Prenatal Development And Birth

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Prenatal Development And Birth
19 Prenatal Development And Birth Death, Dying, and Bereavement This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. Copyright © Allyn & Bacon 2006

The Experience of Death
Death Itself Clinical death The few minutes after the heart stops pumping, breathing stops, and there is no evidence of brain activity but resuscitation is still possible Brain death The person no longer has reflexes or any response to vigorous external stimuli; the person may still be able to breathe and to survive for some time Social death Deceased person is treated like a corpse by others Death is a process as well as a state. The experience of death is shaped by the circumstances surrounding the end of life. Copyright © Allyn & Bacon 2006

Copyright © Allyn & Bacon 2006
Where Death Occurs Hospitals in the U.S. Among old old, death in a nursing home is common. Hospice care Alternative form of terminal care Writings of Elizabeth Kubler-Ross emphasized a “good death” and “death with dignity” Patient and family have more control over the process More likely to have the death at home Copyright © Allyn & Bacon 2006

Hospice care Death should be viewed as normal. Families and the patient should prepare for death. The family should be involved in the patient’s care. Control of care should be in control of the patient and the family. Medical care should be palliative care rather than curative. Preparation for death should include examination of feelings, planning for after death, and talking openly about death. The family should be involved in the patients care as much as possible, because it gives the patient emotional support and allow each family member to come to some resolution of their relationship with the dying person. The patient and the family decides if the person will stay at home or be hospitalized. Palliative care emphasizes controlling pain and maximizing comfort not on invasive, life-prolonging measures. Copyright © Allyn & Bacon 2006

Hospice care Home-based programs One family caregiver – usually the spouse – provides constant care for the dying person Supported by specially trained nurses Special hospice centers Small number of patients in the last stages of a terminal illness Hospital-based programs Provide palliative care and utilize family daily in the patient’s care See Table 18.1 on hospice care. Special hospice centers tend to promote home-like environment. Copyright © Allyn & Bacon 2006

Hospice care Hospital-based and home-based hospice care provide similar experiences. No differences are reported in patients’ pain, length of survival, or satisfaction with care. Family members were most satisfied with hospital-based care. Home-based care produced a greater sense of burden. Additional research shows home-based care provides better feelings of control for the patient and the family. Copyright © Allyn & Bacon 2006

Hospice care Economic costs of death are reduced by hospice care. Home-based care is a tremendous burden on the central caregiver. Patients and family worry about pain management in hospice care. Hospice care is better for supporting the grief and stress of the caregiver. Copyright © Allyn & Bacon 2006

The Meaning of Death across the Lifespan
Children’s and Adolescents’ Understanding of Death Preschool aged children do not understand death and believe it can be reversed. Some lucky people can avoid death. Teaching young children about biological life helps them understand death. Preschool aged children do not understand death and believe it can be reversed – through prayer, magic, or wishful thinking. Copyright © Allyn & Bacon 2006

Children’s and Adolescents’ Understanding of Death
School-aged children Understand both the permanence and the universality of death Children’s specific experiences help with the understanding of death. Adolescents Understand that death is inevitable Unrealistic beliefs about personal death contribute to adolescent suicide. Sometimes believe that death is a pleasurable experience Influenced by personal life experiences Copyright © Allyn & Bacon 2006

The Meaning of Death for Adults
Early adulthood Unique invulnerability – belief that bad things, including death, happen to others but not themselves Possess unique characteristics that protect them from death Show increased fear of death following open discussion of the process of dying Sudden loss of a loved one tends to shake ideas about death and invulnerability. Text discusses death of famous people who are young and the resulting feelings of loss and the changes in feelings of invulnerability. Copyright © Allyn & Bacon 2006

Middle and late adulthood Death changes the roles and relationships of everyone else in the family. One’s view of time may be shaped by death. Middle-aged and older adults who are preoccupied with the past are more likely to be fearful and anxious about death. Copyright © Allyn & Bacon 2006

Death as loss Young adults worry about loss of opportunity to experience things and about loss of family relationships. Older adults worry more about the loss of time to complete inner work. Mexican Americans would increase time spent with family or loved ones. See Table 18.2 to see ethnic and age differences in response to death. Copyright © Allyn & Bacon 2006

Fear of Death Middle-aged adults are most fearful of death. Sense of unique invulnerability prevents intense fear of death in young adults. Older adults think and talk more about death than anyone else. Leads to less fear and anxiety May feel a period of uncertainty rather than fear Copyright © Allyn & Bacon 2006

Fear of death Religious beliefs Adults who are religious are less afraid of death. View death as a transition from one life to another Religion provides adults with death stories that help them cope with their own deaths. Copyright © Allyn & Bacon 2006

Figure 19.1

Fear of Death Personal Worth Adults who have accomplished goals or believe they have become the person they set out to be have less fear of death. Belief that life has purpose or meaning reduces the fear of death. Supports Erikson’s theory of ego integrity versus despair Copyright © Allyn & Bacon 2006

Questions to Ponder Your loved one is dying of a terminal illness. Would you use a hospice center? Why or why not? If you were told that you had a terminal disease and only 6 months to live, how would you want to spend your time until you died? On a scale of 1– 5, with 5 being high, how much do you fear death? Copyright © Allyn & Bacon 2006

Preparation for Death Practical preparations Purchasing life insurance Making a will Directives regarding end-of-life care – living will Directs health care professionals about wishes for feeding tubes, or invasive measures to prolong life Advance funeral planning Older adults are more likely to have made these arrangements. Copyright © Allyn & Bacon 2006

Preparation for Death Deeper preparation Some process of reminiscence Unconscious changes just before death – a terminal drop for psychological health Persons become less emotional, introspective, and aggressive and more conventional, dependent and warm Copyright © Allyn & Bacon 2006

The Process of Dying Criticisms Methodological problems Kubler-Ross did not interview enough people nor did she explain her sample. Cultural specificity Cross-cultural studies suggest that cultures vary in beliefs about what a “good death” is. The stage concept Not all dying patients exhibit all 5 emotions, and seldom in order. Collectivist cultures may find bargaining less important. Native Americans think of death as part of nature’s cycle, death is to be faced with composure. Mexican culture – death is a mirror of the person’s life. Death is celebrated in a national feast day. Religious beliefs may not follow the model. Copyright © Allyn & Bacon 2006

Alternate Views Shneidman Dying process has many “themes.” Terror, uncertainty, rescue fantasizes, incredulity, fear of pain and many more. Corr Coping with death involves taking care of specific tasks. For health professionals, thinking in terms of helping the patient perform tasks is more helpful than themes. Corr Satisfying bodily needs and minimizing physical stress. Maximizing psychological security, autonomy, and richness of life. Sustaining and enhancing significant interpersonal attachments. Identifying, developing, or reaffirming sources of spiritual energy, and thereby fostering hope. Copyright © Allyn & Bacon 2006

Responses to Impending Death
Attitudes and behavioral choices can influence the course of a terminal disease. Steven Greer 62 women with breast cancer Identified 5 groups Denial Fighting spirit Stoic acceptance Helplessness/hopelessness Anxious preoccupation Greer checked the survival rates of these 5 groups after 5, 10, and 15 years. See Table 19.4 for outcome rates. 35% who showed denial or fighting spirit had died at 15 years. 76% of the others were dead 15 years later. Data from studies of patients with melanoma and aids support this theory. Copyright © Allyn & Bacon 2006

Responses to Impending Death
The message may be Those who struggle the most, who fight the hardest, who express their anger and hostility openly, and who find some sources of joy in their lives live longer. Difficult patients who question and challenge those around them last longer. This may be appropriate for cancer-like illnesses, but not others, such as heart disease. Copyright © Allyn & Bacon 2006

The Experience of Grieving
Psychosocial functions of death rituals Help family members and friends manage grief by giving a specific set of roles to play Expected and prohibited behaviors Role content differs markedly from culture to culture Bring family members together like no other occasion Inspire shared reminiscences and renew family relationships Can strengthen family ties, and clarify new roles Funerals establish shared milestones for families. Ceremony and ritual can help survivors understand the meaning of death itself. Funerals, wakes, and other death rituals. Copyright © Allyn & Bacon 2006

The Process of Grieving
Factors associated with grief Age of the bereaved Children express feelings of grief like teens and adults. Sadness, crying, loss of appetite, age-appropriate anger Resolve their grief within the first year after death Teens show prolonged grief responses. Still feel intense feelings 9 months after a death More likely to grieve for celebrities More likely to idealize peers’ suicides Sign of adolescent’s “what if” thinking about their ability to have prevented the death Copyright © Allyn & Bacon 2006

Factors associated with grief
Modes of Death Widows who have cared for spouses are less likely to show depression after death. Death that has intrinsic meaning reduces grief. Sudden and violent deaths evoke more intense grief responses. Suicide produces unique responses in survivors. Family and close friends report feelings of rejection and anger. Many feel that they should have prevented the suicide. Bereaved are less likely to discuss the loss. Loved ones may suffer long-term negative effects. Copyright © Allyn & Bacon 2006

Widowhood Immediate and long term effects on the immune system Immune system responses were suppressed initially after death but returned to normal a year later. Incidence of depression among widows and widowers rises substantially. Length of depression may be highly variable. Mental health history, lack of social support, quality of relationship with spouse, and economic changes influence the length and quality of depression. Copyright © Allyn & Bacon 2006

Pathological Grief Depression-like symptoms following death of a loved one that last longer than 2 months Grief lasting longer than 6 months leads to long-term depression and physical ailments such as cancer and heart disease. Problems may continue for up to 2 years after death of the loved one. Copyright © Allyn & Bacon 2006

Sex Differences Death of a spouse is more negative for men than for women. Risk of death from natural causes or suicide is higher in men immediately after the death of spouse. Widowers withdraw from social activities. Widowers find it difficult to return to earlier levels of emotional functioning. Alcohol use may play a role in higher levels of depression. Copyright © Allyn & Bacon 2006

Preventing Long-Term Problems
“Talk-it-out” approach to managing grief can be helpful in preventing grief-related depression. Developing a coherent personal narrative of the events surrounding the spouse’s death helps manage grief. Participating in support groups helps. Appropriate amount of time off from work to grieve is important. Copyright © Allyn & Bacon 2006

Theoretical Perspectives on Grieving
Freud Death of a loved one is an emotional trauma. Ego tries to insulate itself from unpleasant emotions by using defense mechanisms. Defense mechanisms provide only temporary relief. To stay healthy, people must eventually examine their emotions and their source directly. The more traumatic a death, the more likely it is to be followed by physical or mental problems. Mental illness Post-traumatic stress disorder Copyright © Allyn & Bacon 2006

Psychoanalytic Theory
Grief therapy with children makes use of defense mechanisms. Sublimation – expressing their feelings through art Identification – watching popular films to discuss young characters’ feelings and compare the characters’ feelings to their own Copyright © Allyn & Bacon 2006

Bowlby’s Attachment Theory
Intense grief is likely to occur at the loss of any person to whom one is attached. 4 stages of grief Numbness Yearning Disorganization and despair Reorganization See Table 19.5 for stages of grief. Copyright © Allyn & Bacon 2006

Alternate Perspectives
Contrary to psychoanalytic thought Avoiding expressions of grief neither prolongs grief nor inevitably leads to mental and physical illness. Grieving does not occur in fixed stages as Bowlby proposes. Many themes are present at the same time, but one or another may dominate. Adults develop different patterns of grieving. Copyright © Allyn & Bacon 2006

Patterns of Grieving Wortman and Silver Normal The person feel great distress immediately following the loss with relatively rapid recovery Chronic The person’s distress continues at a high level for years Delayed The person feels little distress in the first few months but high levels of distress some months or years later Absent The person feels no notable level of distress either immediately or at any later time Copyright © Allyn & Bacon 2006

Prenatal Development And Birth
19 Prenatal Development And Birth End Show This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. Copyright © Allyn & Bacon 2006

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