PSYCHOSOCIAL ISSUES AT THE END OF LIFE - clinicalCE

PSYCHOSOC
THE END

with

Margot Escott, M

5633 Strand Blvd
Naples, Florid
(239) 434-
me1818@ao

CIAL ISSUES AT
D OF LIFE

MSW, LCSW

d., Suite 307
da 34110
-6558
ol.com

WHY ARE WE

„ Substitute EOL f
Violence licensu

„ 90% want to die
only 20% actual

E HERE?

for Domestic
ure requirement
e at home but

lly do

GOALS OF COU

At the end of this w
will be able to:

„ Identify three ps
the dying patient

„ Understand adva
„ Identify specific i

families in need o

URSE

workshop participants

sychosocial concerns of
t and their families
ance directives
interventions to assist
of hospice care

PSYCHOSOCIA
TERMINAL

„ Fear of the dy
„ Fear of aband
„ Financial conc
„ Focus on spiri

AL ISSUES IN
L ILLNESS

ying process
donment
cerns
itual issues

PSYCHOSOC
LIFE IS

„ Increased weakn
dependency on o

„ Increased drowsi
Do not assume p

„ Withdrawal from
caregivers
Letting go and tr
death

CIAL END OF
SSUES

ness = increased
others
iness and sleeping
patient cannot hear

family, friends and

ransitioning toward

MENTAL
INTERVEN
END OF LI

„ Referrals
„ Advance Directiv
„ Food & Water Is
„ Life Review

HEALTH
NTIONS IN

IFE CARE

ves
ssues

REFERR

Referrals may come
individual, family,
hospice team will
information and e
However, a physi
that a patient is t
that patient to be
hospice program.

RALS

e from the
, friends and a
l provide
education.
ician must certify
terminally ill for
e admitted to a
.

ADMI

„ Level of patient a
of terminal diagn

„ Family understan
„ Assess patient’s a

experience with d
„ Interventions – s

directive.

ISSIONS

acceptance/awareness
nosis.
nding of illness.
and family’s prior
death.
supportive, reflective,

ADVANCED D
How do we kn

clients want?

DIRECTIVES
now what our
?

ADVANCE CARE
THE LAW AN

‰ US Supreme
‰ Federal Law
‰ State Law
‰ Statutory Do

E PLANNING:
ND POLICY
e Court, 1990
w, 1991

ocuments

ADVANCE
CON

ƒ Doing somethin
patient’s will

ƒ Omitting the pr
ƒ Not discussing a
ƒ Avoiding it - tas

E DIRECTIVE
NCERNS

ng against the

roxy from discussion
all the options
sk seems too difficult

ADVANCE
CON

ƒ Not informing l
ƒ Excluding comp
ƒ from discussi
ƒ Not reading the
ƒ Letting our own

E DIRECTIVE
NCERNS

loved ones/family
promised patients
ions who retain DMC
e Advance Directive
n values interfere

COMPETE
DIRE

ƒ Complete your ow
ƒ Ask proxies if the

to fulfill their role
ƒ Identify a patient

for life-sustaining
ƒ Five Wishes – edu

http://www.agingwith

ENT ADVANCE
ECTIVES

wn Advance Directive
ey are able and willing
e
t's personal threshold
g intervention
ucational tool

hdignity.org/5wishes.html

FOOD A
AT THE E

“She never feels lik
her food so that
strength.” Famil

“All they talk abo
wanting me to ea
understand that
could.” Patient

AND WATER
END OF LIFE

ke eating. I try to give
she can keep up her

ly

out is food, always
at more. They don’t
I would eat more if I

14

FOOD
EXTRAORDIN

ƒEffects
ƒBenefits
ƒHardships

&WATER -
NARY MEASURES?

15

CONFLICT I
SY

Family:
Loss of appetite

life
Patient:
Loss of appetite

of their losses.

IN THE FAMILY
YSTEM
e equates to loss of

e may be the least
.

16

LIFE RE

„ Assists identifying loss
„ Allows expression of fe

loss/grief
„ Explores past losses an
„ Understands knowledg
„ Reinforces strengths o
„ Teaches responses to
„ Helps patient/family w

EVIEW

s due to disease
eelings/issues of

nd coping strategies
ge of grief reactions
of pt/family
loss/grief
with closure

ELISABETH KU

Dying is an integra
natural and pred
born. But wherea
for celebration, d
become a dreade
unspeakable issu
by every means
modern society.

UBLER-ROSS

al part of life, as
dictable as being
as birth is cause
death has
ed and
ue to be avoided

possible in our

BENEFITS OF KU
STAG

„ Increased public
„ The dying are sti

have unfinished n
„ Effective provider

actively to the dy

UBLER-ROSS’S
GES

awareness
ill alive and often
needs
rs need to listen
ying

WEAKN
KUBLER-RO

„ No cookie-cutter
„ No valid research

of and movemen
„ Does not take en

into account
„ Can be misused

professionals and
„ Responses rathe

NESSES OF
OSS’S STAGES

model for all people
h supporting existence
nt through stages
nvironmental factors

by well-meaning
d caregivers
er than stages

TASK-BASED

„ Physical
„ Psychological
„ Social
„ Spiritual

APPROACH

THOUGHTS ON DE

Life does not cease
people die any m
be serious when

George Berna

Never go to a doct
have died.

Erma Bo

EATH & DYING

e to be funny when
more than it ceases to

people laugh.

ard Shaw

tor whose office plants

ombeck

BIBLIOGRAPH

„ Corr, Charles, Na

Donna. (2000)D
and Living.

„ Fitzgerald Helen.

Handbook.

„ Helton & Jackson

with Families, A D

HY

abe, Clyde & Corr,

Death and Dying, Life
. (1995) Mourning
n. (1997) Social Work
Diversity Model.

Web-Links

ƒ American Academy
Palliative Medicine

ƒ National Hospice &
Organization - http

ƒ The American Hosp
http://www.americ

ƒ EOL decision makin
www.caregiver.org
lifeC.html

y of Hospice and
e - http://www.aahpm.org/
& Palliative Care
p://www.nhpco.org/
pice Foundation -
canhospice.org/
ng
g/factsheets/end-of-