Exam Flashcards
(46 cards)
1
Q
When was hospice first introduced
A
First introduced in Middle Ages, referred to a place of shelter or refuge for weak and tired travellers seeking a place to rest, the down and out and the sick and dying
2
Q
What is hospice now?
A
A holistic or whole person (body mind and soul) philosophy or model of health care for dying persons and their families
- combines medical care (good pain relief and symptom control) and compassionate care (emotional social and spiritual and practical support)
- a physical bricks and mortar place (ie residential hospice)
3
Q
What is Palliative care and what are some other terms for it
A
To "palliate" or provide "palliative care" generally means to provide relief from pain and any other distressing symptoms or a disease without actually trying to cure the underlying cause(s) of the disease Other terms: End of life care Compassionate care Comfort care Supportive care Terminal care -we say hospice palliative care in Canada and in the US they say Hospice care
4
Q
What is the Canadian Hospice Palliative Care Association (CHPCA) definition for hospice palliative care?
A
Care that is “aimed at relief of suffering and improving the quality of life for persons who are living with or dying from advanced illness”
5
Q
Where do Canadians die
A
- hospital (in an acute care bed or a multi bed palliative care unit)
- nursing home
- residential hospice (Bobys house)
- dying persons home
- prison
- on the street/abandoned building/car/or shelter for homeless
6
Q
What is the admission criteria for Bobb’s house in St. John NB?
A
- 18+
- NB Medicare card
- less than 3 months expected
- cannot be supported at home
- limited diagnostic tests or treatments required
- patients and family aware of diagnosis and prognosis and agree agree to palliative end of life care with no extraordinary life saving measures
- do not resuscitate (DNR) in place
7
Q
What is the cost of care for hospice palliative care houses?
A
- only cost to patients and families is medication coverage
- all other costs are free (nursing care, housing, food, supplies etc)
8
Q
When/where and who started the first modern hospice care
A
1967-Dame Saunders founded st. Christopher’s Hospice(54 beds) in the U.K.(London), the first in a long line of modern hospices.
-“a place of refuge for terminally ill against pain, indignity and isolation while making the journey from life to death”
9
Q
When and where was the first palliative care in Canada?
A
Began in 1974 in hospitals in Winnipeg and Montreal
- Dr. Mount visited St. Christopher’s in London and meet with Saunders to see for himself how Hospice model worked
- > he created a 12 bed unit (Hospice like) in the Royal Victoria hospital
- Dr. Mount coined the term palliative care (a place of last resort to the poor-French roots)
- Mount is widely regarded as the “father of Canada’s Hospice Palliative care”
10
Q
What are some attributes to Hospice palliative care?
-the gold standard when it comes to providing care for dying and grew out of reaction to the “medicalization of death”
A
- 2 patients: person dying and family of dying person
- circle of care around the 2 patients (interdisciplinary team of caregivers working together to meet the individuals needs of the patient and their family -therapists, social workers, physicians, nurses, trained volunteers, spiritual councillors)
- focus is on caring, not curing (doesn’t aim to hasten or postpone death
- affirms life and regards death as a normal process
- variety of bereavement and counselling services for family members both during and after loved ones death
- enhance quality of life and relief from pain/distressing symptoms
11
Q
Two major functions of funeral practices
A
- To separate the body of the deceased from the community of the living
- To assist mourners in adjusting to their loss and to help the mourners restructure their lives without the presence of the person who died
12
Q
What are some important benefits that funeral serve
A
- provide of social support system for the bereaved
- help the bereaved face the reality that someone they love has died
- provide a safe environment for acknowledging and expressing one’s feelings of loss and grief
- Mark and important conclusion to someone’s life
- provide time to say goodbye
- help the bereaved begin the healing process
13
Q
Difference between a funeral service and memorial service
A
Deceased persons body is present at a funeral service but not for memorial service (body is already buried or cremated)
14
Q
What are the 5 typical elements usually found in many contemporary North American funerals
A
- Removal of the body from the place where death has occurred and usually taking it to the funeral home -usually from hospital or nursing home
- preparing the body for viewing or final disposition.
- embalming: usually done when there’s extended period of time before the burial or if you have an open casket.drains bodily fluids and replace it with preserving fluids (Refrigeration is in alternative)
- cosmetic work: restoring the dead to life like appearance (Open glueing eyes and mouth shut. Emphasis on face and hands) - Visitation or viewing.
- Funeral service
- church or funeral home - Disposition or disposal of bodies
- in ground, entombment, cremation (less expensive route)
15
Q
What are some alternatives to traditional burials
A
- do it yourself (at home funerals)
- Internet sites that offer homemade coffin plans, do it yourself and embalming and kits etc.
- Green/Eco funerals
- handwoven wicker coffins, “ecopod” – a coffin made entirely from recycled paper
- Green burial sites for Eco burials
- organic burial pod – turn remains into nutrients or tree/your life fuels another life
- mushroom burial suit – cleanses body of toxins before returning it to nature.leave behind pollutant free compound - Donating body to science
16
Q
What are some of the unusual options of saving or disposing of a love ones cremains
A
- Lifegem- developed a carbon collection kit that makes jewellery with ashes, however diamonds are expensive
- Cremation memorials – wear it as a necklace or hang it somewhere/a lot cheaper
- Heavenly Star Wars fireworks – make firework from love ones ashes
- eternal Reeves – refills composed partly of cremains on sea floor
- launch a symbolic portion of loved ones remains into space, 1 g of ashes
- have remains compacted into a sports ball/bag/rifle shelves/beer bottles/etc.
- personal head urn/expensive
- tattoos from ashes dust
17
Q
How long does normal grieving take
A
It takes as long as it takes, there are no shortcuts
18
Q
What are subsequent temporary upsurges of grief (STUGs)
A
-brief periods in which the grief for the deceased is experienced afresh, as if the bereavement had been very recent
-usually triggered by something that stimulates a memory about the deceased loved one and remind you of their absence.
Example. A significant date, a holiday, an event(wedding/birth), smell, meaningful piece of music
19
Q
Briefly list four grief work models
A
- Elizabeth Kubler Ross’s stage model of grief
- Colin Murphy-four phases of grief
- William Worden’s task model of grief
- Margaret Stroebe and Hank Schut’s Dual process model of coping with grief
* last 2 are the newer models
20
Q
Describe Elizabeth Kubler Ross’s stage model of grief
A
- how Peyton’s react to the news that they’re going to die (DABDA)
1. Denial: “no no no I just can’t believe that she’s gone, this can’t be”
2. Anger: “why didn’t the doctor do more to save her, why did God let this happen, how could you do this to me”
3. Bargaining: if I devote the rest of my life to helping others and then can they come back
4. Depression: I miss her so much, how am I going to go on
5. Acceptance: I’ll always love/miss her but I’ll go on with my life with her in my heart
21
Q
Explain Colin Murphy’s four phases of grief model
A
- Shock and numbness
- in a state of shock and disbelief and feels cut off from reality (I just can’t believe it’s true)
- a blunting of emotions occurs; grieving person feels numb (automatic pilot) - Yearning and searching
- pangs of grief, profound episodes of missing the lost person, crying, anxiety and anger
- wishing to bring back the deceased person - Disorganization and despair
- difficulties functioning in every day life, lacks ability to concentrate, and often desires to withdraw and disengage from others and the activities he/she use to enjoy
- depression and unable to think about the future - Re-organization and recovery
- The individuals begin to pull their life back together, moving forward with life and adjusting to their new reality/new state of normal (learns to cook)
22
Q
Explain William Worden’s task model of grief
A
- To except the reality of the loss
- bereaved person has to recognize both emotionally and intellectually that the deceased person is no longer physically present and will not return (open coffins will help) - Work through the pain of grief
- processing the pain (feeling the pain) rather than trying to avoid it (more pain if close, sudden vs expected death influences pain)
- helps prevent people from caring their pain into the future
- many people try to avoid dealing with this pain/throw themselves into their work, drugs, alcohol, etc. - To attempt to an environment (a world) in which the deceased is missing
- external adjustments (take on the duties and roles previously fulfilled by the deceased person)
- internal adjustment (adjust one’s sense of self in view of the loss)
- spiritual adjustments (adjust one’s view of the world) - To find an enduring connection with the deceased while embarking on a new life
- staying connected with the deceased while moving on
23
Q
Describe Margaret Stoebe and Hank Schut’s dual process model of coping with grief
A
- Loss oriented coping
- coping with things/issues that are directly related to the loss (i.e. loneliness, sadness, hopelessness)
- yearning, remembering and reminiscing, looking at old photos, crying, talking about feelings - Restoration oriented coping
- coping with issues related to secondary changes brought on by the loss
- I.e. cooking, cleaning, looking after kids/finances things the deceased use to do
24
Q
What is oscillation
A
-The process of switching back-and-forth between loss oriented coping and restoration oriented coping
(From looking at pics to balancing the check book)
-this is a good thing, staying in one or the other is bad for effective coping and harmful to health
25
What are the gender differences in grieving
- males more likely to engage in restoration oriented coping and females more likely to engage in loss oriented coping
26
Why are the models called grief work models
Because the griever must work through their difficult and painful feelings surrounding their loss
-they will never recover from their loss if they do not go through these stages, phases, or tasks to confront their difficult emotions
27
What is Dennis's Klass's model of continuing bonds
-The bereaved do not sever their ties with their deceased loved ones but, overtime find new ways to stay connected.
Those ways of staying connected do not interfere with the formation of new relationships and bonds to others.
Example taking flowers to gravesite
28
What is anticipatory grief
Common grief reaction among people who are facing the impending death of a loved one.
I.e. begins before the loved one actually dies
Tips: spend time with dying loved one, learn more about them and listen to their life stories, share thoughts/feelings
29
What is normal grief
Difficult to define (so many different types of grief reactions.)
-Everyone grieves in their own way, there's no right or wrong way
30
What is complicated grief
Intense, long-lasting form of grief
- takes over a persons life/mind and won't let go
- they feel stuck in their grief or are unable to work through their grief.
- Have trouble resuming their own lives (time goes on but they don't)
- Joy/ satisfaction is gone
- images of deceased constantly in their mind and life without them has no meaning
- difficult to get out of by themselves – need training professional help
- diagnosed when grieving is intense beyond six months (more likely for sudden/unexpected/traumatic death)
31
What is disenfranchised grief
Aka hidden grief
- grief that is not recognized or acknowledged by others
- type of grief that cannot be publicly expressed
- example. Grief by Gate and lesbians or by people having affairs, or abortion, or suicide (grief is kept to themselves for fear of judgement by others, keeps them from getting support)
32
What is conflicted great
Often exhibited by family members whose loved ones have experienced a slow, prolonged illness (Alzheimer's disease, cancer)
-feel relieved but sad, mixed feelings
33
How to help those who are grieving
1 provide a listening ear.
2. Don't rush someone through grief; people need time to grieve.
3. Make support available especially beyond the funeral period
4. Don't trivialize someone's grief
5. Allow the deceased to be important during the grieving process (encourage the sharing of memories of the deceased)
6. Give permission to grieve
7. Help the bereaved deal with any anger or guilt
8. Realize the importance of obsessive review
9. Remember that grief is highly individual
10. Help the bereaved to get on with living
34
What did Maria Nagy do? What were the stages she came up with?
She asked for 100 children between three and 10 years old "what is death" and tell her everything that comes to mind about death. She got them to draw a picture
-she came up with three stages of understanding of death for children
Stage 1: (0-5 years)
-death is separation, very curious about death, it did our "less alive" than the living, being dead is like being very sleepy/May not wake up
Stage 2: (5-9)
-death is final and irreversible, seen as a person (i.e. Grim Reaper, skeleton, ghosts, angel), they can't escape death if they are clever or lucky enough
Stage 3: (10+)
-death is final, irreversible and inescapable
35
What are the five major components of children's understanding of death proposed by mark speece and Sandor Brent
1. Irreversibility: once death takes place, it cannot be reversed
2. Non-functionality: when death occurs, all of the typical/life defining functions/things that living people do (i.e. breathing, eating, hearing, seeing) cease to occur
3. Universality: all living things must eventually die, every plant, every animal and person
4. Causality: an understanding of the internal and external events that might cause someone to die
- internal (Old age, illness)
- external (automobile accident)
5. Personal mortality
- The understanding that the individual will die ("I will die too")
36
How was death defined until the mid-1950s
The cessation of heartbeat and breathing
- The individuals cardio pulmonary system – heart and lungs – have stopped operating ( but we have machines that can do this now??)
- clinical death
37
What is neocortical death
- persistent vegetative state (PVS) – the brainstem functions, but the neocortex is no longer active (the part that makes you you)
- 34% of people said individual was legally dead when brainstem was functioning but they were in a PVS (never be the same)
38
What is whole brain death
The permanent loss of all brain functions, from brainstem (which controls breathing and heart rate) to higher cortical (neocortex) functioning (conscious thought, awareness, personality, etc.)
- absence of all brain functions is complete and irreversible
- this is the definition Canada uses for death
- 86% of people said an individual was legally dead when all brain function has stopped but the heart was kept going on a machine
39
Where is the only country where you can buy and sell human organs
Iran
Kidney =$200-4000
But I have to be a citizen to buy/sell
40
What are some of the themes with organ transplants
In the US 22 people die every day waiting for a transplant, and someone is added to the transplant list every 10 minutes. Each year the number of people waiting for a transplant is increasing
- kidney transplant is the most common, then liver, heart, lungs
- living donors can donate one kidney, a portion of liver or lobe of the lung
- first successful transplant was a 1954- kidney went from one identical twin to the other
- 1967 was the first heart transplant, only lived another 18 days
41
Who are the best organ transplant donor's
Whole brain dead individuals on ventilators(usually from accidents, commas)
42
What are some of the main findings from the Canadian Council for donation and transplantation (2005)?
- 96% of Canadians strongly(71%) or somewhat(25%) approve of organ and tissue donation
- more than half (54%) say that they have signed an organ donor card or registered as an organ donor
- most (74%) who have made their decision to donate have discussed their wishes with others
43
What are the most frequently mentioned reasons for not wanting to donate ones organs
- "Ick" factor (its yucky)
- religious beliefs
- medical reasons ( hepatitis, cancer, HIV)
- personal preferences/reasons – they just don't want to
- want to keep my body intact
- too old - "you wouldn't want my organs"
- don't know enough about it
- fear that hospital staff wont work as hard to save my life
44
What did Dr Williard Gaylin (1974) come up with
"harvesting the dead"-wants to store dead bodies for later harvest
The term neomorts = newly dead individuals
("Neomorts have a legal status of the dead with none of the qualities one now associates with death. They would be warm, respiring, pulsating, and excreting bodies requiring nursing, dietary and general attention
-could probably be maintained so for a period of years"
-to serve as an organ and tissue bank
45
What regions groups believe in reincarnation
Hindus(believe in atma/soul) and Buddhists(don't believe in soul)
46
What religious groups believe in cremation
In the Hindu tradition, cremation or antyesti is the normal way
-it is forbidden in Judaism and Islam
