SO309 Exam 2

A Gallup poll declared in 2013 that _____ percent of Americans declared no religious identity, and another ____ percent did not answer. Furthermore, ____ percent of Americans identified with a Christian religion.

14% 2% 76%

Living with Dying--The Hospice Approach According to the National Hospice and Pallative Care Organization, about 3,000 Hospice Programs in the US provided care to some 700,000 patients in 1999. Roughly ___% of all Americans who died in that year. NHPCO reports that Hospices now care for over ______ of all Americans who die from cancer. The goals and methods of hospice are reflected in the term _________ ____________--which comes from the latin term palliatus, meaning to cloak or conceal and by extension, to moderate or reduce the ___________ of an event or situation. The WHO defines palliative care as the active total care of patients whose disease is not responsive to _________ treatment.

30 half palliative care severity curative

Afterlife experiences by the Clinically Dead -A 1981 Gallup Poll reported that _______ million Americans had experienced the near-death phenomenon. -Barbara Walker claims that __________ in ___________ within the US has undergone a near-death experience. -The description in "_____________ after ____________" developed by ___________ __________, is a composite of the many accounts by individuals who have survived the experience of being near death or being declared clinically dead. --This ideal model was constructed by interviewing more than 150 people who had these experiences. ___________ reports the similarity of most of these life after death accounts in which _______ traits define the near-death experience.

8 one in five Life after Life, Raymond Moody Moody, 9

Anthropologist _________________________ disagrees with Malinowski's contention that religion functions primarily as an anxiety reliever. -He claims that religion gives people fears and anxieties from which they would otherwise be ___________--the fear of spirits, god's judgement, the devil, and hell.

A.R. Radcliffe-Brown free

__________ ___________ observed that to seize the opportunities offered by illness we must live actively and must __________ about the illness.

Arthur Frank talk

Communication Patterns--in their classic study entitled--___________ of ____________, _____________ and ____________ (1965) examined communication patterns between dying persons and those interacting with them. They identified four awareness contexts--classified by what each interacting person knows of the patient's defined status, along with the recognition of others' awareness of his own definition. ___________ _______________: the patient does not know he or she is dying even though medical personnel and family members know it. __________ _____________: the patient does not know but only suspects, with varying degrees of certainty, that he or she is dying. The medical staff and family do know the patient is terminally ill. ___________ _________________: the patient, medical personnel, and family know the patient is dying but there is tacit agreement to act as if this were not the case. __________ ____________: the patient, medical personnel, and family recognize and openly acknowledge that the patient is dying.

Awareness of Dying, Glaser and Strauss Closed Awareness Suspected Awareness Mutual Awareness Open Awareness

__________________ is a recognition accorded by the Catholic Church of a dead person's accession to heaven and capacity to intercede on behalf of individuals who pray in his or her name.

Beatification

Future of Hospice New types of Hospice Care may be needed to meet some of the challenges mentioned _______ __________ suggests three levels of hospice care: -___________ Hospice care for persons with fairly definable short-term prognoses -________ _________ Hospice care for persons with an indeterminate diagnosis who do not require expensive therapies to improve quality of life during a prolonged period of dying (Alzheimers) -________-______ Hospice care for persons who require expensive therapies to maintain reasonable relief of symptoms in the face of a limited, although uncertain prognosis (Advanced Aids)

Bill Lamers Traditional Long term High-tech

Needs and Concerns of the Dying _________ ___________ is the internal representation of one's feelings and attitudes toward one's body __________ ___________ may change over time as physical maturation progresses and physical skills develop A terminal illness may affect a previous sense of _________ __________due to such changes as a severe drop in weight or less of body parts and function -Ex: Loss of hair due to chemotherapy, women and hysterectomy and the fact that a woman can no longer bear children, physical weakness and the ability to perform tasks once carried out easily. The body's ability to function normally is referred to as _________ ___________--dying individuals may face the gradual loss of various body functions and thus, manifest feelings of sadness, anger, helplessness, and hopelessness.

Body image Body image Body image Body integrity

________________: declares a dead person to be a saint

Canonization

Withdrawal--____________ (1980) describes three major contributors to the withdrawal that is frequently experienced by the dying and those in their social environment. Environmental conditions, for example, patient may be in a hospital. Factors such as discomfort, pain, lapses into unconsciousness, a variety of fears. Social avoidance of the dying. Society may withdraw because of a fear of death, uncertainty as to how to interact with the dying. ____________ ____________ or ____________ __________: terms used to signify a withdrawal pattern that is of extreme magnitude.

Charmez Sociological Death or Social Death

Origins of Hospice In 1963, a visit by ___________ ___________ to the school of Nursing at Yale University stimulated interest in Hospice Care in the US. While Saunders again visited Yale in 1966, __________ _________, as Dean of Yale's Graduate School of Nursing, organized a meeting attended by Saunders, Elisabeth, Kubler-Ross, Colin Murray Parkes and others interested in improving care of the dying. Wald, was instrumental in establishing the first American Hospice, which opened in New Haven, Conn. in ___________. Other key events: -Establishment of hospital-based palliative care team at St. Luke's hospital in _________ ______ in 1974. -Publication of assumptions and principles for terminal care by the International Work Group on Death, Dying and Bereavement in ___________.

Cicely Sanders Florence Wald 1974 NY City 1979

_____________ ____________ is concerned with the transcendent meanings that support the state and provide it with a super-empirical or supernatural identity.

Civil religion

Psychological Needs and Concerns of the Dying ____________ and ________________: many who are dying have indicated that retaining some sense of control in their lives is crucial to their emotional well being. Since there is so much that the dying cannot control, it is crucial to permit control where it is possible. ____________ to ___________: in order to avoid a feeling of being dependent on others, caregivers should allow patients the opportunity to contribute to the well being of others. They may choose to do this in a variety of ways, depending to a great extent on such factors as energy level, presence of pain, and time remaining. __________ of _________ ____________: all of us want to know that our lives have been meaningful. To help answer this many dying patients engage in a process of life review. Reminiscing is an important tool in promoting the life review and in breaking out of the conspiracy of silence described earlier.

Control and Independence Contribution to Others Review of One's Life

__________ ___________ (1989) cited research showing that confronting individuals with the fact that they will die makes them cling tenaciously to their deepest moral values.

Daniel Goleman

Factors Affecting the Dying Process _____________ Stages- ___________/______________ Background: Membership in a particualr cultural group not only has an impact on attitudes and customs, it can also have an effect on the sensation or expression of pain. Persons with a strong german heritage, for example, typically do not openly address personal feelings. Some Native Americans regard pain as a sign of weakness and therefore, socially unacceptable. Older Japanese Americans often try to mask their pain, even if in agony, in order to avoid distressing others.

Developmental Ethnic/Cultural

Diagnosis _____________ of Diagnosis -The majority of studies carried out prior to 1970 found that physicians did not favor telling patients about the severity of their illness. -There is evidence in more recent years that physicians and medical students are much more likely to disclose directly to a patient that she or he is dying than they have been in the past. --___________ and ___________ (1985) collected data from 103 medical students and 15 family physicians. --In response to the question, "What is your feeling about telling a patient that they are terminally ill?" _______ percent of the medical students and all of the physicians felt that patients have a right to known the truth about their illness if they request the information. This data reflects a changing trend in sharing with a patient a prognosis of likely death.

Disclosure Eggerman and Dustin 93

Factors Affecting the Dying Process ____________ _____________--The certainty or uncertainty that a particular physical condition will end in death influences the emotional and psychological state of the individuals as does the time frame within which one is expected to die. _________ and ___________ (1968) describe four __________ _____________. -Certain Death at a ___________ Time: Liver Cancer -Certain Death at an ____________ Time: Cystic Fibrosis -____________ Death but at a known time of Resolution: Advanced Heart Disease--Outcome dependent upon successful heart surgery -____________ Death and ___________ Time of Resolution: Multiple Sclerosis

Dying Trajectories Glaser and Strauss, Death Trajectories Known Unknown Uncertain Uncertain, Unknown

_______________ __________ ___________ (1969) suggested that the patients should be told, but the prognosis should not include the amount of time the patient has left.

Elisabeth Kubler Ross

______________ ___________ ____________ has challenged professionals and nonprofessionals alike to be sensitive to the needs of the dying. In her classic book entitled "_______ ____________ and ________" (1969) she delineated five stages to describe the dying person's progression toward acceptance of his or her impending death. -_________: typically the initial reaction to the diagnosis of a terminal illness. Rather quickly replaced by partial acceptance. -_________: feelings of anger, rage, envy, and resentment--why me? -_________: attempt to delay the inevitable by making promises such as a life in the service of others. -__________: This stage is marked by two types --___________ ____________: results from losses that are experienced as a part of the illness (ex: loss of a body part) --__________ ___________: which anticipates impending losses such as separation from family -________________: this stage is marked by a "degree of quiet expectation...not a resigned and hopeless giving up. The individual no longer actively struggles to survive. __________-____________ Theory has been criticized because it does not take into account characteristics inherent in the dying individual such as sex, age, previous life experiences, ethnicity, coping strategies or the nature of the illness.

Elisabeth Kubler Ross On Death and Dying Denial Anger Bargaining Depression Reactive Depression Preparatory Depression Acceptance Kubler-Ross

_____________--Dying individuals often experience a wide variety of __________, including the ___________ of pain or suffering, __________ of isolation or abandonment, ___________ of extinction, ____________ of rejection, ____________ of the unknown, _________ of indignity, and ___________ of an inability to fulfill one's responsibilities. Not only do dying individuals experience a multitude of fears, so do family and friends. Open communication among all persons in the system allows them to become more sensitive to the presence of fears and to be of mutual support to one another in alleviating their concerns. ____________--____________ is a natural response to loss. We must understand that the dying themselves experience __________. Dying persons often respond emotionally to the many physical losses that they might experience. People who are dying often face a loss of independence and as a result, a loss of self-esteem. Anger, guilt, remorse, anxiety, depression, rebellion and aggression are common manifestations of the grief from these losses.

Fear Grief

___________________ attempted to resolve the problem by declaring that both malinowski and radcliffe-brown are correct. He argues that radcliffe-brown's hypothesis is a supplement to malinowski's theory. According to _____________, Malinoski is looking at the ___________, radcliffe-brown is looking at the _____________. Whereas Malinoski says that the individual tends to feel anxiety on certain occasions, radcliffe-brown says that society expects the individual to feel anxiety on certain occasions. _______________ thesis is that when individuals encounter death, the anxiety that they experience is basically socially _____________. -Death Fears can be linked to the fears of other things--snakes, electricity, or whatever -Religion, with its emphasis on immortality of the soul and its belief in a coming judgement, _____________ the level of death anxiety for individuals who follow the teachings of the religion. -However, after individuals have fulfilled the requisite religious or magical ceremonies they experience only a _____________ amount of anxiety.

George Homans Homans, individual, community Homans, ascribed increases moderate

Hellenistic Concepts of Immortality -Among the Ancient Greeks the afterworld was not an attractive prospect.. ___________, the realm of the dead, was typically pictured as a shadowy place inhabited by bloodless phantoms. -In the Athenian Democracy, what mattered was the survival of the ________--city state, personal immortality was important only to the extent that it affected the survival of the ____________, within this context, a person could achieve social immortality by fulfilling the responsibilities of citizenship. -Among the early Greek philosophers, most thought of life and death as aspects of an _____-___________ flux. Although they elieved that the soul was a vital principle that continued in some fashion after, they generally did not imagine it surviving as a __________ entity. If some quality of "soul" continued beyond death, it merged with the stuff of the universe. -_______________ taught that one's conduct during life determined the destiny of the soul after death. Thus, with discipline and purification, one could influence the transmigration-successive rounds of births and death. -With _______________, there are signs of a shift from a social immortality predicated on the life of the community to the possibility of personal survival after death. -_________________ advanced a number of "proofs" that the soul is eternal and is released from the body at death. The _____________ of the body and soul is emphasized and their respective fates are distinguished. Because it is mortal, the body is subject to corruption; the soul, however, is immortal and therefore not subject to death.

Hades Polis Community ever-changing distinct Pythagoras Socrates Plato Dualism

Students entering the medical profession come in with certain attitudes and feelings toward patients that will be shaped and continually processed until their attitudes comply with those of the medical profession itself. _________ _________ 1964) referred to this "molding" as ___________ ____________

Howard Becker situational adjustment

________________ surveyed 372 randomly selected resident in Minnesota concerning death anxiety and religious activities, beliefs, and experiences. He found that the relationship between the variables of religiosity and death anxiety is _____________. Persons with a moderate commitment to religion have _____________ to the general anxiety that has been socially ascribed to death from secular sources. Highly committed individuals have the ___________ anxiety concerning death.

Leming curvilinear added least

_________________ held that religion functions to relieve the anxiety caused by the crisis experiences that people encounter in their lifetimes. -Religion has its origin in the crisis experience in death because it provides individuals with a means of dealing with extraordinary _______________. -Religion functions to bring about a restoration of ____________ for the individual. -From _________________ perspective, death is not only the greatest source of _______________, but also the primary crisis event that calls for religious behavior.

Malinowski phenomena normalcy Malinowski's, anxiety

___________ _____________. which are characteristic of the human condition, force individuals to the realm of the transcendent in their search for meaningful answers.

Marginal situations

______________ are the basic component of human behavior because individuals respond to the ___________ of phenomena rather than to the ___________ themselves.

Meaning

The Afterlife in Islamic Tradition -The third of the great religious traditions stemming from the patriarch Abraham is Islam. Like Judaism and Christianity, Islam shares the Semitic religious heritage of _______________. -Islam means ____________ or ______________. Thus, a Muslim is one who has submitted and therefor is at peace with God. Muslims are those who have accepted Islam as a way of life, an approach to ________________ reality, which embraces both this world and "the other life." -The Islamic message came through Muhammad, who received his call to be a prophet in 610 when he was about forty, and was recorded in the _____________. -According to Muslims the Koran does not abrogate or nullify, but rather corrected the scripture preserved by the Jewish and Christian communities. -A basic premise of Koranic teaching about death is that God determines the span of a person's life. Allah judges a person's ___________. -The Book of ___________, wherin are recorded good and bad actions, will be opened and each person will be consigned wither to everlasting bliss or everlasting torment. For the Muslim, life on Earth is the seedbed of an eternal future.

Monotheism peace or submission transcendent Koran conduct Deeds

____________ are plans of action or expected behavior patterns felt to be appropriate for a particular situation. __________ are plans of action or expected behavior patterns specifying what should be done by persons who occupy particular social positions.

Norms Roles

Traditional medical care is often based upon a ___________ approach, which means that medication is given "as the situation demands."

PRN

Dying individuals experience a mix of emotions at any point in time, and those emotions may peak, diminish, and then recur Rather than advocating a stage theory _________ (1977) has described three common clinical phases of the dying process -_____________ _________ _____________: triggered by the crisis of knowing that death is approaching. This phase is marked by great anxiety and sense of threat to one's self. -___________ __________--__________ ___________: usually the longest and typified by a variety of fears, as well as grief for the many losses that are experienced as part of the dying process. -_________ ___________: characterized by an increased withdrawal into one's self and an increased sense of acceptance

Pattison Acute Crisis Phase Chronic Living Terminal Phase

_________ ____________ (1969) suggested that the human world has no order other than that created by humans.

Peter Berger

____________ _____________--___________ and __________ (1995) argue that crises, such as impending death, allow the dying and their loved ones an opportunity to unlock emotions as they explore other ways of living and deepening human experience. _______________ ____________ that occurs as one faces death can help counterbalance feelings of depression, anxiety, and fear.

Positive Emotions--Mead and Willemsen Psychological Growth

Within any health care setting, the patient's confinement serves to diminish his or her social and personal power. According to _________ ______ (1970), three processes occur within the institution to accomplish this--__________, ________ _________, and ____________ ___________.

Rodney Coe stripping, controlling resources, and restricting mobility

According to __________ ____________ (1990) people with near-death experience have the following aftereffects as a result: -Loss of ___________ of ____________: people report that they no longer fear the obliteration of consciousness or self. -Sense of the Importance of __________: can radically change people's value structure. -Sense of __________ connection: feeling that everything in the universe is connected. -An appreciate of ___________: gain a newfound respect for knowledge, but not self-gain -A new feeling of _____________: feel that they have more responsibility for the course of their lives. -A sense of ___________: realize the shortness and fragility of their lives. -A better-developed ___________ side: spiritual curiosity and abandoning of religious doctrine for sake of doctrine. -reduction in _____________: some people feel more in control of life's stresses and are able to be more forgiving, etc. ______________ syndrome: some have trouble adjusting to normal life. Some report psychic abilities

Skip Johnson fear of death Love Cosmic Learning Control urgency spiritual worries reentry

____________ ____________ and ______________-- In order for the dying to deal effectively with their fears and to come to terms with their own grief, they need to know that others still care about them. A primary fear experienced by dying individuals is a fear of loneliness or abandonment. This may be exacerbated as others fail to disclose the truth regarding the diagnosis of a terminal illness, refuse to deal openly and honestly with death-related issues and feelings, or physically and emotionally withdraw from dying persons.

Social Needs and Concerns

Meeting Patient's Needs ___________ ___________ and ____________: Many persons' sense of spirituality becomes magnified as death approaches and issues related to meaning, hope, and belief systems are often a primary concern ____________ ___________ of ____________: As concern has grown over providing quality holistic care to dying individuals, many health care facilities have formalized their philosophy by adopting a patients' bill of rights.

Spiritual Needs and Concerns Patient's Bill of Rights

____________ _______________ (Lifton and Olson, 1974) refers to the belief that the meaning of the person can continue after he or she has died.

Symbolic Immortality

Buddhism--There are many types of Buddhism, but the most popular are ___________, ______________, and _____________. -Buddha was born in 563 BC as a prince in ______________. When he was a child his thoughts were preoccupied with the finitude of human existence. -Beginning at age 29 he left his life of privilege to search for personal ____________. -He attained a state of _______________ through intense meditation. For the remaining 50 years of his life he served as a missionary and preached his message of salvation to all people regardless of social position and gender. -The Message is the "___________ __________ ___________" --All human existence is characterized by pain and suffering in an endless _____________ of death and rebirth. --The cause of the agony of the human condition is desire for personal _____________, which is impossible to attain. --Salvation comes by _____________ these desires. By completely destroying ignorance, one experiences enlightenment, and the cycle of transmigration of the soul is broken. -One can experience perfect ___________ through the eightfold path to enlightenment.

Therevade, Mahayana, and Tantrayana Northern India salvation enlightenment Four Noble Truths cycle satisfaction destroying peace

Religion and Death Attitudes Many situations in life challenge the order on which social life is based. Most of these situations are related to what _________ ________ (1966) refers to as the three fundamental characteristics of human __________. -____________ -____________ -____________ _____________: refers to the fact that human activity does not always lead to predictable outcomes _____________: we recognize that there are many situations in life, and events in the universe, over which humans have no control. _____________: humans experience inequality with regard to the distribution of wealth, power, prestige, and other things that make a satisfying life.

Thomas O'Dea existence uncertainty, powerlessness, and scarcity uncertainty powerlessness scarcity

the ____________ are recognized by almost all Hindus as an authoritative source of spiritual knowledge

Vedas

As people gather information to confirm their suspicions that they are seriously ill, they are in a state described by ___________ (1972) as ________ ___________--somewhere between open knowledge of death and its utter repudiation is an area of uncertainty called __________ __________.

Weisman middle knowledge

The Principle of Hospice and Palliative Care Unlike ________ _______--which involves taking measures to sustain life, palliative care focuses on: -Controlling pain and relieving suffering by caring for the ___________, ____________, ____________ and ___________ needs of the patient. Palliative care embodies the idea that the ultimate goal of medicine is __________ rather than curing disease -__________: involves restoring, or preserving, a sense of equanimity ad personal integrity in the face f the many and varied disturbances in living that are necessarily caused by illness. Palliative care is not "__________" -Measures are actively taken to relieve pain and suffering so that the dying person can go on living until his or her death. An important feature of palliative care is its response to the conventional message heard by dying patients and their families that "_______ _________ ____ ____ _______" The primary aim of hospice and palliative care is to help people live as fully as possible until the end of their lives.

acute care physical, psychological, spiritual, and existential healing Healing passive nothing more can be done

Summarizing the relationship between religiosity and death anxiety, we can arrive at the following theoretical assumptions: -The meanings of death are socially ____________--Death per se is neither fearful nor non fearful -The meanings that are ascribed to death are transmitted in the society through the ____________ process. --Anxiety reduction may be accomplished through social ____________ and institutional _______________. Institutional cohesiveness in religiousness is fostered by giving participants a sense of ____________ concerning death and _____________ them through a common concern. If religious institutions are to remain viable, they must provide a means for anxiety ______________. Through its promise of a reward in the afterlife, and its redefinition of the negative effects of death upon the ___________ life of the individual, religion diminishes the fear that it has _____________ to death and reduced anxiety that are ascribed to death by _____________ society.

ascribed socialization cooperation, participation anxiety, uniting reduction temporal, ascribed, secular

Durkheim designates four essential ingredients of religions--a system of _____________, a set of religious practices or _____________, the sacred or supernatural as the object of ____________, and a community or ________ base. From The Elementary Forms of Religious Life (1915)

beliefs, rituals, worship, social

The Hopi believed that a duality of being existed in each person--a soul and a body expressed as a "________-__________."

breath-body

Mutual Pretense Today, even though more patients are directly being told by doctors that they are going to die, interactions with family and friends still often reflect patterns related to the mutual pretense context. These interactions are characterized as a ____________ of ______________--which is a mutual pact to avoid issues of consequence as they relate to the death and to focus only on the mundane (e.g., the weather) This places them into an __________ ____________--in which others do not allow them to share their true feelings, but rather force them to participate in formalities and to exchange platitudes.

conspiracy of silence emotional quarantine

Homans' Four Conclusions -Religion function to relieve anxiety associated with _________ ________ situations. -Death anxiety call forth religious activities and __________. -In order to stabilize the group of individuals who perform these rituals, group activities and beliefs provide a potential threat of anxiety in order to ____________ group members through a common concern. -This secondary anxiety may be effectively removed through the group rituals of ____________ and _____________.

death related rituals unite purification and expiation

The Japanese do not clearly _____________ the dead from the living and seem to recognize the continuity between life and death.

distinguish

Traditional Concepts about Life after Death Jewish Beliefs about Death and Resurrection -The bible (does/does not?) present a systematic theology of death or the afterlife. Death is not ignored but biblical literature about it reflects a progression of ideas over a long period of time. The Biblical story describes a people focused on their _______________ destiny. -The characteristic theme emphasizes _________--________ in the people of Israel as a community with a common destiny and ____________ in YAHWEH, whose promises will be realized in the unfolding of the divine plan. -Over time there were corresponding changes in how mortality and its meaning were understood. Righteous conduct is advised because it leads to harmony in the __________ life, ____ because it guarantees future rewards for the individual. -Between the time of Job and the later prophets there was a gradual change from ______________ to hopefulness in the face of death. Strands of thought are woven together in ideas about the _____________ of the body. This is an important development in Hebrew thought, and it greatly influenced Christian theology. -This development consists in the belief that, at the end of time, the bodies of the dead will be ____________ from the grave and reconstituted.

does not communal faith temporal, not resignation resurrection resurrected

From an ________________ perspective, the creative efforts that compromise ones life can pride individuals with personal meaning for both life and death.

existentialist

Needs and Concerns of the Dying -Realize that the needs and concerns of the dying are unique to each individual--what we say here may not be true of every individual, but are simply ___________. Physical needs and concerns: -__________ is the most commonly experienced symptom of terminally ill patients. In order that the dying may be assured as high a quality of life as possible, many would argue that pain must be controlled in a manner that maintains ____________. -Freedom from pain while in a conscious and alert state allows dying individuals to have as much control of their lives as possible and to have opportunities to complete their "__________ ____________" prior to death. -_________-_________(1969) first used this term to refer to the need to draw closure to many facets of one's life. -Many health practitioners, including proponents of the hospice philosophy, believe that medication should be ______-_____________, self-regulation allows the dying to retain a sense of control and also minimizes their fear that their pain will be exacerbated if an upcoming dosage is not given in time. In sum, unrelieved, purposeless chronic pain leads to needless anxiety, depression, and suffering, which in turn can ___________ the natural process of deterioration.

generalizations Pain alertness unfinished business Kubler-Ross self-administered accelerate

For the Roman Catholic there are four potential dispositions of the soul after death--_________, ___________, ____________, and ___________.

heaven, hell, limbo, and purgatory

Within a given society there are ______-status and ________-status types of death.

high, low

For the ancient Hebrews, the cultural institution of the _____________ _____________ required that a relative of the deceased husband have sexual intercourse with his dead relative's widow to provide a male heir.

levirate marriage

The Dying Process In examining the dying process we must remember: -A dying individual is a __________ individual. Just as healthy people have a variety of needs, so do the dying. --___________ and ___________ (1979) noted several decades ago that "all deaths involve a complex interplay of cognitive, social and biological processes." --Like healthy individuals, dying individuals are affected by particular developmental trends: therefore their needs, interests, and capabilities vary with each _______ _________. -A second premise is that death is a natural part of the life ______. -A third premise is that _________, such as respect and empathy, can be as important in helping dying individuals deal with their impending deaths as the functional skills (e.g., medicine, etc.) used in their care. -Fourth, attention must be paid to both the people who are dying and to the social _________ of which they are a part. -Finally, a __________ approach to meeting the needs of the dying individual and his or her family is valuable.

living Rebok and Hoyer life stage span attitudes units holisitc

There is no culture where the ______________ view on death is normative.

nihlistic

Hospice Philosophy and Principles Hospice is a ___________, not a facility -The Hospice philosophy affirms ______, not death. -Hospice care for and about persons who are dying because they are still _________. -The affirmation of life that is central to the hospice philosophy is expressed in an effort to maximize present ________ in living. -Hospice is a form of palliative or __________-___________ care that tries to minimize discomfort. Hospice is mainly concerned with caring when cure is no longer a reasonable expectation. -The hospice approach offers care to the patient and family unit. -This means that both the dying person and those whom he or she regards as ___________ are part of the unit that receives care and that helps to give care. -Hospice is _____________ care. -It approaches the dying individual as a ___________, a whole human being. To do this, hospice care addresses physical, psychological, social and spiritual needs. It seeks to enhance quality in living in each of these dimensions.

philosophy life living quality symptom-oriented family holistic person

Origins of Hospice and Palliative Care The roots of hospice and palliative care are found in age-old customs of hospitality and in "__________ of __________" maintained by early Christians to care for pilgrims and travelers. Among the earliest hospices were those founded in the fourth century by a disciple of __________ ___________ named ____________, a wealthy Roman widow who became both patron and nurse in caring for the sick and dying. The most influential model of modern hospice care is ____ ___________ _________ in Sydenham, England, founded in 1967 by Dr. ___________ ______________. -It was founded during the 1940s. -While training as a medical Social Worker, Saunders met David Tasma, a Jewish refugee from Poland who was dying of inoperable cancer. Together, they formulated the vision of a have where people could find relief from pain and die with dignity.

places of welcome Saint Jerome, Fabiola St Christophers Hospice Cicely Saunders

Challenges to Hospice and Palliative Care Demand for Hospice and Palliative care is growing, but there are challenges that must be faced if this kind of compassionate, comprehensive care at life's end is to become more widely accepted Because most hospice care is provided in patients' homes, a virtual requirement is the presence of a __________ ______________ who is available 24 hours a day. -Ex: For men, the ___________ ___________ is usually a spouse, for women, it is usually another relative, often a child or child-in-law. Homecare is provided mostly by unpaid family members and friends. Another challenge involves _____________ for Hospice care. Although Hospice services are covered by medicare.medicaid programs as well as by most private health plans, there are certain restraints on who qualifies. For ____________--Physician must certify that life expectancy is 6 months or less. Patients and physicians must also agree to stop treatment aimed at prolonging life. The _______-______ _________ causes Hospice officials to be wary of government auditors questioning whether patients are sick enough to qualify for hospice care and cracking down when patients don't die on schedule.

primary caregiver primary caregiver funding Medicare Six-month rule

Christian Beliefs about the Afterlife -Jesus spoke of the kingdom of Heaven as a place of eternal reward with many dwelling places. The life, death, and resurrection of Jesus is the model of ultimate ____________ for Christians. -In effect, Jesus is the prototype of _____________ from death, a salvation is available to all who, by faith, share in his _______________. Gradually there developed a greater emphasis on the destiny of the individual soul and increasing concern about the _________________ of an individual's conduct during life. -Church doctrine began to accommodate the idea that punishment for misconduct could take place during an intermediate period between death and resurrection, and intermediate state, which came to be known as _____________, offered an opportunity for purification to eliminate any remaining personal obstacles to the full enjoyment of eternal union with God. -In the writings of Dante and ____________ ________________, earlier concepts of death, which focused on eventual resurrection of the body, are subordinated to a more pronounced emphasis on the soul's immortality after death.

reality salvation resurrection consequences purgatory Thomas Aquinas

Some sociologists have argued that to be inclusive of phenomena that most people consider religious, it might be proper to exclude the necessity of having a sacred point of ____________.

reference

Vernon (1970) pointed out that individuals whose interpretations are primary temporal share the following beliefs and attitudes: 1. They tend to __________ or de-emphasize a belief in the afterlife. 2. They tend to believe that death is the ______ of the individual. 3. They tend to focus on the needs and concerns of the ______________. 4. They tend to be ___________-oriented for themselves, but __________- and __________-oriented for those who will continue after them. 5. Any belief in _____________ is related to the activities and accomplishments of the individual during his or her lifetime--including biological offsppring and social relationships that the individiaul has created.

reject end survivors present, present and future immortality

A ________________ is a unified system of beliefs and practices relative to sacred things; that is to say, things set apart and forbidden--beliefs and practices that unite into one single moral community called a church, all of those people who adhere to them.

religion

According to Moody at least one of the following 9 traits is enough to constitute a near-death experience. -A __________ of being dead. At first people don't realize that the experience that they are having has anything to do with being near death. -___________ and _____________. An illness or accident is frequently accompanied by intense pain, but suddenly during a near-death experience the pain vanishes. -________ of _____________ Experience. Most say that they are not simply a point of consciousness but seem to be in some kind of body. -The ____________- Experience. This generally occurs after an out of body experience. The sense of heading toward an intense light is common to almost all tunnel experiences. -_____________ of ___________. After the tunnel, they usually meet beings of intense light that fill the people with feelings of love. -___________ of ____________. Meeting with the supreme being of light. Most want to stay with him forever. -The __________ __________. The being of light helps put the events of life into perspective. -_________ __________ into the Heavens. Some report a floating experience in which they rise rapidly into the heavens. -_____________ to return. Many find their unearthly surrounding so pleasant that they don't want to return.

sense peace and painlessness out of body Tunnel People of Light Being of Light Life Revie Rising Rapidly Reluctance

In addition to the disengagement process, patients are expected to acquire the ______ _________ (Parsons, 1951). They are expected to want to get better and to want to seek more treatment even though everyone realizes that such treatment only prolongs death and not life.

sick role

Death and Immortality in Asian Religions -Hinduism--Unlike the religious traditions that we have previously discussed, Hinduism does not have a _________ religious founder nor a single ___________ text. -Many theologies and religious approaches exist within Hindu tradition. Three concepts are central to an understanding of Hinduism. --___________: refers to a moral law of causation; it suggets that an individual's actions produce results for which the individual is responsible. Karma also refers to the balance of good and bad deeds performed in previous existences. --__________: are the religious duties, requirements, and/or prescriptions. The extent to which one fulfills one's dharma determines one's karma. --__________: is the reward for living a saintly life. The main ways of achieving moksha are by acquiring true knowledge, performing good deeds, and living a life of love and devotion to god. -The central doctrine affecting death related attitudes and behavior in the hindu religion is ____________ and ______________ of souls. For the Hindu, one's present life is determined by one's actions in a previous life.

single sacred Karma Dharma Moksha reincarnation and transmigration

Humans attempt to live in a world that is ordered and _______________. To live in a world without order contributed by one's culture would force one to experience a _____________ existence. -Sociologists refer to this condition as ___________--meaning without order Religious-meaning systems provide answers to these problems of ______________, ________________, and _____________ created by death. -Religion as a means of providing ___________ of death. -Religious systems provide a means to reestablish the ________ ______ challenged by death.

stable meaningless anomie uncertainty, powerlessness, and scarcity understanding social order

Hospice Philosophy Hospice offers continuing care and ongoing support to ___________ survivors after the death of someone they love. Care for family and friends does not cease with the ________ of the person they love. The hospice approach seeks relevant ways to combine _______________ skills and human ______________ through interdisciplinary teamwork. Expertise in terminal care and the management of distressing symptoms is essential. Equally important is the availability of human _______________. Hospice programs make services available on a 24 hour a day, 7 day a week basis. Hospice is an effort to recreate ____________ communities in the service of dying persons and their families. When and where a need does exist, these programs must be available around the clock, just as a ___________ community is. Hospice programs support their own staff and volunteers. Hospice programs also offer _________ and ___________ programs of support for their own staff members and volunteers. Caring for those who are coping with dying and/or bereavement and working within the structure of an interdisciplinary team can be stressful. The hospice philosophy can be applied to a variety of individuals and their family members who are coping with a life-threatening illness, dying, death, and/or bereavement.

survivors death professional, presence companionship caring, caring formal and informal

The major types of meanings to which individuals respond in death-related situations are the following: ______ meaning, ______ meanings, ______ and ______ meanings, ________ meanings, ________ and ________ meanings, and _______ __________ meanings.

time space norm and role value object and self social situation

Challenges to Hospice and Palliative Care Another challenge to Hospice and palliative care is broadening its access to _____________ populations. -Since its inception, hospice has expanded to serve diverse patient populations, including ___________ -But ethnic and minority groups continue to be _____________. -In 1999, 83 percent of patients were __________, 8 percent were ____________, 3 percent were ____________, and 6 percent were ____________. -The challenges of accommodating the cultural and personal values of under-served people must become a priority for hospices and palliative medicine. As hospice has become a more regulated industry, it faces the challenge of excessive ____________ that can lead to the _______________ of care. A final challenge for hospice and palliative medicine involves education about end-of-life care for both the public and professional caregivers.

underserved children underrepresented white, African American, Hispanic, other bureaucracy routinization