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

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

Elisabeth Kübler-Ross, (2014), a Swiss-born American psychiatrist, introduced concept of providing psychological counselling to the dying. In her first book, On Death and Dying (published in 1969), she write about the “five stages of grief”, they are denial, anger, bargaining, depression, and acceptance. based on her studies of the feelings of patients facing terminal illness, and have being generalised to other types of negative life changes and losses, such as divorce, loss of property or job, and offered strategies for treating patients and their families as they negotiate these stages.

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

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

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.

Cultural consideration must be taken into account when discussing end-of-life issues with patients and family members. One cannot assume that cultural affiliation equals a deep connection to cultural beliefs and affiliation with one or more groups should not be used as an assumption about

Families wanted truthful disclosure about the prognosis of a loved one and detailed explanations from healthcare providers (Dose et al., 2015). A Literature review concluded that communication at the end of life was poor, that patients were not informed about their prognosis, insufficient explanations were given to patients and their families and that busy staff were unavailable. (Robinson, Gott, Ingleton,2014). Doctors are sometimes over optimistic in diagnosing end of life which does not give patients and their families adequate time to prepare for death (Al-Qurainy, Collis, & Feuer, 2009).

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.

What was once believed to be a form of neglect has resulted in a change in practice with the idea that doing less is more. Culture is an important factor in how care is rendered and thus, the limitations of palliative and hospice care lie within the desires of the family and patients. A thorough understanding of our surrounding demographics helps to ensure a seamless approach to providing care without bias or imposition of ones beliefs. However, just as with all things, providing care for the sick and comforting the dying should be rendered in moderation as to prevent the effects of burn out. Likewise, the same effects occur in the caregivers who sacrifice their responsibilities in order to care for their love ones. Finally, and with some closing thoughts, the writer wishes to express with gratitude the benefit of having taken this course to better understand oneself and others in the realm of healthcare. The lessons learned throughout have expanded this writer's knowledge and understanding of the human desire to make a connection through communication, emotion, compassion, and spiritually - the platform from which this writer wishes to continue seeking further knowledge and

Further experiences in both cardiology and medical-surgical provided opportunity to "connect-the-dots," via the use of physical assessment skills as correlated to illness and pathological findings. (Self-evaluation reflects sound clinical/assessment skills and a good grasp of pathophysiological conditions.) Clinical experiences in hospice and palliative care provided opportunity to view health care from the dichotomous spectrum of life and death, with understanding that not only should one be afforded a quality life, but also a quality and dignified death. An issue of contention for this clinician has always been the unilateral focus of medical care without attention to the psychological framework that governs physiological states. Working in Hospice and palliative care was enlightening as it allowed for introspection and exploration of feelings that might otherwise remain untapped unless personally faced with a similar situation. Cultural awareness, biosocial skills, and communication skills were

In viewpoint, it is essential to be nonjudgmental about an individual’s practice related to death and dying as each person has different views. Therefore, if an individual chooses to uphold confidentiality regarding beliefs, their request should be respected. In experiencing personal loss, grieving relates to all cultures and practices relating to death and dying are a practice of an individual’s personal preference. Therefore, assisting individuals to choose for themselves how their end-of-life wishes should be handled has assisted people to take control over their dying practices related to death and dying and their final scenario (Kail & Cavanaugh, 2013).

Because our thoughts, feelings, and actions are interconnected, I focused on reflecting on reasons for my discomfort with DNR Order. Subsequently, I understood that this discomfort is rooted in my belief about sanctity of life. In addition, my grandparents died in hospitals, in circumstances where I did not have a chance to say goodbye. I started reflecting on my feelings about death and dying. In addition, during one of the conferences with community education coordinators on hospice and palliative care, I had a chance discuss end of life care. I also gained deeper understanding on the role of social workers in hospice settings, such as assessing the needs of patient and family and maximizing their quality of