Chapter 13: Dying and Bereavement

Question 1

What are the common signs of near death

Answer 1

• sleeping most of the time
• disoriented
• irregular breathing
• visual and auditory hallucinations
• decline in vision
• decreases production of urine
• mottled skin, cool hands and feet and overly warm trunk
• excessive secretion of bodily fluids
• very weak
• may be in pain
• may not recognize family members

Question 2

What is anorexia-cachexia Syndrome

Answer 2

• loss of appetite and muscle mass when dying

Question 3

What are the positive aspects that may be experienced near death

Answer 3

• emotional and spiritual growth

Question 4

What is Crude Mortality Rate

Answer 4

• the number of deaths divided by the population alive during the particular time period
  (deaths / alive population)

Question 5

What are Age-Specific Mortality Rates

Answer 5

• crude death rate for a specific group

Question 6

What are Age-Standardized Mortality rates

Answer 6

• take into account differences in age structure between different time periods or different locations

Question 7

First Nations in Canada Mortality Rates

Answer 7

• higher age standardized death rate

Question 8

What are some factors of life expectancy

Answer 8

• income
• education
• marital status
• occupational staus
• eating habits, smoking, obesity

Question 9

Causes of death

Answer 9

• changes over time
• influenza and pneumonia sticking around (still a significant factor in cause of death)
• some drastic change: Covid 19 and TB

Question 10

What is Death ethos

Answer 10

• sociocultural perspective
• cultures prevailing philosophy of death can be inferred by:
• funeral rituals
• treatment of the dying
• belief in afterlife and ghosts
• social conventions in discussion
• representation in the arts

Question 11

How has death ethos shifted over time

Answer 11

• invisible death (being in hospitals away from families and not in homes)
• medical advances have impacted the understanding of death (good death and death with dignity)

Question 12

What is death with dignity

Answer 12

• the period of dying should not be subject the individual to extreme physical dependency or loss of control of bodily functions
• bring death back to home
• control and decision made by patient not doctor

Question 13

what is good death

Answer 13

• the autonomy in making decisions about the type of care and duration of care received until death

Question 14

What is the Kubler-Ross study

Answer 14

• studied people diagnosed with a terminal illness

Question 15

What are Kubler-Ross 5 stages that people with terminal illness go through

Answer 15

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
   - a lot of individual variability and not necessarily in order

Question 16

What is Identity Assimilation in bereavement

Answer 16

• deny that death may be approaching
• want identity balance, accept and adjust
• the way you die may become part of your identity (eg: want to die in a composed manner)

Question 17

What is the Legitimization of Biography

Answer 17

• give meaning to life through stories

- may or may not be in writing

Question 18

What is Awareness of finitude

Answer 18

• recognition of own mortality

Question 19

What is the Terror Management Theory

Answer 19

• thoughts of death activated (reminded), can lead to change of healthy behaviours
• religious involvement

Question 20

End-of-life Advance Directives

Answer 20

• legal document
• make wishes known: unconscious or otherwise incapable of expressing them
• health care durable power of attorney: appoint someone to act on your behalf
• Do not resuscitate (DNR)
• Do not Hospitalize (DNH)
• over-treatment when orders not followed
• 8/10 Canadians havent heads to advance care planning

Question 21

Medical Assistance in dying in Canada

Answer 21

• MAID become legal in canada in June of 2016

Question 22

Medical Assistance in dying in Canada: 2 Options

Answer 22

1. physician or nurse practitioner can directly administer a substance
2. Physician or nurse practitioner can give or prescribe a substance that they can self-administer
   - patients mist be capable for providing informed consent at the time that MAID is provided, this just be voluntary (no external pressures(
   - NEW- allows eligible persons whose natural death is reasonably foreseeable and who have a set date to receive MAID, to waive final consent if they are at risk of losing capacity in the interim

Question 23

Who is eligible for MAID in Canada

Answer 23

• must be 18+ and meet the following
• have a serious and incurable illness, disease or disability
• be in an advanced state that is irreversible decline in capability
• endure physical and psychological suffering that is intolerable to them
• their natural death has become reasonably forseeable
• temporarily excludes eligibility for individual suffering soley from mental illness for 24 months and requires the ministers of justice and health to initiate an expert review tasked with making recommendations within the next year on protocols, guidance and safegaurds for MAID for persons suffering from mental illness

Question 24

MAID stats

Answer 24

• roughly 50% of people who get approved actually use it (cancer most common diagnosis seen)

Question 25

challenge’s to MAID

Answer 25

• ambiguity (different points of view)

- ensuring providers do not feel pressure to provide

Question 26

What is Hospice Palliative Care

Answer 26

• assisting dying people
• different from MAID
• emphasizes pain management , quality of life and death with dignity
• de-emphasis on prolonging life
• inpatient and outpatient services
• staff role- be with patients
• less than 30% of people have access

Question 27

What is Hospice Care

Answer 27

• allows patient to have pain control and symptom management, avoid extended period of dying, achieve sense of personal control, reduce burden on other, strengthen ties with those close to them
• assist people dying

Question 28

Improving end of life care

Answer 28

• research SUPPORT study to understand prognoses and preferences for outcome and risk of treatments
• training, educating and options
• cultural and language differences
• individual needs/ preferences

Question 29

What is Bereavement

Answer 29

• process of coping with the death of another

Question 30

What is Grief

Answer 30

• feelings after a loss, sorrow, hurt and anger ‘

Question 31

What is mourning

Answer 31

• expressing our grief, cultural norms

Question 32

Bereavement Biopsychosocial perspective

Answer 32

• biological: stress on body
• Psychological: range of negative emotions, impaired attention and memory
• Sociocultural: altered reposition in family and community, financial burden, change in support network (losing sense of community)
  loss of a child is most distressing

Question 33

What is the traditional view of Bereavement

Answer 33

• death should be worked through

- grief that goes on for more than a year is abnormal

Question 34

What is the attachment view in Bereavement

Answer 34

• maintaining continuing bond with deceased

- keeping possessions is not abnormal

Question 35

What is the dual Process model for Bereavement

Answer 35

• restorative: practical adaptations to loss
• loss: adjustment to the emotional consequences
• Adjustment : alternate between the two
• responses to loss may depend on attachment style
• flexible adaptation shows best outcomes
• repressive coping might be okay at times

Question 36

Other factors related to dual process model for bereavement

Answer 36

• optimism
• capacity for positive emotions
• maintain sense of continuity