Chapter 13: Death and Bereavement

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  1. Sociocultural Definitions of Death

    1) All cultures __
    2) __ and __ also vary in different cultures. 
    3) Death can be a truly __, such as when major tragedies occur.
    4) Death can be __ and __
    have their own views

    mourning rituals and states of bereavement

    cross-cultural experience

    personal and public
  2. How do we determine someone has died?
    clinical death: lack of heart beat and respiration; used for 100s of years as determining factor

    Today's determination: whole brain death
  3. criteria for whole-brain death
    • - no spontaneous responses to any stimuli
    • - no spontaneous respiration for at least one hour
    • - total lack of responsiveness to even the most painful stimuli
    • - no eye movements, blinking, or pupil responsiveness
    • - no postural activity, swallowing, yawning, or vocalizing
    • - no motor reflexes
    • - a flat EEG for at least ten minutes
    • - no change in any of these when tested again 24 hours later
  4. Persistent vegetative state
    occurs when cortical functioning ceases but brainstem can still be active

    the person does not recover

    allows for spontaneous heartbeat and respiration, but not for consciousness

    whole-brain standard not met
  5. Bioethics
    examines the interaction between human values and technological advances

    • Grew from two bases: 
    • - respect for individual freedom
    • - impossibility of establishing any single version of mortality by rational argument or common sense
  6. The most important bioethical issue is __, which is __
    euthanasia; the practice of ending life for reasons of mercy
  7. Two types of euthanasia
    active: deliberately ending someone' slife through some sort of intervention or action; based on a person's wishes or power of attorney; ex: drug overdose or mercy killing

    passive: ending someone's life by withholding treatment  (ex: stopping chemo)
  8. Controversy with euthanasa
    religious and political beliefs
  9. True or False:

    Some ethicists and medical professionals don't differentiate between active and passive.
    true
  10. Physician assisted suicide
    provides for people to obtain prescriptions for self administered lethal doses of medication
  11. Research on PAS
    70% of amerians favor having a choie
  12. Where is PAS allowed?
    in several countries--Belgium, Switzerland, and Columbia

    Oregon and Washington
  13. Rules of PAS
    physician must explain illness and discuss alternatives

    two oral and one written request with 15 days between each
  14. PAS seems to have __.

    What is an argument against it?
    psychological benefits

    who has the right to play God
  15. A Life Course approach to Dying

    Young adults report what?
    Middle aged adults do what?
    Older adults do what?
    young: report a sense of being cheated by death

    middle aged: begin to confront their own mortality; undergo a change in their sense of tie lived and time until death; when their aprents die, they realize thy are the oldest generation

    older adults: are less anxious and more accepting of death
  16. Kubler Ross theory
    • Denial
    • Anger
    • Bargaining
    • Depression
    • Acceptane

    These stages can overlap and be experineced in a differnt order

    Individual differences are great
  17. Corr'scontextual theory of dying
    • Corr ID'ed four dimensions of tasks that must be faced:
    • 1) bodily needs
    • 2) psychological security
    • 3) interpersonal attachments
    • 4) spiritual energy and hope
  18. Death anxiety
    people's anixety or fear of death and dying
  19. Death anxiety may have a beneficial side. How so?
    it reduces impulses
  20. Death anxiety consists of several components that can be accessed at the __, __, and __ levels.
    • public
    • private
    • noncounscious
  21. Examples of related behaviors in response to death anxiety.
    • cosmetic surgery
    • having children and raising them properly
  22. Age and gender in terms of death anxiety
    • older adults have less anxiety
    • men are more fearful of the unknown
    • women are more fearful of the dying process
    • teens engage in risky behaviors because of their low death anxiety
  23. Terror Management Theory
    addresses why people engage in certain behaviors to achieve particular psychologial states based on their deeply rooted concerns about mortality

    Neuroimaging research supports the use of this theory in understanding death anxiety

    Selecting behaviors that serve as buffers and keep you alive
  24. How does one deal with death anxiety?
    • living life to the fullest
    • exercises to increase one's death awareness, such as writing obituaries and planning funeral services
    • death education
  25. End of life issues
    • managing the final aspects of life
    • after death disposition of the body and how one is memorialized
    • distribution of assets
    • writing a will
  26. Grandparents and parents of baby boomers in terms of end of life issues
    rarely made plans

    today' generation has a much more "matter of fact" stance
  27. A final scenario
    • making choices about what people do and do not want done
    • a crucial aspect of the final scenario is the process of separation from family and friends (bring closure to relationships)
  28. Health care workers understand the importance of __.
    __ and __ is critical. 
    __ is also important
    • the final scenario
    • open and honest communication 
    • respecting an individual's decisions
  29. The hospice option
    an approach to assisting dying people that emphasizes pain management (palliative care) and death with dignity
  30. Hospice care emphasizes __ rather than __. 

    - The goal is a deemphasis on the __. 

    Both __ and __ exist, the latter being cheapter
    quality of life; quantity of life

    prolongation of death for terminally ill patients

    inpatient and outpatient hospices
  31. The role of the staff in hospice
    to be with the patients, not to treat them

    • grooming and appearance
    • leads to more mobility, less anxiety and depression, more participation
  32. Making your end-of-life intentions known
    • living will
    • durable power of attorney
  33. living will
    a person simply states his or her wishes about life support and other tx
  34. durable power of attorney
    • an individual appoints someone to act as his or her agent for health care decisions
    • many are not told
  35. The purpose of making your end of life intentions known?
    to make one's wishes about the use of life support known in the event one is unconscious or otherwise incapable of expressing them
  36. End of life intentions an also serve as the basis for __
    DNR (do not resuscitate)

    medical order which is used when cardiopulmonary resuscutation is needed
  37. What is the Patient Self-determination and competency evaluation
    health care facilities must provide info in writing about patients' rights
  38. What are the two types of determination as to whether a person can make decisions?
    • capacity to make decisions (clinical(\)
    • competency (legal)
  39. True or False: Surrogate decision makers are often right about what patients really want.
    False: They are usually wrong
  40. bereavement
    the state or condition caused by loss through death

    (the situation you're in after the death; ex: widow)
  41. grief
    the sorrow, hurt, anger, guilt, confusion, etc. that arise after a loss

    the emotion
  42. mourning
    the way we express our grief (ex: crying)
  43. The grief process
    a complicated and personal one; described as reflecting on many themes and issues that people confront
  44. Unlike bereavement, over which we __, grief is a process that __
    • have no control
    • involves choice
  45. A person, in the grief process, must do four things
    acknowledge the reality of the loss

    work through the emotional turmoil

    adjust to the environment where the deceased is absent (outsiders have to help with this)

    loosen the ties to the deceased
  46. Recover and the grief process?
    it's misleading; we need to learn how to live with it
  47. Dual process model
    ther e are two types of stresors

    loss oriented: concern the loss itself

    restoration oriented stressors: involve adapting to the survivor's new life situation

    there is a cycle back and forth
  48. What distinguishes prolonged grief?
    separation distress: preocupied with the deceased to the point that it interferes with everyday life

    traumatic distress: disbelief about the death; the experience of physical presence of the deceased; mistrust, anger, and detachment from others
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Chapter 13: Death and Bereavement
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