Download Caring for the Dying

Caring for the Dying
2007 Psyc 456
Dusana Rybarova
Compassion and empathy
as basic human qualities
• We are biologically programmed to be
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cooperative, supportive, and altruistic
In the right environment empathy, compassion,
and caring behavior will unfold naturally and
both the caregiver and the care-recipient will
grow and thrive from their participation in it
(Larson, 1993)
Harsh and unloving childhood can inhibit the full
expression of these tender, human qualities, but
compassion and caregiving are part of our
biological inheritance
The Development of Altruism and
Caregiving
• Newborns react by crying to distress of others in their
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presence
Children 1 ½ to 2 years old attempt to comfort a
distressed person by patting, hugging, or presenting an
object
Role-taking ability developing around 2-3 years of age
Later we are able to empathize beyond our immediate
situation, beyond individuals (compassion for groups of
people such bereaved parents, victims of an attack etc.)
50% of Americans report performing some kind of
volunteer work during the past year
Later gestures of caregiving
– Suggestions about how to solve problems
– Trying to cheer others up
– Alternative helping responses to reduce suffering in others
Caregiving behavior:
Biological and social roots
• Animals demonstrate almost universal tendency towards
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cooperation and altruism and tend to become aroused in
the presence of a distressed member of their species
Caring for injured, incapacitated members of group in
chimpanzees and monkeys
Survival value of altruism and caring essential for human
species that is not physically superior to other species
– Reciprocal altruism
– Non-reciprocal altruism
• Support of compassionate and altruistic tendencies
through social learning
– Seeing reactions of others to caring acts and learning that
responding with empathy and compassion is both rewarded and
rewarding
Caregivers Fears
– Caregiving can reveal a vulnerable, more fearful side
of our nature
– We may face a mixture of compassion, anxiety, and
fear
– How to relate to a dying person at other than
superficial level
– Social barriers – expression of grief connected to the
death of a patient is often considered unprofessional,
associated with feelings of inadequacy and
incompetence
Caregivers Fears
• Fear of our own death
– Experience of caring for a dying person can arouse our
own fear of mortality without a conscious experience of
it
– It can lead to detachment from the person we are
caring for
– Important facing the issues and developing strategies
of coping
• Fear of hurting the person we are helping
– Often combined with time pressure, the urge to be
perfect, often the necessity to make decision based on
vague or incomplete information
– Powerful emotional consequences of mistakes for a
caregiver
… Caregivers Fears
• Fear of Being Hurt
– Fear of being the target of others’ anger
– Fear of being hurt when our patient or a loved one finally dies
– Repressed and unacknowledged feelings over long periods of time
can generate ongoing stress and activate grief and fear from
other parts of the caregiver’s life
– Can result in depersonalized and dehumanized care
– The fear and grief needs to be confronted and worked through
• Fear of Being Engulfed
– Being immersed in the grief and stress of the dying, feeling used
and defensive
– The risks of either being overwhelmed by emphatic feelings for
the dying, or slipping into depersonalized and dehumanized
attitude
Dying in a Hospital
• 40% of patients spent 10 days in coma isolated
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from family
Living wills stating that the patient should not be
artificially resuscitated were not respected in half
of the cases
1/3 of patients spent most or all of their life
savings for unsought, unrequested, and vain
efforts to postpone inevitable death
Nurse-advocates did not have any effect on the
treatment of the patients
The Physician
• High priest in American society
• Physicians commit suicide at three times the rate of the
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population at large
79% reported that their care decisions were influenced
by financial issues
Physicians are highly death avoidant, have inordinately
high fear of death
Medical education leads to desensitization and
dehumanizing attitudes
Have limited understanding of the social, psychological,
spiritual, and comfort needs
Avoidance of dying patients
Caregivers grief is both unrecognized and expected to be
so
Social Death and Depersonalization
• Social death
– Patients treated by medical personnel they don’t know, isolated
from their family and friends
• I.C.U. psychosis
– Severe disorientation of patients reacting to windowless,
mechanical environment
• Depersonalization
– Dying in a strange, and sterile environment, isolated from
spiritual nourishment, and loving support
• The conspiracy of silence
– 74% of doctors avoids talking to patients about their terminal
illness
– About 80% of patients wants to know that they are dying
– Closed awareness, suspicious awareness, mutual pretense
Genuine and compassionate care
• Education
– Information about psychological aspects of death and care
options of the dying
• Learning and applying coping strategies
– Prevention of cognitive denial, emotional repression and
behavioral passivity
– Relaxation techniques, meditation, writing as a coping strategy,
seeking advice, talking to colleagues, spiritual advisors and
counselors
• Communication training
– Attending workshops about effective communication with the
dying
– Seeking information about how to communicate about death
The Hospice Alternative
• Hospice refers to a comprehensive philosophy of
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compassionate care for the terminally ill
Hospice care is mutlifocused and includes coping
with the psychosocial, spiritual, and economic
issues as well as medical problems
It is comfort-centered rather than cure-centered
Interdisciplinary team includes the nurse
coordinator, the home health aide, the grief
counselor, volunteers, specialized therapists,
nutritionist, hospice physician, clergy
The Hospice Alternative
• 2,500 hospice programs in the USA
• Three types of hospice care
– A house where people go for visits and counseling
– A separate ward or palliative care unit of a hospital,
where patients are cared for by an interdisciplinary
hospice team
– Home care service with the goal of allowing patients
to remain in their home environment as long as
desired as possible (predominant in the USA)