1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. CHAPTER 32 Care for the Dying and for Those Who Grieve 1

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Hospice and Palliative Care Dr. Elisabeth Kübler-RossDr. Elisabeth Kübler-Ross Goal is quality, compassionate care for people facing a life-limiting illness or injuryGoal 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 supportTeam-oriented approach to expert medical care, pain management, and emotional and spiritual support Tailored to patient’s needs and wishesTailored to patient’s needs and wishes Support to patient's loved ones includedSupport to patient's loved ones included

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Hospice Care Available to everyone regardless of age, diagnosis, or the ability to payAvailable 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 lessRequires 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 treatmentPatient chooses hospice care rather than curative treatment

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Nursing Goals in End-of-Life Care Practice the art of presencePractice the art of presence Assess for spiritual issuesAssess for spiritual issues Provide palliative symptom managementProvide palliative symptom management Become an effective communicatorBecome an effective communicator Counsel about anticipatory grievingCounsel about anticipatory grieving Practice good self-carePractice good self-care

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Nursing Goals in End-of-Life Care Continued The Four Gifts of Resolving RelationshipsThe Four Gifts of Resolving Relationships –Forgiveness –Love –Gratitude –Farewell

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Styles of Confronting the Prospect of Dying: Seven Motifs 1.Struggle – living and dying are a struggle 2.Dissonance – dying is not living 3.Endurance – triumph of inner strength 4.Incorporation – belief system accommodates death 5.Coping – working to find a new balance 6.Quest – seeking meaning in dying 7.Volatile – unresolved and unresigned

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Grief Reactions, Bereavement, and Mourning Grief – the reaction to lossGrief – 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 deathBereavement – period of grieving following a death Mourning – things people do to cope with griefMourning – things people do to cope with grief

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Dual-Process Model of Coping with Bereavement Loss-oriented stressors – concentrating on the loss experience, feeling the pain of grief, remembering, and longingLoss-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 lifeRestoration-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. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Four Tasks of Mourning Accept the reality of the lossAccept the reality of the loss Experience the pain of griefExperience the pain of grief Adjust to an environment without the loved oneAdjust to an environment without the loved one –Externally, internally, and spiritually Relocate and memorialize the loved oneRelocate and memorialize the loved one

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Maladaptive Grieving Chronic griefChronic grief Delayed griefDelayed grief Exaggerated griefExaggerated grief Masked grief reactionsMasked grief reactions

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Helping People Cope with Loss Four constructs that support personal growthFour 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