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What characterizes terminal illness?
Which of the following conditions is NOT classified as a terminal illness in adults?
What is a primary focus of palliative care effectiveness?
Which factor is crucial for providing quality care at home for terminally ill patients?
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What is one benefit of hospice day care?
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Which of these is NOT a consideration for hospice/palliative care units?
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What emotional elements does palliative care aim to address?
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Terminal illnesses can lead to the need for which type of care?
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What is the purpose of hospice care?
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Which phase of death describes the irreversible cessation of all vital functions?
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What is a common belief about death in American and European culture?
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Which of the following describes passive euthanasia?
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What is NOT a characteristic of a 'good death'?
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Which phase of death typically allows for a brief possibility of resuscitation?
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What does prolonged grief refer to?
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What is a common result of patients being admitted to a busy hospital?
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What is disenfranchised grief?
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Which factor influences the experience of grief?
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What characterizes dysfunctional grief?
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Which of the following is a phase of grieving according to Engel's theory?
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How does sudden loss impact the grieving process?
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What is meant by anticipatory grief?
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What can be a consequence of prolonged grief after a terminal illness?
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During which phase of Engel's grieving process might a person experience physical symptoms such as fainting or rapid heartbeat?
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What is the main focus of Phase IV in the grieving process?
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In Rando's grieving theory, which of the following is the correct sequence of responses?
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Which of the following best describes the 'Anger' stage in Kubler-Ross's grieving process?
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What characterizes the 'Bargaining' phase in grieving according to Kubler-Ross?
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What does the 'Depression' phase indicate in Kubler-Ross's model?
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What development occurs during Phase V of grief?
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In the context of grieving, which stage involves shock and denial?
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Which of the following descriptions matches the 'Acceptance' phase of Kubler-Ross's model?
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Study Notes
Terminal Illness
- Terminal illness refers to a progressive disease where curative treatment is impossible or inappropriate, resulting in certain death.
- The duration of a terminal illness varies from a few days to many months.
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Types of Terminal Illness:
- Cancer: Lung, trachea, bronchus, ear, nose, throat, female breast, lymphatic, digestive tract, genitourinary, leukemia, and haemopoetic.
- Progressive Non-Malignant Diseases: Cardio/cerebrovascular diseases, respiratory system diseases, HIV/AIDS.
- Children's Terminal Illnesses: Cystic fibrosis, muscular dystrophy.
Palliative Care
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Palliative Care Effectiveness:
- Quality of life before and at the time of death.
- "Good death" for the patient.
- Impact on family or carers.
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Elements of Palliative Care:
- Pain and symptom control.
- Relief of emotional problems.
- Grief resolution.
- Achievement of specific wishes.
Place of Care for Terminal Illness
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Home:
- Provides quality care if the patient has a good social network and involved family members.
- Requires careful consideration for emergencies.
- Family members may experience burnout and fatigue.
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Hospice Day Care:
- Offers palliative care for patients in the community 1-2 days a week.
- Provides complementary therapies and relaxation along with necessary nursing care.
- Allows patients to stay at home longer.
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Hospice/Palliative Care Unit:
- Offers the highest level of palliative care.
- Patients stay for 10-14 days after symptom management.
- Approximately 50% of patients die while receiving care, while others return home for Hospice Day Care.
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Hospital:
- Patients are often brought to the hospital in critical condition.
- Hospital care is needed primarily when curative therapies are still being employed.
- The busy hospital environment may not be conducive to achieving a "good death."
Death
- Some cultures hold specific philosophical/religious beliefs surrounding death and have rituals for dealing with it.
- American and European cultures typically avoid and deny death.
Phases of Death
- Agonal Phase: Characterized by changes in heart rhythm.
- Clinical Death: A brief interval during which life-saving measures are still possible.
- Mortality: Permanent death.
Issues in Terminal Illness/Terminal Care
- Advance Directives: Procedures for withdrawing life support when a patient is dying.
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Euthanasia:
- Passive Euthanasia: Withholding treatment previously provided.
- Active Euthanasia: Intentionally inducing death.
- Good Death: Physical comfort, support from loved ones, adequate healthcare, acceptance of impending death, and not being a burden on others.
- Hospice: A program committed to achieving a painless, anxiety-free, and depression-free end of life. Hospice prioritizes symptom management rather than life extension.
Grief
- Grief: Emotional numbness, disbelief, anxiety due to separation, despair, sadness, and loneliness accompanying the loss of a loved one.
- Prolonged Grief: Persistent and unresolved despair for an extended period.
- Disenfranchised Grief: Grief over the loss of someone that is socially unacceptable to openly express.
- Grief is Multidimensional: Grief can last for years.
Types of Grief
- Anticipatory Grief: A state in which an individual experiences the emotional responses to an actual or perceived loss of a relationship, object, or functional ability before the actual loss occurs.
- Dysfunctional Grief: A state in which an individual's response is exaggerated, particularly when experiencing an actual or potential loss of a relationship, object, or functional ability. This type of grief may approach abnormal grieving patterns.
Factors Affecting Grief
- Personal characteristics.
- Social, cultural, and spiritual beliefs.
- Nature of the relationship.
- Socioeconomic status.
- Individual's physical and psychological condition.
- Support system.
Nature of Loss
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Sudden (Unpredictable) Loss:
- Sudden and unexpected losses may lead to a slower recovery.
- Death due to violence, suicide, or murder can be particularly difficult to accept.
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Gradual (Predictable) Loss:
- Prolonged and debilitating illnesses can cause emotional exhaustion for survivors.
- Research suggests that those who lose a loved one after a long illness of at least 6 months have greater needs for dependency, are more prone to isolation, and experience heightened feelings of anger and hostility..
Theories of Grief
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Engel's Theory (1964):
- Stage I (Shock and Disbelief): Denial of the loss, withdrawal, and physical reactions such as fainting, sweating, nausea, diarrhea, rapid heart rate, sleeplessness, and fatigue.
- Stage II (Developing Awareness): Experiencing the loss in a real and acute manner, which may lead to desperation. Anger, guilt, frustration, depression, and emptiness may arise.
- Stage III (Restitution): Trying to accept the feeling of emptiness and seeking ways to cope.
- Stage IV: Suppression of negative feelings, like hostility and guilt, towards the deceased.
- Stage V: Acceptance of the loss, developing a new way of life while acknowledging the loss.
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Rando's Theory (1993):
- Avoidance: Characterized by shock, denial, and disbelief.
- Confrontation: Involves intense emotional outbursts as the individual repeatedly confronts their loss and deepest grief.
- Accommodation: Gradual reduction in acute grief and a return to emotional and social involvement in daily life. The individual learns to live with their loss.
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Kübler-Ross' Theory (1969):
- Denial: The individual acts as if nothing has happened, often refusing to believe the loss has occurred. Common expressions include "No, it can't be true," or "It won't happen to me!"
- Anger: The individual is more sensitive and easily irritated, manifesting a coping mechanism to cover up disappointment and anxieties about facing the loss.
- Bargaining: The individual seeks support to alleviate feelings of loss. They may turn to others for reassurance and vent their frustrations.
- Depression: Occurs when the individual acknowledges the loss and its impact. This stage allows the opportunity to process the loss and start to solve problems associated with it.
- Acceptance: Physiological reactions decrease, and social interactions resume. Kübler-Ross defines acceptance as the ability to face reality rather than surrendering or despairing.
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Description
This quiz explores the concepts of terminal illness and palliative care. It covers types of terminal illnesses, the effectiveness of palliative care, and the elements crucial for providing quality end-of-life care. Test your knowledge about this important aspect of healthcare that emphasizes comfort and support for patients and their families.
