New York Psychological Issues in Advancing and Terminal Illness Paper Please reply to two of the prompts below Explain the medical, social, and psychologic

New York Psychological Issues in Advancing and Terminal Illness Paper Please reply to two of the prompts below Explain the medical, social, and psychological factors associated with continuing treatment of a terminal illness. What options are now available to terminally ill patients and their families? Describe Kübler-Ross’s theory of dying. Evaluate the usefulness of her theory. Suppose that you are working in a facility that provides care for terminally ill patients and their families. Outline the useful set of goals that will enable you to work with the dying. There has been a great deal of interest in hospice and home care for the terminally ill. What are the advantages of each for patients and care providers? What are the disadvantages? Describe the psychological and physiological correlates of grief. Each of your responses should incorporate
course content assigned during that particular week and should be approximately
250 words Chapter
Twelve:
Psychological
Issues in
Advancing and
Terminal Illness
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
•Death across the life span
•Psychological issues in advancing illness
•Are there stages in adjustment to dying?
•Psychological management of the terminally
ill
•Alternatives to hospital care for the
terminally ill
•Problems of survivors
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Education.
2
•Lack of free or low-cost maternal care
programs
•Congenital abnormalities
•Sudden infant death syndrome (SIDS):
Condition where an infant stops breathing,
which is to occur:
• In lower-class urban environments
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Education.
3
• If the mother smoked during pregnancy
• If baby is put to sleep on its stomach or side
•Children under age fifteen
• Accidents
• Cancer
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Education.
4
Ages up to five
• Think of death as a great sleep
• Curious about death
Ages between five and nine
• Idea that death is final develops
• No biological understanding of death
Ages nine or ten
• Moderate understanding of the processes involved in
death
• Realize that the person who has died will not return
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
5
Unintentional injury
Homicide
Suicide
Cancer
Heart disease
AIDS
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Education.
6
•Young adults facing a terminal illness
• Feel shock, outrage, and an acute sense of
injustice
• May face a long and drawn-out period of dying
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Education.
7
•Becomes more realistic since:
• It is more common
• Chronic health problems leading to death can
develop
•Premature death: Occurs before the
projected age of 78
• Mainly caused by heart attack or stroke
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Education.
8
•Most people prefer a sudden death as:
• It facilitates a more graceful departure
• Their family does not have to witness their
worsening condition
• Finances and other resources are not severely
taxed
•Socioeconomic status is a strong determinant
of age of death
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
9
•The elderly are more prepared to face death
as they have:
• Seen friends and relatives die
• Thought about their death and made some
preparations
•Causes
• Degenerative diseases
• Physical decline that predisposes them to
infectious disease or organ failure
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
10
•Factors that predict mortality in the elderly
• New illnesses and the worsening of preexisting
conditions
• Poor mental health and reduced satisfaction
with life
•Women live longer than men
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
11
•The Patient Self-Determination Act – Requires
health facilities to have policies concerning
patients’ wishes for life-prolonging therapy
•Right-to-die movement – Maintains that dying
is more a matter of personal choice and
personal control
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
12
•Euthanasia: Ending the life of a person who
is suffering from a painful terminal illness
•Living will: Instructions and legal protection
for the physician
• So that life-prolonging interventions will not
be indefinitely undertaken
• Does not always ensure patient’s requests are
met
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
13
Changes in the
patient’s self-concept
Issues of social
interaction
Communication issues
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Education.
14
•Reasons for people falling prey to dubious
remedies
• Hope for a miracle cure
• Deteriorating relationship with the formal
health care system
• Desire for a more humanistic care
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Education.
15
•Denial – Patient’s initial reaction on learning
of the diagnosis
• Defense mechanism by which people avoid the
implications of an illness
•Anger – Harder response for family and
friends to deal with
• Patient is not really angry with them but at
fate
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
16
•Bargaining – Trading good behavior for good
health
•Depression – Time for anticipatory grief
• Patient mourns the prospect of his/her death
•Acceptance – A tired, peaceful calm descends
• Patients decide to divide up their possessions
and say goodbye to friends and family
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
17
•Patients do not:
• Go through the stages in a predetermined
order
• Fully acknowledge the importance of anxiety
• One of the most common responses
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Education.
18
•Provide physical assistance
•Help reduce pain
•See patients on a regular basis
•Are the only source of realistic information
•Are privy to the patient’s act of dying
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
19
•Physical care that is palliative
• Palliative care: Designed to make the patient
feel comfortable
• Curative care: Designed to cure the patient’s
disease
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Education.
20
•Staff may burn out from watching patient
after patient die
•Patients interpret it as abandonment when
the physicians spend less time with them
• Physicians spend less time with terminally ill
patients to dedicate their time for patients
who can most profit from it
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
21
Informed consent
Safe conduct
Significant survival
Anticipatory grief
Timely and appropriate death
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
22
•Therapy
• Short-term
• Nature and timing of visits depend on the
patient’s desires and energy level
•Thanatologists: People who study death and
dying
• Believe that cognitive-behavioral therapies
can be constructively employed with dying
patients
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
23
•Children infer about their condition
taking cues from:
by
• Their treatments
• People around them
•Counseling
• Helps therapists take cues about what to
discuss from the child
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
24
• Helps parents to cope with the impending
death
• Restores balance in a family with other
children
• Provides supportive mental health services to
the parents who experience post-traumatic
stress disorder
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Education.
25
•Provide palliative care and emotional support
to dying patients and their family members
•Hospice: Place that provided care and
comfort for travelers in medieval Europe
•Painful or invasive therapies are discontinued
•Oriented toward improving a patient’s social
support system
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Education.
26
•Taking care of the patient at home
•Most popular and economically feasible
•Provides psychological advantages for the
patient
•Stressful for the family
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Education.
27
•Grief: Feeling of hollowness marked by:
• Preoccupation with the image of the deceased
• Expressions of hostility toward others
• Guilt over the death
•Grief response is more aggravated in:
• Men
• Caregivers
• People whose loss was sudden and unexpected
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
28
•Biggest burden
• For women – Financial strain
• For men – Strains of managing a household
•Death of a sibling raises complications for
children
•Children should be prepared for the death
• Questions should be answered honestly
• Information should be provided at the right
time
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
29
•Developing realistic expectations about:
• What modern medicine can achieve
• The kind of care the dying want and need
•Colleges have developed courses on dying
• Volunteer work with dying patients
• Potential problem – Unintended
encouragement for self-destructive leanings
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
30
Chapter
Twelve:
Psychological
Issues in
Advancing and
Terminal Illness
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
•Death across the life span
•Psychological issues in advancing illness
•Are there stages in adjustment to dying?
•Psychological management of the terminally
ill
•Alternatives to hospital care for the
terminally ill
•Problems of survivors
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
2
•Lack of free or low-cost maternal care
programs
•Congenital abnormalities
•Sudden infant death syndrome (SIDS):
Condition where an infant stops breathing,
which is to occur:
• In lower-class urban environments
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
3
• If the mother smoked during pregnancy
• If baby is put to sleep on its stomach or side
•Children under age fifteen
• Accidents
• Cancer
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
4
Ages up to five
• Think of death as a great sleep
• Curious about death
Ages between five and nine
• Idea that death is final develops
• No biological understanding of death
Ages nine or ten
• Moderate understanding of the processes involved in
death
• Realize that the person who has died will not return
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
5
Unintentional injury
Homicide
Suicide
Cancer
Heart disease
AIDS
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
6
•Young adults facing a terminal illness
• Feel shock, outrage, and an acute sense of
injustice
• May face a long and drawn-out period of dying
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
7
•Becomes more realistic since:
• It is more common
• Chronic health problems leading to death can
develop
•Premature death: Occurs before the
projected age of 78
• Mainly caused by heart attack or stroke
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
8
•Most people prefer a sudden death as:
• It facilitates a more graceful departure
• Their family does not have to witness their
worsening condition
• Finances and other resources are not severely
taxed
•Socioeconomic status is a strong determinant
of age of death
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
9
•The elderly are more prepared to face death
as they have:
• Seen friends and relatives die
• Thought about their death and made some
preparations
•Causes
• Degenerative diseases
• Physical decline that predisposes them to
infectious disease or organ failure
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
10
•Factors that predict mortality in the elderly
• New illnesses and the worsening of preexisting
conditions
• Poor mental health and reduced satisfaction
with life
•Women live longer than men
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
11
•The Patient Self-Determination Act – Requires
health facilities to have policies concerning
patients’ wishes for life-prolonging therapy
•Right-to-die movement – Maintains that dying
is more a matter of personal choice and
personal control
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
12
•Euthanasia: Ending the life of a person who
is suffering from a painful terminal illness
•Living will: Instructions and legal protection
for the physician
• So that life-prolonging interventions will not
be indefinitely undertaken
• Does not always ensure patient’s requests are
met
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
13
Changes in the
patient’s self-concept
Issues of social
interaction
Communication issues
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
14
•Reasons for people falling prey to dubious
remedies
• Hope for a miracle cure
• Deteriorating relationship with the formal
health care system
• Desire for a more humanistic care
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
15
•Denial – Patient’s initial reaction on learning
of the diagnosis
• Defense mechanism by which people avoid the
implications of an illness
•Anger – Harder response for family and
friends to deal with
• Patient is not really angry with them but at
fate
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
16
•Bargaining – Trading good behavior for good
health
•Depression – Time for anticipatory grief
• Patient mourns the prospect of his/her death
•Acceptance – A tired, peaceful calm descends
• Patients decide to divide up their possessions
and say goodbye to friends and family
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
17
•Patients do not:
• Go through the stages in a predetermined
order
• Fully acknowledge the importance of anxiety
• One of the most common responses
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
18
•Provide physical assistance
•Help reduce pain
•See patients on a regular basis
•Are the only source of realistic information
•Are privy to the patient’s act of dying
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
19
•Physical care that is palliative
• Palliative care: Designed to make the patient
feel comfortable
• Curative care: Designed to cure the patient’s
disease
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
20
•Staff may burn out from watching patient
after patient die
•Patients interpret it as abandonment when
the physicians spend less time with them
• Physicians spend less time with terminally ill
patients to dedicate their time for patients
who can most profit from it
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
21
Informed consent
Safe conduct
Significant survival
Anticipatory grief
Timely and appropriate death
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
22
•Therapy
• Short-term
• Nature and timing of visits depend on the
patient’s desires and energy level
•Thanatologists: People who study death and
dying
• Believe that cognitive-behavioral therapies
can be constructively employed with dying
patients
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
23
•Children infer about their condition
by
taking cues from:
• Their treatments
• People around them
•Counseling
• Helps therapists take cues about what to
discuss from the child
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
24
• Helps parents t…
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