Death and Dying Exam 1

sensorimotor

(0-2): coordination of senses with motor response, sensory curiosity about the world. language used for demands and cataloguing. object permanence developed.

formal operational

(11+): theoretical, hypothetical, and counterfactual thinking. abstract logic and reasoning. strategy and planning become impossible. concepts learned in one context can be applied to another.

autonomy vs shame and doubt

(18mo -3y): the child is developing physically and becoming more mobile. children begin to assert their independence, by walking away from their mother, picking up which toy to play with, and making choices about what they like to wear, eat, etc.

preoperational

(2-7): symbolic thinking, use of proper syntax and grammar to express full concepts. imagination and intuition are strong, but complex abstract thought still difficult. conservation developed.

concrete operational

(7-11): concepts attached to concrete situations. time, space, and quantity are understood and can be applied, but not as independent concepts.

DRGs

(Diagnosis related group): statistical system of classifying any inpatient stay into groups for the purposes of payment. Divides possible diagnoses into more than 20 major body systems and subdivides them into almost 500 groups for the purpose of medicare reimbursement

identity vs role confusion

(adolescence): period btwn childhood and adulthood, exploring who they are as individuals.

trust vs mistrust

(birth - 1y): infants learn to trust their caregivers will meet their basic needs. if these needs are not met, mistrust, suspicion, and anxiety may develop.

QALYs

(quality-adjusted life year): generic measure of disease burden including both the quality and the quantity of life lived. Used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health

5 challenges of hospice care

1. presence of a primary caregiver who is available 24/7 2. adequate funding 3. 6mo rule 4. expanding access to underserved populations 5. excessive bureaucracy leading to routinization of care

3 reasons for initiating EOL discussions

- choices differ based on the info (more info yields more choices) - could receive undesired treatments (CPR?) - allows time for healing relationships, completing goals, completing wills, etc; allows for preparation

what are the aims of palliative care

- control pain - relieve suffering - provide care for physical, psychological, spiritual, and existential needs - help pt achieve a good or peaceful death

nonmaleficence

- do no harm - Sometimes interventions meant to do good can end up causing harm - i.e. catheters can cause UTI - many procedures cause pain to be inflicted onto patients and many procedures done have possible side effects and infection risks

death ritual of NA ohlone

- ensure progress of decreased to supernatural realm - adorn the corpse - personal possessions burned with corpse - name of deceased not mentioned for 6mo - 1y

in many traditional societies death is believed to occur because..

- evil influence - shaped by magic - untimely death is viewed as unnatural - cause of death may be d/t social interactions - anger, fright, or envy

justice

- fairness - can be difficult d/t the capitalistic nature of american society - Issue of who actually decides what is fair and who should be getting treatment and who shouldn't be getting treatment

3 sources of caregiver stress

- feelings of inadequacy (what can i say) - nonreciprocal giving - too many demands - feelings of being devalued (eg nurse/pt ratios) - inability to cure a disease or save a life

epidemiologic transition

- historical shift in disease patterns - characterized mainly by a redistribution of deaths from the young to the old - this shift results in a growing proportion of age ppl in the population

institutional medical care

- hospitals - nursing homes - hospice programs

fidelity

- loyalty and support - truth telling during end of life periods have historically proven problematic--or at least not the norm - unfamiliar ethical terminology and perceived legal threats put strain on healthcare works as they try to carry out this duty.

rising cost of healthcare

- medical coverage extended to more ppl - technological imperative - rationing scarce resources

autonomy

- patient's right to make their own choices - challenges: pt with dementia, comatose pt, poor mental capacity

4 urgent clinical indications for discussing EOL care

- pt facing imminent death - pt talks about wanting to die - pt or family inquires about hospice or palliative care - pt recently recently hospitalized for severe progressive illness - severe suffering and poor prognosis

4 topics that should be included in EOL discussions

- relative emphasis on life prolongation - relative emphasis on quality of life - advanced directives - DNR orders, mechanical ventilation, feeding tube, ABX, hemodialysis - palliative care (pain management; psychological, spiritual, and existential suffering; unfinished business)

4 ways religion functions in societies

- shared set of beliefs, values and norms help form common identity for ppl - answers to big question about human existence and purpose - foundation for norms and laws of a society - emotional and psychological support

traditional societies tend to view disease and death as

- supernatural cause often sought - societies often embrace an ecological orientation - look at possible role of phenomena (ie wind or moon, heredity and behavioral excesses like not getting enough sleep) - both natural and supernatural options are explored as well as socioeconomic and psychosocial - ie Senufo ppl of Africa ivory coast - a child dies ant it will disrupt the whole community; sacrifices are made to restore a sense of security and proper order and to purify/protect community

5 features and goals of hospice care

1. provide relief from pain and suffering 2. promote an aura of peacefulness and acceptance of dying 3. treat patient and family as unit of care 4. provide access to comprehensive services 5. designed for those in the final stages of a terminal illness who agree to forgo medical interventions intended to extend life

industry vs inferiority

6-11): childs peer group will gain significance and will bcm a major source of child's self esteem. the child feels the need to win approval by demonstrating specific competencies that are valued by society and begin to develop a sense of pride in their accomplishments.

beneficence

- to do good - health and mental health professionals have a duty to attempt to do good once they have entered into a professional relationship with an individual--at minimum, balance the good that may result from actions against harm - societal needs for self determination have made this principle conflict with autonomy

what is the appx death rate per 1000 in the US today?

8.7 per 1000

sites of memory

A structure or site that brings you back to a specific memory. e.g.: Zidane statue in Qatar

4 agents of socialization

1. family - early socialization, first experience with socialization 2. school and peers - school treated as a group to learn how to interact socially; peers are the same age and aid in learning to be individual 3. mass media - influences, tastes, thoughts, how we should or should not look/dress 4. religion - provides a set of morals and community

health care triangle

1. patient 2. staff 3. institutions/administration

mean world syndrome

a term coined by George Gerbner to describe a phenomenon whereby violence related content of mass media makes viewers believe that the world is more dangerous than it actually is.

which country was the most influential modern hospice established

england

childhood experiences with death are more likely to

give them a developmentally outlook on life

managed death

involved ending treatment at just the right time: "peaceful death", sometimes involved in organ donation

what does death involves causality mean?

it means there are biological reasons for the occurrence of death

institutional denial

lack of support reported by caregiver due to institution disregarding fact of death

what percentage of americans are affiliated with a religious tradition?

more than 90% of americans are affiliated with a religious tradition

what is the leading cause of death in the US today?

most deaths result from chronic illness, such as heart disease or cancer - tend to follow a slow progressive course that lasts weeks, months, even years

respite care

temporary institutional care of a dependent elderly, ill, or handicapped person, providing relief for their usual caregivers

thanatology

the scientific study of death and the practices associated with it, including the study of the needs of the terminally ill and their families

the sociological theory that most resembles the study of the human body

the structural functionalist approach

what percentage of the GDP of the US in 2000 was spent on health care?

total was 1.3 trillion, which is more than 13% of the GDP

define hospice care

unlike hospitals and nursing homes, hospice is not necessarily a place, but a program of caring that is oriented toward the needs of dying pt and their families. the focus is on comfort rather than cure.

4 principles/goals for a good death

- To know that death is coming and to understand what can be expected - to be able to retain reasonable control over what happens to be afforded dignity - to have adequate relief of pain and other symptoms - To have choice about where death occurs (home or elsewhere) - To have access to information and expertise of whatever kind is needed - to have access to desired spiritual and emotional support - To have access to hospice or palliative care - to have a say about who is present and who shares the end - to be able to make advance directives that ensure wishes are respected - To have time to say goodbye - to be able to die when it is time and not have life prolonged pointlessly

dimensions of managed care

- attempts to control when, where, and from whom medical services can be obtained - diagnosis related groups (DRGs) involved in a predetermined schedule of fees for reimbursement to care providers - may be restrictive, requiring bedside rationing of services

4 aspects that comprise cultural sensitivity

- avoid stereotyping - beware of judging the worth of other communities - understand that culture is not defined simply by ethnicity - know that there are many more differences within than btwn cultural groups

what are characteristics of invisible death?

- care of dying and dead are largely the domain of hired professionals - deathbed scenes often dominated by efforts to delay death - role of family and friends as witness to a loved ones diminished - mourning customs that held sway in the past now seem excessive - funerals and memorial services are shorter, more discrete and private

3 things guide the care and influence care provided

1. rising cost of healthcare 2. dimensions of managed care 3. institutional medical care consists of

what are the five major social institutions delineated by sociologists

1. the economy 2. the educational system 3. the family 4. the political system 5. religion these institutions are related in such a ways that changes in one leads to changes in others

discuss a mature concept of death. what 4 aspects does a mature concept include?

1. universality - all living things die eventually, death is all inclusive, inevitable 2. irreversibility - death is final, organisms that diet cannot be made alive again 3. non-functionality - death involves the cessation of all physiological functioning, or signs of life 4. causality - there are biological reasons for the occurrence of death - unfolds throughout lifespan - core concept enriched (and redirected) by questions, doubts, expectations, conditions, etc - either/or logic replaced by more sophisticated fuzzy concepts - allows for elaboration about the meaning of death - values other cultural contexts expressions - avoids ethnocentrism

initiative vs guilt

3-6, children begin to assert their power and control over the world through directing play and other social interaction

how much has the average life expectancy in the US increased since 1900?

47 to 77

what is palliative care

active total care of pt whose disease is unresponsive to curative tx

hospital health care focuses primarily on which aspect of the pt well being

acute intense care of a limited duration