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

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

3. 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)

4. 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

5. 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

6. 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?

7. 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

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

9. 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

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

11. 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

12. 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

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

14. 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

15. 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.

16. 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

17. 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.
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