Exam 1 Death and Dying

Trust vs. mistrust

(1) Children need predictability to learn trust. If they experience death they might be more reluctant to trust people

Sensorimotor Stage

(1) the child has just passed object permanence and death goes against this theory because the person will not come back

Autonomy vs. shame

(2) A time for letting go. If a child experiences death they may become clingy, cry a lot, or suck their thumb

Preoperational Stage

(2) child still uses fantasy reasoning, died because they were bad

Concrete operational Stage

(3) A child begins to use logic and understands the irreversibility of death. They mimic how those around them deal with death

Initiative vs. guilt

(3) The child is looking for approval and feels guilty about death because they assume it is their fault (world revolves around them)

Industry vs. inferiority

(4) the child is nervous about their shortcomings and so need constant encouragement. If a parent dies they loose the main source of encouragement

Formal operational Stage

(4) the child uses abstract/symbolic reasoning. Death can interrupt their ability to reason

Identity vs. role confusion

(5) Figuring out who you are. If a child experiences death it can hinder self-formation

Provide three reasons for initiating end-of-life discussions:

1. provide patients with autonomy (the patient needs information to make an appropriate decision) 2. lack of conversation may lead to undesired treatments (like CPR) 3. Allows time for the family to heal and he patient to complete tasks/goals

What are some Features and Goals of Hospice Care?

1. provide relief from pain and suffering 2. access to comprehensive services 3. helps patients to accept their death

What is the approximate death rate per 1000 in the United States today?

8.7/1000 people

Discuss a Mature Concept of Death

A mature concept of death develops throughout life and moves from "either/or" logic to fuzzy concepts

Define Hospice Care:

A type of palliative care that focuses on the terminally ill. This care seeks to promote comfort and quality of life over curing the disease. The patient has opted out of live-saving interventions Typically hospice is preformed at home.

List and describe four agents of socialization.

1. family- parents teach you from birth values, norms, and rules 2. school/peers- learn social skills and norms from teachers and those surrounding you 3. mass media-you learn things that other might be uncomfortable teaching (violence) 4. Religion has a considerable influence on people's beliefs and values

What are three sources of caregiver stress?

1. feelings of inadequacy (what do I say/do) 2. too many demands 3. inability to save a life 4. feelings of being devalued

Describe three ways religion functions in societies

1. gives people an emotional and psychological support system 2. answers big questions about human existence and purpose 3. foundation for norms and laws in a society

What are two challenges to Hospice Care?

1. need a primary caregiver who's available 24/7 2. need a life expectancy of less than 6 months provided by two separate doctors

List three Urgent Clinical Indications for Discussing End-of-Life Care:

1. patient is facing imminent death 2. it wouldn't be shocking if the patient died within 6-12 months 3. patient wants to talk about death 4. patient was hospitalized for a severe prognosis illness

Define Thanatology

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

According to the text, what is the leading cause of death in the United States today?

chronic illnesses like heart disease and cancer

Beneficence

do as much good as possible for one person good might be saving a life and for another good might be dying in peace

Managed death

even when death is known and accepted it will still be managed so it can be played out right

Technological imperative

extend life at all costs. death is a medical failure

Justice

fairness in treatment and distribution of good/services some people are placed in a lower DRG and so they don't get as much covered by insurance

Define QALYs

how long the insurance company thinks you're going to live and how much your health will cost the system

Mortality Salience

if you remind people that they are going to die they will deny death more example: giving judges a survey about death then having them judge people- more harsh judgements

Define: institutional denial

in hospitals death isn't discussed

Childhood experiences with death are most likely to

increase their concept of death more mature about death

Approximately how much has the average life expectancy in the United States increased since 1900?

increased from 47-77 30 years

Define Ethnocentrism

making a judgement for others based on one's own cultural assumptions/biases

According to the text, what percentage of Americans are affiliated with a religious tradition?

more than 90% 95% of teens believe in g-d

Define Nonfunctionality

once you die you cannot do things you did when you were alive (eating, sleep, walk)

Autonomy

self-determination/ the ability to make one's own decisions Sometimes doctors believe they know best so they may sway the patient towards one choice

Define Epidemiologic transition.

shift in disease patterns most recent was a redistribution of deaths from the young to the old

The sociological theory that most resembles the study of the human body is:

structural-functionalism-death is controlled

Traditional societies tend to view disease and death as ________________?

supernatural and psychological

Define Palliative Care:

the active total care of patients who's disease is unresponsive to curative treatments (you can have this type of care without a life threatening illness)

Define: Death anxiety

the fear of one's mortality

Define Structural-functionalist approach

the five social institutions need to work together to keep a balanced equilibrium

What does the statement "Death involves causality" mean?

there are biological reasons for people to die

Fidelity

trust should be established between doctor and patient confidentiality is a huge part of this and can be difficult when a patient wants to make a choice and the doctor believes the family should be informed

Define "mean world" syndrome

violent media images make people believe the world is very violent making them more aggressive and more fearful of victimization

Erik son's Theory vs Piaget's Theory

Erikson- 8 stages of psychosocial behavior Piaget- Stages of cognitive transformation

What percentage of the gross domestic product of the United States in 2000 was spent on health care?

13% or 1.3 trillion dollars

Describe the major factors affecting our familiarity with death in the contemporary U.S. Please know the statistics we discussed.

-In the 1900's the average age of death was 47 and 50% of deaths occurred between the ages of 0-14-- death was normalized -Now we have life extending technologies like CPR, IV's, transplants - most people don't die at home anymore they die in institutions (80% of American's died in insitutions)

What are the Aims of Palliative Care?

1. Relieve symptoms/control pain 2. help patients and families reach goals and solve conflicts 3. help patient have a good and peaceful death/rest of life

What four aspects / acknowledgments does a mature concept of death include?

1. Universality- death happens to everyone 2. Irreversibility- once you die you can't come back to life 3. Non-functionality- once you die you will loose all your abilities 4. Causality- there's a biological cause for dying

List three specific topics that should be included in end-of-life discussions.

1. advanced directive (example: a living will) 2. DNR orders 3. Life sustaining remedies (example: feeding tube) 4. Desires for pain management

List three aspects that comprise cultural sensitivity:

1. avoid stereotyping 2. don't judge the worth of other communities 3. understand culture isn't defined by ethnicity

What are the non-material aspects of culture?

1. beliefs 2. values 3. norms 4. signs and symbols

What are characteristics of the concept of invisible death?

1. death takes place in an institution instead of at home 2. families aren't the one's caring for their dying 3. funerals and memorials are much shorter and more private

What are the five major social institutions delineated by sociologists?

1. economy 2. educational systems 3. family 4. political system 4. religion

In many traditional societies, death is believed to occur because _______________?

1. transgression (one sinned) 2. action (you did something bad) 3. testing 4. omission

Define DRGs

Diagnosis Related Group when you apply for insurance you must fill out information about yourself (QUALY) and the COMPANY decided what group you get

In which country was the most influential modern hospice established?

England

Know the four phases of intolerance, and what presumption about truth resides at the center of such intolerance, usually.

Presumption: Only one person's perspective can be right so the other's must be corrected 1. Derogation→ some people think they are right and then disregard others as wrong 2. Assimilation→ when we can convince someone else we are right then we are psychologically "better" Go to a culture and make them take up the bible→ you're right 3. Accommodation→ Take an ethos and modify it Example: Blue jeans→ blue jeans were only for laborers, hippies decided that they didn't care what they looked like and took the jeans and affiliated with the working class, then the fashion industry took it and made it high class but takes out the threatening parts of the jeans (the revolution) 4. Annihilation→ fight to see who's right and get rid of the other

What are some attributes of the mean world syndrome? How does it manifest? What contributes to it? What are some remedies for it? Do you think it really does exist, or is it an academic rationalization?

Reason: media, video games- entertainment constantly showing death and tends to be gruesome Effect: lessens people to real world violence, increased fear of victimization, irrational dread of dying Solution: avoid tv/video games that focus on gruesome death

Define Teachable Moments

an opportunity to learn about death through an unexpected event or situation example: observing a dead animal in the road

Hospital health care focuses primarily on which aspect of the patient's well-being?

curing the disease

Be able to discuss the main points of the Flight from Death Film (i.e., what is death anxiety, how do symbols help mitigate it, how does culture help as well etc).

death anxiety: must live with the knowledge that we will die and can't do anything about it Symbols: people can "live on" through symbols like tombstones, people also attack part of their identity to symbols like an american flag culture: gives people a sense of meaning and security

Tamed death

death is an ordinary human experience and shouldn't be hidden. This ended in the 20th century and became the invisible death

Define: managed death

death is controlled by professionals and technology, sometimes treatment is ended at a chosen time

Define Irreversibility

death is final, you can't come back from being dead

Nonmaleficence

do as little harm as possible different people have different ideas on what is harmful one person might think it's harmful to let someone die and another might think it's more harmful to live on a respirator for the rest of their life