Despelder8_ppt_ch07

Despelder8_ppt_ch07 - i Chapter SevenC ` Chapter ` Facing...

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Unformatted text preview: i Chapter SevenC ` Chapter ` Facing Death Living with Life-Threatening Illness Living Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Personal and Social Meanings of Life-Threatening Illness s s s s s Anxiety and fear about pain and dying Social stigma Costs of medical care Lost earnings Confrontation with mortality Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Models of Coping with LifeThreatening Illness s s s s Glaser and Strauss’ awareness Glaser contexts contexts Kübler-Ross’s stage-based model Corr’s model of dimensions in coping Doka’s phase-based task model Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Models of Coping with LifeThreatening Illness (continued) s s Weisman’s interrelated task model Rando’s psychological and behavioral Rando’s patterns patterns Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Awareness of Dying: Interaction Patterns s s s s Closed awareness Suspected awareness Mutual pretense Open awareness Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Closed Awareness Context s The dying person is unaware of his or The her impending death, although others may know. Lack of communication about the person’s illness or the prospect of his or her death. prospect Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Suspected Awareness Context s The dying person suspects his or her The prognosis, but those who know do not not verify this suspicion. Despite this secrecy the patient observes disruptions in communication patterns caused by the illness and senses others’ anxiety, thus tending to confirm suspicions. confirm Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Mutual Pretense Context s Everyone, including the patient, Everyone, recognizes that death will be the outcome but all act as if the patient will recover. Distancing strategies preserve the illusion that the person is not terminally ill. not Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Open Awareness Context s Death is acknowledged and discussed, Death allowing for the possibility of shared support. support. Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Elisabeth Kübler-Ross’s Stagebased Model (1969) s s s s s Denial Anger Bargaining Depression Acceptance Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Charles Corr’s Model of Coping Dimensions s s s s Physical Psychological Social Spiritual Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Ken Doka’s Phase-based Task Model s s s s s Prediagnostic phase Acute phase Chronic phase Terminal phase Recovery phase Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Prediagnostic Phase s Suspect presence of disease and seek Suspect medical attention medical Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Acute Phase s s s Understand disease and maximize Understand health/lifestyle health/lifestyle Optimize coping strengths and Optimize develop strategies to deal with issues created by the disease created Explore effect of diagnosis on self and Explore others others Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Acute Phase (continued) s s Express feelings and fears Integrate present reality into past and Integrate future future Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Chronic Phase s s s s Manage symptoms and side effects Carry out health regimens Maximize social support and preserve Maximize self-concept self-concept Normalize life to extent possible and Normalize manage stress manage Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Chronic Phase (continued) s s Express feelings and fears Find meaning in uncertainty and Find suffering suffering Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Terminal Phase s s s s Manage discomfort, pain, Manage incapacitation, other symptoms incapacitation, Cope with medical procedures and Cope stress stress Prepare for death and saying goodbye Maintain appropriate relationships Maintain with others with Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Terminal Phase (continued) s s Express feelings and fears Find meaning in life and death Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Recovery Phase s s Applies when there is a cure or Applies remission of previously liferemission threatening disease Cope with “residues” of having had a Cope potentially terminal illness potentially Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Avery Weisman’s Interrelated Task Model s s s Confront the problem and revise one’s Confront plans as necessary plans Keep communication open and wisely Keep use the help offered by others use Maintain a sense of optimism and Maintain hope hope Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Therese Rando’s Psychological and Behavioral Patterns s s s Retreat and conserve energy Exclusion from the threat of death Attempt to master or control the threat Attempt of death of Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Patterns of Coping: Defense Mechanisms s s s Occur without conscious effort or Occur awareness awareness Function to change a person’s internal Function psychological state, not the external reality reality May or may not be adaptive Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Patterns of Coping: Coping Strategies s s s Involve conscious, purposeful effort Aimed at establishing control over a Aimed stressful situation or to solve a problem problem May include x Emotion-focused coping x Problem-focused coping x Meaning-based coping Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Emotion-focused Coping s s s Allows relief from impact of stress Helps regulate level of distress by Helps reframing or distancing reframing Puts stressful situation in more Puts positive light, thereby reducing the sense of threat sense Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Problem-focused Coping s s s Deals with managing the problem Deals causing distress causing Involves pursuit of personally Involves meaningful goals meaningful Examples include gathering Examples information and making choices about options options Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Meaning-focused Coping s s s Helps maintain sense of perspective Helps and positive well-being and Involves finding some benefit in the Involves distressing situation distressing May involve turning to spiritual May beliefs for insight that makes the burden easier to bear burden Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Maintaining Coping Potency s s s s Sustain positive sense of self-worth Sustain and self-image and Set realistic goals and strive to meet Set them them Exercise choice to extent possible Engage in active interactions in one’s Engage environment environment Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Maintaining Coping Potency (continued) s s Seek information and support Maintain hope and positive attitude Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Treatment Options and Issues s s s s s Surgery Radiation therapy Chemotherapy Alternative and complementary Alternative therapies therapies Pain management Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Alternative and Complementary Therapies s s s s Mind-body interventions Systems-oriented approaches Manual healing methods Symbolic healing Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Mind-Body Interventions s s s s s Psychotherapy and support groups Meditation, prayer, and mental Meditation, healing healing Imagery, hypnosis, and biofeedback Yoga, dance therapy, other movement Yoga, therapies therapies Music therapy and art therapy Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Systems-oriented Approaches s s s s s Traditional Chinese medicine Acupuncture and acupressure Herbal medicine and diet/nutrition Community-based practices (Native Community-based American “sweat lodges,” Mexican curanderismo, Ayurveda [India]) curanderismo Ayurveda Homeopathic and naturopathic Homeopathic medicine medicine Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Manual Healing Methods s s s s s Osteopathic medicine Chiropractic treatment and massage Chiropractic therapy therapy Laying on of hands (biofield Laying therapeutics) therapeutics) Reflexology and bioenergetics “Body Work” (e.g., Rolfing, Trager, Body Feldenkreis method, Shiatsu) Feldenkreis Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Symbolic Healing (Shupe and Hadden) s Our beliefs potentially affect the Our functioning of our bodies. Examples include… include… x Faith healing x Supernatural healing x Folk healing Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Managing Pain s s s Distinguish between “acute” versus Distinguish “chronic” pain “chronic” Distinguish between “pain” and Distinguish “suffering” “suffering” Consider personal and cultural Consider “meaning” of pain “meaning” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Managing Pain (continued) s s Stepwise approach, from basic Stepwise medications to powerful opioids (e.g., morphine) morphine) Respond to patient’s “total pain” Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Technology of Pain Management s s s s Epidural and intraspinal drug delivery Innovative drug “cocktails” Patient-controlled analgesia (PCA) Nerve blocks, electrical stimulation, Nerve acupuncture, neurosurgery acupuncture, Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Technology of Pain Management (continued) s s Antidepressants and other drugs to Antidepressants relieve anxiety, confusion, and depression depression Adjuvant drugs to minimize Adjuvant discomforting symptoms (e.g., constipation, nausea, respiratory depression) depression) Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Dying Trajectories s s s Sudden and unexpected (e.g., massive Sudden heart attack or accident) heart Long period of slow decline with Long episodes of crisis, the last of which is “suddenly” fatal (e.g., chronic illness) “suddenly” Progressive, slow decline as life fades Progressive, away slowly and inevitably away Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Social Role of Dying Person s s s Mobilize resources for attending to Mobilize prospect of death prospect Set own agenda for activities and Set relationships at end of life relationships Find meaning and purpose in one’s Find life life Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright Social Role of Dying Person (continued) s s Maintain appropriate sense of Maintain creativity and hope creativity Give and receive love Copyright © 2009 Lynne Ann DeSpelder and Albert Lee Strickland Copyright ...
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