Attending end of life - Assisting a family member

Anonim

Assisting a family member

Assisting a family member

Attend the end of life

The Great Journey Death and Mourning
  • The Great Journey
    • The denial
    • Anger
    • The plea bargain
    • The Depression
    • acceptance
  • Death and mourning

The Great Journey

The moment when the body becomes a corpse and the living definitively leaves its envelope is called death. The confrontation with death takes place for all human beings since childhood and takes on meanings and nuances that vary throughout life according to the experiences gained and their values. Religions have inevitably focused on this puzzle by providing explanations, influencing the life of human beings and using a framework based on almost universal values ​​in order to find answers to what worries and frightens, precisely by virtue of the fact that with death the unknown and the dissolution of what one is advances. Among the scientists who have investigated the topic of death with great interest, the figure of Elisabeth Kubler Ross, physician, psychiatrist, founder of psychotanatology, a science that deals with accompanying the terminally ill on the Great Journey stands out. His merit is that of having masterfully described the phases that the dying person passes through, thus providing a path on which to move the steps in the last moments of our journey.

Briefly summarizing this process, five psychological phases can be identified through the dying person: denial, anger, plea bargaining, depression and acceptance. It is clear that it is not an obligation to go through them in chronological order and it is not even indispensable to go through them all: much depends on the person's degree of consciousness.

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The denial

It is the first defense mechanism that is implemented when the subject becomes aware of a serious organic pathology: "I believe there is a mistake, perhaps the analyzes are not mine, I am sure that you are wrong". This is the typical attitude of denial, that is, the subject unconsciously implements a procedure to make the immense pain and anxiety that he feels tolerable.

Service tips (for relatives)

  • Surely we are in a condition of total despair and it is not at all easy to keep this state of mind hidden; the relative makes no effort to grasp the desperation of the loved ones who assist him.
  • Speak to your doctor, nurse and / or psychologist immediately for help and advice.
  • The patient continues to say that everything is fine, also because the health problem is not yet so evident, and it is better not to remove this protection since it would end up destabilizing the already precarious defenses of one's loved one.
  • Some diseases can go on for years and depression has a very negative effect on the immune system, so playing games is the best solution. Surely the patient wants to do pleasant things and to "enjoy life".
  • If your relative feels the desire to speak, it is good to listen to him and understand: willingness to listen is very important. Be careful not to appear superficial and, if possible, do not run away if the patient wants to speak.

Service tips (for operators)

  • The first recommendation to anyone who can follow the patient in one way or another is to categorically avoid pronouncing phrases that minimize the problem, such as "but come on you have nothing, don't worry that you're fine". Always remember that verbal language is only a minimal part of communication while non-verbal is very incisive and truthful: the patient tries to defend himself as he can but is not stupid!
  • Try to act as a "recipient of anxieties" avoiding to download worries or insecurities on the patient.
  • A calm and reassuring attitude is certainly an excellent medicine.
  • To listen.
  • Be silent.
  • This period is probably made up of many selfish attitudes in which everything must revolve around the sick person: avoid showing yourself detached and distant, but do not make the mistake of being too dragged into the suffering of others.

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Anger

The anger phase is a very complicated period in which devastating feelings intertwine, which are turned against you and against others. The classic phrases are: “Why me? With all the criminals who are there, if there was a God, he wouldn't do all this to me. " The sick person is desperate and this feeling must be understood.

Service tips (for relatives)

  • Allowing emotional content to emerge without trying to counter it sooner or later the patient will calm down.
  • Sit down and keep silent: after the "outburst", the patient is likely to cry and seek your understanding.
  • The phase of anger can last a long time, even days, especially if the character of the patient was previously prone to anger.

Service tips (for operators)

  • Nobody likes to be insulted by remaining silent, but in this case it is necessary to keep in mind that one must not fall into the staff and reproach the sick person with phrases of this tenor: “You must not speak like this to me, with those who believe to speak, I don't care if she is sick, I don't get insulted by anyone ”. If you are unable to understand this psychological phase, it is perhaps a good idea to ask yourself if you are the right person for the person to be assisted.
  • In certain situations a lot of self-control may be necessary, sometimes one gets the impression that the subject provokes or wants to instigate the dispute.
  • Arguing can also be productive, but be careful though: you must then be able to settle conflicts, under penalty of exclusion from the relationship.
  • The sick person is not angry with you, only with his problem.

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The plea bargain

After the anger and the sense of helplessness, the plea bargaining phase appears: "If you heal me I promise you that I will help the children who suffer, I will never behave like this again". This childish attitude emerges as a consequence of growing desperation in the face of the worsening of the disease; even begging God to be removed from one's destiny refers to a boyish thought: "If I am good, will you please me?". These are normal psychological strategies that are put in place to deal with the immensity of the problem.

Service tips (for relatives)

  • After the angry phase, this moment allows more to get in touch with the deepest part of the loved one and to re-establish a dialogue.
  • The refusal to seek treatment has probably eased or disappeared, now you can try to approach with relaxing massage techniques or request the help of the psychologist.

Service tips (for operators)

  • Show yourself close to the patient.

This phase is the prelude to depression and it is possible that attitudes very detached from everything around you may begin to emerge.

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The Depression

When the general conditions have dramatically worsened, self-deception is exhausted and the patient begins to have an exact perception of their condition. A deep depression arises in the patient, which has the purpose of preparing him to leave the world definitively. This stage is called preparatory depression.

Service tips (for relatives)

  • All efforts to try to bring back a good mood are in vain and counterproductive, the patient is depressed because at this stage it is important to be detached.
  • Staying silent near the bed is of great use.
  • Seeing your loved one doing this can lead you to believe that you are no longer important to him. With this attitude the subject is trying in every way not to suffer from the imminent detachment.

Service tips (for operators)

  • Do not insist on inviting the patient to seek pleasant things.
  • If the person cries, let them release all their negative energy.

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acceptance

The war is lost, the disease has taken over and nothing can stop it; at this point it is clear to everyone that the end is near. An attitude of submission and acceptance appears in the patient, provided he is still lucid. Some individuals struggle to the end, others surrender. Everything is ready for departure, probably the patient will want to greet relatives or children; it's time for recommendations and promises, for those who remain, for the future.

Service tips (for relatives)

  • This moment is very dramatic: it is not easy to resign yourself to the idea of ​​no longer seeing who you love.
  • The time has come to be supported in turn and let yourself be helped.
  • If your loved one asks to say goodbye, don't be angry with him. If you have not had time to settle the conflicts that necessarily arise over the course of your life, it is good to talk to each other and reconcile to avoid feeling guilty for matters that should have been clarified.

Service tips (for operators)

  • Stay close to the sick person.
  • Stay close to relatives.

Assistance to the dying is characterized by a series of interventions that aim to provide the patient with well-being and to replace him in all those activities that he can no longer perform independently. The most compromised care needs concern the need to feed, communication, safety, elimination.

The need to communicate probably becomes more and more incessant, sometimes the sense organs are damaged (deafness, mutism, blindness) and therefore it is important to be able to make yourself understood, and understand, what the patient means. When the individual is no longer able to communicate or the situation worsens so much that one is no longer sure whether the subject understands or not, it is good to remember that hearing is the last sense to vanish. For delicate communications it is always good to preserve the privacy of the patient.

When the conditions are very serious, it is useless to continue feeding the person, especially if the state of consciousness is altered: it would risk obstructing the airways. In the event that the prognosis is not short-term, the best solution to adopt to feed the patient will have to be decided with the doctor; in all cases it is always possible to use IV drips to maintain proper hydration when you are at an advanced stage.

Moving the subject in bed can become a problem and perhaps more people will be needed. The body becomes thin, the loose muscles, the joints can be compromised; moreover, the patient's skin may have sores, sometimes pain treatments can completely anesthetize a portion of the body. Conversely, pain can increase during posture changes.

The dependence on hygiene increases considerably and therefore sponges and bidets will have to be carried out in bed. Fecal or urinary incontinence may be present, sometimes constipation. The patient may have a bladder catheter or diaper. In the room unpleasant odors will be felt coming from the mouth, sphincters or any sores. To ensure a minimum of rest, medications that can cause numbness and mental confusion will be needed; a similar result may also occur with pain treatments. Breathing will become increasingly superficial and rapid.

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