death Rituals
  • Psychosocial functions of death rituals such as
    funerals
  • Help family and friends manage grief by giving a
    specific set of roles
  • Bring family members together in unique ways
  • Establish shared milestones for families

35
Theoretical Perspectives on Grieving The Process
of Grieving
  • Factors Associated with Grief Age of the
    Bereaved
  • Children express feelings of grief like teens and
    adults
  • Teens often show prolonged grief responses

36
Theoretical Perspectives on Grieving Factors
Associated with Grief
  • Modes of Death and Grief
  • Caregiver widows may show depression.
  • Death with intrinsic meaning reduces grief.
  • Sudden and violent deaths evoke more intense
    grief.
  • Suicide produces unique responses in survivors.

37
Theoretical Perspectives on Grieving Widowhood
and Effects of Grief
  • Immediate and long term effects on the immune
    system
  • Incidence of depression among widows and widowers
    rises substantially

38
Theoretical Perspectives on Grieving
Pathological Grief
  • Depression-like symptoms lasting longer than 2
    months
  • Grief lasting longer than 6 months can lead to
    long-term depression and physical ailments
  • Problems may continue for up to 2 years after
    death of loved one
  • BUT cultural practices may mimic pathological
    grief

39
Theoretical Perspectives on Grieving Sex
Differences
  • Spouse death more negative for men than for
    women.
  • Risk of death higher in men immediately after a
    spouses death.
  • Widowers withdraw in multiple ways.
  • Alcohol use may influence depression.
  • Social relationships remain important for both
    sexes.

40
Theoretical Perspectives on Grieving Preventing
Long-Term Problems
  • Talk-it-out approach to managing grief can help
    prevent grief-related depression.
  • Developing coherent personal narrative of events
    surrounding spouses death helps manage grief.
  • Participating in support groups helps.
  • Appropriate amount of time off from work to
    grieve is important.
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