Relational Dialecticics Theory: End Of Life Communication

Last year 23 September 2012. I had a resident called “Mrs X” she was a 72year-old widowed living at ---, a Nursing Care Home. She’s not a religious type of person as she was Atheist. She has lived in the home for the past two years, and during that time I was assigned as her key worker. Mrs X had One Son and 3 grand daughters they are all regular visitors to the home. She has recently been diagnosed with renal failure, and her life expectancy is only a couple of months without dialysis. In the past Mrs X has made it clear that when her “time comes” she wants to be able to stay at Belmont House, and “go quietly”. She has stated that she does not want any treatment that will prolong her life. This means

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

Getting prepared for death can be an exhausting experience for the patient and their family. It is very important that the patient not only knows what they want as far as their right to receive or reject treatment and medications or knowing whether they want to receive palliative care at home or in a hospital setting to include the advantages and disadvantages of each. The main focus of this paper is to give the reader an in depth look on how an end of life crisis affects a patient and their family. Ella is a breast cancer patient who just came out of remission and is at the end of her life.

Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Part One: In the documentary "Being Mortal" by Atul Gawande talks about the death of patients and how it 's a surprise to a large amount of the patients. He also explains the fear in the medical field, and as a doctor your suppose to help people and cure them, that you 're supposed to give them a better shot and if it later doesn 't go they way you expected,the doctors start to tell themselves what went wrong or what happen everything was going so well. Gawande talks about how he wants to learn more about how to communicate with patients and telling them that they have a certain weeks, days or months left. For example, He talks about one of his patients that he had, her name was Sarah and had stage 4 lung cancer was young and just had a

My perception of palliative and Hospice care has changed slightly when it comes to communication with the family. I walked into the hospice unit mentally preparing myself to talk with patient families about their loved one and the dying process; this was certainly not the case. The family and the patient did not want to be bothered unless comfort interventions needed to be carried out and there was no conversation to be had about the patient and his situation. This shows that each family is different, each patient is different; and we need to respect and accommodate their unique

Even though death is inevitable, it is quite clear that people can devise methods under which they can cope with the loss of their loved ones; for instance, their immediate relatives if not friends. Drawing practical guidelines from this book, one can constructively come up with communication strategies that may have encouragement to those who have lost their loved ones. This initiative encourages

Furthermore, these presumptions were not entirely correct. Although, my patients were in their late 70s, with limited mobility, reduced cognizance, and from lower socioeconomical class backgrounds, I did not contemplate the actual humanistic qualities of my patients. I completely neglected to acknowledge the unique lives I was about to enter. Alternatively, looking back with some disappointment, I was not able to conduct a deep, meaningful conversation about the implications of death. I predicted I would discuss different views of death and dying, but this subject is much more personal than I imagined. In conjunction, I did not encounter a bitter attitude from my patients, as I predicted. However, both my patients’ conditions determined their willingness to engage upon each visit. Sometimes patients were too tired to hold a conversation, often overwhelmed by questions about their lives. During one visit I asked my patient about his hobbies when he was younger. He proceeded to discuss the wonderful recreational vehicle cross-country trips he and his wife would take. This led to sorrow about the loss of his wife, dog, and inability to conduct the trips in the future. Aside from the unpredictable interactions themselves, I did not forecast how my patient’s conditions would dictate our visits together.

The three articles were most relevant to the topic and explored the implications that family involvement has during end-of-life in long term care from the family perspective. The three recurrent themes that family involvement has during EOL in long term care are: improved caregiver advocacy and improved quality of end-of-life care for patients achieved through improved communication.

A care team will go about doing this in different ways, but when it is done, good and clear communication as well as support and comfort for the person living with an illness, not dying from an illness, is essential. The dying process is not an easy one to cope with, nor is being the person whose job it is to tell the patient, family and friends that the person is dying from a terminal illness. A care team will arrange an appropriate day and time to speak with first the patient and then family, or both at the same time if that is what is desired. Every case can be different, and I believe no case necessarily goes the same as the last. Sometimes, “having loved ones attend consultations with patients can have benefits, but when information needs differ, this presents the doctor with a difficult situation” (Furber, Bonas, Murtagh, & Thomas, 2015, p. 263). Sometimes, one family member has a more difficult time understanding the information being given by the doctor compared to another. When this occurs, the doctor is put in an even more difficult situation when he must try and further explain to the friends and/or family by restating the information maybe in a different way but still relaying the same vital information. I have seen families where some are content and understand that there is not anything they can do while others are

According to Forbes (2014), transparency of care through communication, including patients ' opinions of care, improves patient outcomes. To improve the overall coordination of care requires thoroughly communicating to families. Inform families and patients on what to expect when dying in an easily understood way will ultimately improve the care and result in a positive outcome.

Elizabeth Kübler-Ross was a Swiss-born psychiatrist who spent two years of her professional career gathering information from terminally ill patients to create the premise for On Death and Dying. “It is not meant to be a textbook on how to manage dying patients, nor is it intended as a complete study of the psychology of dying.” (Kübler-Ross, 1969). This book was written as a call-to-action; to raise awareness of the voice of the dying. Not only is there stigma surrounding the topic, but also numerous misconceptions concerning the emotional journey of the terminally ill. The Kübler-Ross Model creates a framework for those interacting with dying persons, to help caretakers better understand the transitions that are taking place, resulting in higher-quality care. This model is comprised of five stages, which can be experienced in a variety of combinations. Prior to the first stage, the patient must be delivered the news of their illness or the severity of their illness, which usually results in shock. Denial is the first stage noted by Kübler-Ross. Denial and isolation are normal responses to overwhelming emotions and serve as a temporary response until the individual is ready to accept reality. Although this defense mechanism is normative, it is important to note that it isn’t necessarily healthy, and that some never move past this stage. As reality sets in, pain beings to emerge and manifests itself in the next stage: anger. Rationality takes a

and I as the therapist. It’s never easy to deal with individuals faced with terminal illnesses, therefore, it would be essential for me as the therapist to be in tune with my own self awareness pertaining to my views about death. As I understand the existential psychotherapy’s perspective,

Our society finds it difficult to talk about dying and euphemisms are the norm. It is typical for both doctors and patients to be hesitant to initiate a discussion on dying. Focus instead is often more often placed on interventions and actions for managing symptoms. This avoidance can leave patients and their families unprepared for the inevitable death. (Schapira, 2010) It also often results in requests for therapies which may be excessive, costly and even painful in the hopes for a cure. One study demonstrates that when patients are aware that they are terminally ill, the majority are able to reach a state of peacefulness and also exhibit lower levels of distress. (Ray, Block, Friedlander, Zhang, Maciejewski & Prigerson, 2006) It is also important that family members are willing to discuss end-of-life options with their loved ones. According to elderly patients, they are most often the ones who initiate these conversations with their