HS 301 Study Guide

Autonomy

"Self determination" or "Self government" Challenge: Mental retardation or dementia or rational suicide (helping someone kill themselves

Traditional societies tend to view disease and death as

"Something that is out of balance"

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

- Advance Directives like the living will and health care proxy - DNR orders, mechanical ventilations, feeding tubes, antibiotics, hemodialysis, anything pretty much that will keep them alive for longer and delay their death - Palliative care, dealing with pain management, psychological, spiritual and existential suffering and unfinished business

In my traditional societies death is believed to occur because

- it is unnatural - something is out of balance - ecological orientation - heredity - behavioral excesses - social interactions

Concrete operational

7-12 years (applies logical abilities to concrete ideas . . see sports games. arithremital thinking, grasps death's irreversibility, prob not a good idea to alienate a kid when someone dies because the idea of it is already scary enough

"mean world" syndrome

A situation in which the symbolic use of death contributes to a "discourse of fear" leading to a heightened sense of danger and irrational dread of dying

sites of memory

Focal points for public grief and mourning, as well as memorialization.

What are the Aims of Palliative Care?

Goal is to improve quality of life for both the patient and the family, and provide an extra layer of support, it is appropriate at any age and any stage of serious illness and can be provided together with curative treatment

Respite care

Temporary care that gives family members or other caregivers a break

managed death

The attempt to control or seek mastery of the threat of death or the circumstances of dying by application of medical technology and by personal and social choices

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

The structural - functionalist approach

Define Hospice Care

Unlike hospitals and nursing homes, hospice is not necessarily a place, but a program of caring that is orientated toward the needs of dying patients and their families. The focus is on comfort rather than care

Identity vs. role confusion

b. 11 - 18 years (during adolescents, the main issue is Who am I? Death at this stage can affect one's identity and self-formation

Sensorimotor

birth - 2 years (focus on senses and motor abilities. Object permanence is being refined (parent leaves room - they simply vanish)

Palliative care

ultimate goal of medicine is healing rather than curing disease

Discuss a Mature Concept of Death. What four aspects / acknowledgments does a mature concept of death include?

- An understanding of death that includes recognition of the observable facts about death - 4 Components 1. Universality: All living things eventually die, death is all inclusive, inevitable and unavoidable 2. Irreversibility: Organisms that die cannot come back to life and be alive again 3. Non -Functionality: death involves cessation of all physiological functioning, or sign of life, when we are dead we do not function as we are living 4. Causality: There are biological reasons for the occurrence of death

What are characteristics of the concept of invisible death

- Care of the dying is largely the domain of hired professionals - Deathbed scenes are often dominated by efforts to delay death - The role of family and friends as witnesses to a loved ones dying has diminished - Mourning customs that held sway in the past now seem excessive - Funerals and memorial services are shorter, more discreet and private

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

- Devoted mainly to acute intensive care of a limited deration

Nonmaleficence

- Do no harm, minimizing harm -Challenge: keeping someone on a ventilator or withdrawing treatment Their own view of what is harmful may be inconsistent with perspective of others

Institutional Medical Care consists of:

- Hospitals - Nursing homes - Hospice programs

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

- Imminent or approaching death - Talking about wanting to die - Inquiries into hospice and palliative care - Recently hospitalized for severe progressive illness - Severe suffering and poor prognosis

Fidelity

- Importance of trust and loyalty in professional relationships - Challenge: Gay man dying of AIDS related conditions may refuse to inform his parents of situation because of rejection Physicians not giving the patients the most accurate time to live

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

- Increased from 47 to 77 years

According to the text what is the leading cause of death in the US today?

- Leading cause is heart disease then cancer

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

- More than 13 percent of the gross domestic product

The Health Care Triangle consists of:

- Patients - Staff - Institutions and Administration

What are three Features and Goals of Hospice Care?

- Provide relief from pain and suffering - Promote an aura of peacefulness and acceptance of dying - Treat patient and family as the unit of care

In which country was the most influential modern hospice established?

- St Christoper's Hospice in Sydenham, England founded in 1967

Beneficence

- The duty to "do good" - Cultural issues and not consulting with others

Justice

- The fairness regarding treatment of others and how goods and services are distributed - Challenges: Costs of care, health insurance, discrimination

Define Epidemiologic transition

- The historical shift in disease patterns, which is characterized mainly by redistribution of deaths from the young to the old

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

What does the statement "Death involves causality" mean?

- There are biological reasons for the occurrence of death

What is the approximate death rate per 1000 in the US today?

- Today it is 8.7 per 1000

What are three challenges to Hospice Care?

1. Adequate funding, 10% of workforce is volunteering, people are using palliative care as hospice and in that case taking a lot of the business that hospice would get when they are already on a budget 2. The presence of primary caregiver who is available 24/7, it is not 24/7, they think it is 3. The six month rule, you must have a life expectancy of six months or less

What are the five major social institutions delineated by sociologists?

1. Economy 2. The educational system 3. The family 4. The political system 5. Religion

List and describe three agents of socialization

1. Family: Beliefs of and values of parents are transmitted to their children and some messages of death are communication unconsciously 2. School and Peers: They are connecting to others in a community and getting a set of social norms, the bigger their social network, the increase in possible encounters with death 3. Mass Media: News reports about disasters, death has often had a place in children's stories, especially in earlier versions as well as Lullabies 4. Religion: Helps with coping with death, meaning in death provides mourning rituals that ease grief.

What are three sources of caregiver stress?

1. Feelings of inadequacy, not knowing what to say 2. Too many demands from patients 3. Feeling of being devalued, for example the nurse patient rations 4. Inability to cure a disease or save a life

Describe three aspects that comprise cultural sensitivity

1. People tend to view the world from a single perspective - their own. 2. Culture is not defined simply by ethnicity, within culturally diverse societies we can expect to find great variation within each ethnic group. Know that there may be more differences within than between cultural groups 3. Need to be aware of the fallacy of stereotyping others, stereotypes are often used as a learning strategy to organize and interpret info

Describe three ways religion functions in societies

1. There is a shared set of beliefs, values and norms that help form common identity for people 2. Having religion helps to answer the big questions about human existence and purpose which in turn is coping mechanism with our death anxiety 3. It gives us emotional and psychological support, and gives us a foundation for norms and laws of society

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

1.Choices differ based on the information, and the more info someone has the more choices this individual has 2. They could receive undesired treatments like excessive chemo or CPR (painful and potential to broken ribs) 3. Allows time for healing relationships completing goals, wills, preparation and avoid robbing them of their time when they can be spending it with loved ones

List 4 principles / goals for a "good death?"

1.To know that death is coming and to understand what can be expected 2.To be able to retain reasonable control over what happens, have time to say goodbye 3. To have a choice about where death occurs, like in hospital or home 4. To have adequate relief of pain and other symptoms 5. Access to desired spiritual and emotional support

Formal operational

12+ years (abstract reasoning, hypothetical reasoning, interest in synthesizing, play chess?, impacts thinking and our concentration)

Autonomy vs. shame

2-3 Years (toddlerhood, toilet training, period of letting go and holding on, testing the boundaries Death of a parent can cause regression to earlier behaviors like clinging, crying and being more demanding

Preoperational

2-7 years (learning to use language and symbols. Exploration is key here. Securing and identifying one's place in the world, death has a magical quality to it no mature concept of death yet, magical thinking

Initiative vs. guilt

3 - 6 years (pre-school kindergarten years, seek own purpose and direction. Looks for approval - kids look to adults/parents for confirmation as to their actions as they place themselves in society (egocentrism begins

Industry vs. inferiority

5 -11 years (very active. a lot of comparison making is going on. recognition and encouragement are keys during this stage. death of a family member can greatly hinder getting this

Childhood experiences with death are most likely to

Become fully aware of the impact only in adulthood

Trust vs. mistrust

Birth - 1 year (during infancy, kids are developing a sense of self, seeking trust and predictably. Death can cause unpredictability in their environment, this helps them know what's coming next, helps with creative energies

DRGs

Diagnosis related groups - costs can be managed by using predeteremined schedule of fees for reimbursing health care providers

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

More than 90% of Americans are affiliated with a religious tradition

QALYs

Quality adjusted life years - balance between length of life and quality of life. Individuals may be willing to accept trade off

institutional denial

Socially institutionalized avoidance of death-related thoughts and emotions

Define Palliative Care

Specialized medical care for people with serious illnesses, this type of care is focused on providing patients with relief from symptoms, pain and stress of a serious illness, you do not need to be dying to receive palliative care