Week 13: End of Life/Loss/Grief/Bereavement

Gillooly

signs of impending death

• weakness/immobility

• weight loss/gain

• decreased appetite

• loss of bladder and bowel movement

• diaphoresis: excessive sweat

• lung congestion: death rattle

• altered breathing: cheyne-stokes respirations = abnormal pattern: progressively deepends and speeds up, then gradually becomes shallow and slow, then has a temporary halt

hospice

type of palliative care (for those seriously ill)

• needed for symptom relief, not cure

• supports patient and family through dying process & those going through bereavement

childhood

reactions to death:

• perspective of death on the basis of impulsivity

• fatally ill kids → fear abandonment → require frequent and constant care

• older kids → need logic to be less anxious about death and dying process

  • suggested that head-on exposure to death through funeral allows them to understand finality and the grieving process

adolescence and emerging adulthood

reactions to death:

• teens have little fear of death:

  • seek thrill and take risks

  • invincibility: believe they don’t be harmed

  • questions about the meaning of life

  • understands death is permanent and inevitable

adulthood

reactions to death:

• most quit addictive drugs, wear seatbelts, adopt other precautions to prevent death or risk

• ill adults → worry about leaving others, like their kids, or things undone

late adulthood

reactions to death:

• hope rises

• mental health: acceptance and altruistic concern about those who live on and after them (legacy)

• family becomes most important

• acceptance of death does not mean they give up on living

denial

first stage of grief: most common response, defense mechanism, and buffer of initial shock of trauma

anger

second stage of grief: result of extreme emotional discomfort

bargaining

third stage of grief: individual wrongly assumes they can avoid grief through negotiation

depression

fourth stage of grief: individual accepts the loss is real and is happening

acceptance

fifth stage of grief: individual resists the urge to deny or change their situation

living will

describes the wishes of patient under EOL care

• must be made before patient is terminally ill or incapacitated

• respected and upheld by courts

power of attorney

type of advanced directive that trasnfers healthcare decision-making to a designated person by patient

• used when patient cannot communicate

• must be made before incapacitated

• can legally sign consent for patient

• ends when the person dies

physician assisted suicide

facilitation of suicide where the person knowingly takes lethal drugs prescribed by lethal drugs prescribed by a doctor for the purpose of suicide

euthanasia

intentional act with purpose of causing death (ex. lethal injection)

passive: ill person dies naturally

do not resuscitate: patient directive to not attempt to revive during cardiac or respiratory arrest

brain death

modern evidence of death:

• no brainwaves, no response to pain, or breathing

• absent and voluntary movement

locked-in syndrome

modern evidence of death:

• cannot move except eyes

• normal brainwaves

coma

modern evidence of death:

• deep unconsciousness

• depressed brainstem reflexes

• no pain response

• irregular breathing

vegetative state

modern evidence of death:

• deep unconsciousness

• cognitive function absent

• breathing and heart rate are present

• eyes may open but does not respond to the stimuli

grief reactions

placing blame:

• common impulse after unjust deaths

• blame death, themself, or others

seeking meaning:

• preserve memories: pictures, anecdotes

• support groups: those with similar experiences

• organizations devote causes to loved ones

• start charities to honor them

normal grief

physical: lack of energy, weight loss/gain, insomnia

emotional: anger, anxiety, relief, and despair

cognitive: disbelief, confusion, and inability to concentrate

behavioral: crying, impaired functions, withdrawal, and changes of relationship

incomplete grief

situation interferes with the grieving process: mourning cut short when distracted from recovery

dysfunctional grief

failure to follow predictable course of normal grieving

• maladaptive coping strategies

• expression of unresolved issues and symptoms → interferes with functioning