Therapeutic Response to Clients with Life-Altering Illness Chapter 9 Therapeutic Response to Clients with Life-Altering Illness

Objectives Compare/contrast acute illness, chronic illness, and life-altering illness Differentiate between curative and palliative Identify the appropriate therapeutic response

Acute Illness Rapid onset, short duration, severe symptoms Normally no life changes Educate, assist client with decisions Examples of acute illnesses Fever, diarrhea, nausea, vomiting, stomach cramps, fracture (and repair), appendicitis (appendectomy), Post Partum Depression (PPD)

Chronic Illness May last months or a lifetime Significant impact with life-altering changes May debilitate, shorten life span Stages of grief: client, family, friends Examples of chronic illnesses Arthritis, diabetes, cancer *, HIV*, COPD, obesity, mental disorders continued

Chronic Illness: Role of the Professional Health professional Express warmth, caring, genuineness, honesty Listen; sympathy, empathy Assist clients living to their fullest Refer to support groups, educate Must be comfortable with chronic illnesses to help the patient achieve acceptability with their illness During the clients progression, it is not advisable to discuss end of life decisions, sign or witness an advance directive or living will, unless it is specifically within your duties

Life-Altering Illness Losses When chronic illness progresses to a stage when death is inevitable Feelings of powerlessness and lack of control Anger towards the physician Feelings will vary depending on the course/length of illness Palliative care vs. hospice Both are patient centered focused on relieving symptoms What’s the difference?

Palliative vs. Hospice Care Palliative Care Months or even years Occurs during final stage of illness Focuses on comfort Emotional & physical Relieves symptoms Patient and family centered Hospice Care May be in and out of hospice (6 month) Also during final stage of illness, but affirms death as a natural process. Focuses on comfort Emotional & physical Relief of symptoms Patient and family centered

Be Aware of Cultural Differences Cultural values and beliefs Should client be informed about illness? Who makes healthcare choices? Role of family, friends

The Therapeutic Response Understand cultural differences Prepare for personality changes Discuss feelings, emotions, worries With genuineness, honesty, and an open mind Encourage independence re: decision making Include family, friends in education Manage stress appropriately, the course of disease (if appropriate), pain, and symptoms Be in the present, here and now

Therapeutic Response to Clients: Loss, Grief, Dying, Death Chapter 10 Therapeutic Response to Clients: Loss, Grief, Dying, Death

Objectives Identify the 5 stages of grief/death/dying by Elisabeth Kubler-Ross Define dysfunctional and unresolved grief Discuss the therapeutic responses for loss, grief, dying, and death

5 Stages of Grief, Loss, & Dying Elisabeth Kubler-Ross, PhD Most referred to and help the healthcare professional identify the stages of grief, loss, and dying. The stages are expressed in any order. Examples of each stage Denial: denying reality of the illness, loss, or grief Anger: express toward anyone and anything on the path to acceptance Bargaining: willing to do anything to change the reality Depression: starting to realize the loss and feelings of aloneness Acceptance: acknowledgement of the loss and potential course/outcome

Be Aware of Cultural Influences Who makes end-of-life decisions? Who makes funeral arrangements? After death, what actions are taken to honor deceased?

Remember Loss can come in many different forms The mental age of the person experiencing death will impact the response to grief/loss Men and women may express their grief differently Everyone will grieve differently

Dysfunctional/Unresolved Grief Can cause Uncontrolled crying, hopelessness, helplessness, intense reactions/feelings, eating and sleeping changes, constantly reliving past experiences Somatic responses = body response or ailments (lethargy, difficulty breathing, tightness in the chest, abdominal distress) Stress-related illnesses = (heart disease, asthma, obesity, diabetes, headaches, depression, GI problems) Altered relationships: family, friends Death with no final event MIA’s, missing children, crime with no body recovered, or lost of loved one with and unable to achieve closure.

Therapeutic Response Accept the client’s stage of grief; Avoidance is a roadblock to communication Honor cultural beliefs, values, and decisions Honor all wishes with respect, even if not culturally driven Listen to what is said and not said You cannot move someone out of denial Do not be embarrassed by client’s emotions Its ok to cry with patient and/or family Do not give false assurances or avoid discussing the uncomfortable

Therapeutic Response cont’d Refer to resources as appropriate Answer questions honestly with simplicity Words may not be necessary, but if they are …it’s appropriate to say, “I’m sorry,” and ask, “What can I do to help?” Recognize the illness does take a great deal of energy; physically and emotionally Demonstrate compassion and understanding As a professional, do not view death as a failure Leave the grief in the professional setting T AKE CARE OF YOURSELF This project was funded at $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance Community College and Career Training Grants, as implemented by the U.S. Department of Labor’s Employment and Training Administration. Rogue Community College is an equal opportunity employer/program. Auxiliary aids and services, alternate form and language services are available to individuals with disabilities and limited English proficiency free of cost upon request.   This work is licensed under a Creative Commons Attribution 4.0 International License.