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CHAPTER 32

Care for the Dying and for Those Who Grieve. CHAPTER 32. Hospice and Palliative Care. Dr. Elisabeth Kübler-Ross Goal is quality, compassionate care for people facing a life-limiting illness or injury

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CHAPTER 32

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  1. Care for the Dying and for Those Who Grieve CHAPTER 32

  2. Hospice and Palliative Care • Dr. Elisabeth Kübler-Ross • Goal is quality, compassionate care for people facing a life-limiting illness or injury • Team-oriented approach to expert medical care, pain management, and emotional and spiritual support • Tailored to patient’s needs and wishes • Support to patient's loved ones included

  3. Hospice Care • Available to everyone regardless of age, diagnosis, or the ability to pay • Requires a physician’s best clinical judgment that the patient is terminally ill with a life expectancy of 6 months or less • Patient chooses hospice care rather than curative treatment

  4. Nursing Goals in End-of-Life Care Practice the art of presence Assess for spiritual issues Provide palliative symptom management Become an effective communicator Counsel about anticipatory grieving Practice good self-care

  5. Nursing Goals in End-of-Life CareContinued • The Four Gifts of Resolving Relationships • Forgiveness • Love • Gratitude • Farewell

  6. Styles of Confronting the Prospect of Dying: Seven Motifs • Struggle – living and dying are a struggle • Dissonance – dying is not living • Endurance – triumph of inner strength • Incorporation – belief system accommodates death • Coping – working to find a new balance • Quest – seeking meaning in dying • Volatile – unresolved and unresigned

  7. Grief Reactions, Bereavement, and Mourning • Grief– the reaction to loss • Includes depressed mood, insomnia, anxiety, poor appetite, loss of interest, guilt, dreams about the deceased, poor concentration • Bereavement– period of grieving following a death • Mourning –things people do to cope with grief

  8. Dual-Process Model of Coping with Bereavement • Loss-oriented stressors – concentrating on the loss experience, feeling the pain of grief, remembering, and longing • Restoration-oriented stressors – overcoming loneliness, mastering skills and roles once performed by the deceased, finding a new identity, and facing practical details of life – Stroebe and Schut

  9. Four Tasks of Mourning • Accept the reality of the loss • Experience the pain of grief • Adjust to an environment without the loved one • Externally, internally, and spiritually • Relocate and memorialize the loved one

  10. Maladaptive Grieving Chronic grief Delayed grief Exaggerated grief Masked grief reactions

  11. Helping People Cope with Loss • Four constructs that support personal growth • Seeing some good resulting from the death • Continuing the connection with the deceased • Invoking intrinsic spirituality to understand the death and aftermath • Going forward with life

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