Part 7: Psychosocial well being of the patient

Who proposed the “Stages of Grieving Process”?

Elizabeth Kubler Ross

What groundbreaking book did Elizabeth Kubler Ross write and in what decade?

On Death and Dying

1960s

What are the 5 stages of grief?

DAB DA (pain away)

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

True or False: The 5 stages of grief can happen in any order

True

True or False: We can fully understand our mortality

False: We are mostly incapable of fully and completely understanding our mortality

Research indicates that most people cannot fully understand their mortality until they are at least in their _____

50s

True or False: Denial is always bad and you must confront the patient in denial.

False: Denial is often a necessary defense mechanism for patients, tho it can become pathological

The following is an example of what stage of grief?

“I’m still alive dammit! Treat me like a real person”

anger

Which of the following is a common emotional root of anger?
A. Entitlement
B. Loss of control
C. Anxiety
D. Fear

B. Loss of control

Which type of patient is most likely to express anger?

a. A child who is confused and scared

b. A younger patient who feels cheated by life’s circumstances

c. A middle aged patient who is worried about leaving their children behind

d. An older patient who is in chronic pain and tired from the treatment

b.

Anger is specially prevalent in younger patients, those who feel robbed or cheated by life’s circumstances

True or False: Depression is a bad thing and patients should be told to snap out of it because it will only make their disease worse

False. Depression may be necessary. It is necessary to grieve the loss of a loved one and dying patients are grieving the loss of everyone and everything they know. Depression is seen as a necessary preparation for this loss.

What is the best thing we can do for a depressed patient?

therapeutic silence: Sit and listen. Most patients don’t want advice they just want to be heard.

True or False: Acceptance is the same as giving up.

False

What is acceptance?

being with things as they are instead of fighting them

What is a benefit of reaching acceptance?

calm and peace = reduces stress = enhances healing

Acceptance is (willfulness / willingness)

Willingness

Who created the hierarchy of human needs?

Abraham Maslow

What shape is Abraham Maslow’s hierarchy of human needs?

Pyramid shape

What the the 5 levels of Abraham Maslow’s hierarchy of human needs? (starting from 5 to 1)

SESSP (Cesspool- Sesspool)

5.Self-actualization (top of pyramid)

4.Esteem

3.Socialization/ Affection

2.Safety & Security

1.Physiological needs

term. Self-Actualization

def. the fulfilment of the human potential

term. Esteem

def. a good strong sense of self

True or False: Esteem is the same as being egotistical

False: Esteem is knowing who you are

Which better describes Maslow’s 3rd level : Affection or Socialization

Socialization

term. affection/ socialization

def. healthy integration into society

List factors that Maslow identified as level 1 Physiological needs (8)

1. oxygen

2. water

3. Nutrition

4. Elimination

5. physiological homeostasis

6. Rest and sleep

7. Avoidance of pain

8. Sex (basic motive but not considered essential to survival)

True or False: For Maslow’s Hierarchy of human needs, one must fulfil the first stages before advancing to the next one

True

True or False: For Maslow’s Hierarchy of human needs, one must fully fulfil the first stages before advancing to the next one

False: Partial satisfaction of a need can allow a person to work on the next stage, BUT with a decreasing level of satisfaction in each need as the person climbs up the hierarchy

True or False: For Maslow’s Hierarchy of human needs, you can focus on several levels at the same time

True BUT only one level can be DOMINANT at any given time

True or False: If you are focused on a higher level, circumstances might require increased attention to lower level needs

True:

FYI: E.g. you are working on level 4 Esteem by practicing for a marathon, but then you get really sick for a week and in a lot of pain so you got to level 1, then you get better and go back to level 4

What happens if a person remains at a lower level after those needs are satisfied?

They tend to become bored, fatigued and resentful (cuz they want more)

Which level produces more genuine happiness, security and richness of inner life?

Higher levels especially level 5: Self Actualization

What do the first 4 levels describe?

Needs descriptive of “longing” or “wanting”

What does the top level (self-actualization) describe?

an “inner fullness” without such “needs/ attachments”

True or False: The 5 Stages of Grief are sequential, while Maslow’s hierarchy is not.

False, its the other way around

According to Maslow, about what percent of the population becomes self-actualized

1% or less

Why do only 1% or less of people become self actualized?

Although self-actualization is an innate need, the other 4 levels need to be achieved first, which is hard to do in a poverty-stricken or emotionally deprived environment

True or False: Maslow’s Hierarchy applies to all individuals

False: Some people may become satisfied by meeting lower level needs

How does Maslow’s Hierarchy apply to our patients and patient care?

The cancer process threatens level 1, so patients start from scratch. They must first satisfy physiological and safety needs (e.g. making sure their family is ok financial, securing housing, etc.) before moving to “socialization level”

Once a patient moves onto the socialization level, what is the patient looking for in this stage?

1. Support and camaraderie from family and friends.

2. Seeking people in similar situations

Once a patients reaches the esteem level, what are they looking for?

Approval from the effect of tx from the physician and RTT to gain a feeling of empowerment over the disease