When Life Changes Catherine R. Seeley, M.A. [email protected] Catherine R. Seeley All Rights...
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Transcript of When Life Changes Catherine R. Seeley, M.A. [email protected] Catherine R. Seeley All Rights...
Major Life-Changing Events
• Change in health• Change in job• Change in
residence• Change in status• Change via death
of otherCatherine R. Seeley All Rights Reserved
Crisis: Greek κρίσις (krisis) < κρίνω (krinō)
to decide; to choose.
requirement & liability
Crisis:
danger
Crisis: State of temporary disequilibrium brought about by a major
life-changing event.
Off balance over-responsive;Out of proportion under-functioning
Catherine R. Seeley All Rights Reserved
The Predictable Patterns of Crisis Behavior
Impact Turmoil/
Recoil
Adjust-
ment
Recon-struction
Emotions
Thoughts
Will
(Volition)
Catherine R. Seeley All Rights Reserved
Patterns of Crisis Behavior
Impact
Turmoil/
Recoil
Adjust-
Ment
Recon-
struction
Emotions
Fight/
Flight
numbness
Anger,fear,
Guilt, rage, anxiety:
depression
Intensity
H O
E M E R
P E
G E S
Catherine R. Seeley All Rights Reserved
Patterns of Crisis Behavior
IMPACTTURMOIL/
RECOIL
ADJUST-
MENT
RECON-
STRUCTION
Thoughts
Distraction
&
Disorient-
ation
Uncertainty
Indecision
P R O B
S O L
L E M
V I N G
Catherine R. Seeley All Rights Reserved
IMPACT TURMOIL/
RECOIL
ADJUST-
MENT
RECON-
STRUCTION
EMOTIONS
Fight / flight
numbness
Rage, fear,
Anxiety, anger, guilt:
Depression
H O
E M E
P E
R G E S
THOUGHTS Disoriented;
distracted
Indecision;
&Ambivalence
P R O B
S O L V
L E M
I N G
WILL
(Volition)
Search for
missing
Obs. remin.
Perplexity
(Purpose)
“paralysis”
E X P
T E
L O R E
S T
Catherine R. Seeley All Rights Reserved
IMPACT
RECOIL/
TURMOIL
ADJUST-
MENT
RECON-
STRUCTION
EMOTIONS
Talk
Read SG Conf. Conf. Prof.
THOUGHTS
WILL VOLITION
Catherine R. Seeley All Rights Reserved
IMPACT TURMOIL/
RECOIL
ADJUST-
MENT
RECON-
STRUCTION
EMOTIONS
Fight / flight
numbness
Rage, fear,
Anxiety, anger, guilt:
Depression
H O
E M E
P E
R G E S
THOUGHTS Disoriented;
distracted
Indecision;
&Ambivalence
P R O B
S O L V
L E M
I N G
WILL
(Volition)
Search for
missing
Obs. remin.
Perplexity
(Purpose)
“paralysis”
E X P
T E
L O R E
S T
Catherine R. Seeley All Rights Reserved
When Patients Die
A STUDY OF 10,163 TERMINALLY ILL CANCER PATIENTS January 1995 – December 1999
New York
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
Study investigated assumptions about
when the time of death typically occurs.
4 assumptions were investigated
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
QUERIES
Are generalizations accurate in the claim that most patients die at night?
Is there validity to the belief that most patients die with loved ones present?
How many patients actually die alone?
Of patients who died alone, how many had been placed on “critical”?
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
1. Are generalizations accurate in the claim that most patients die at night?
The answer is “no.”
In fact, over the course of this five year study, it was the daytime shift that saw the most deaths,
at the rate of 3,542 (35%) between the hours of 7:00a.m. to 3:00p.m.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
2. Is there validity to the beliefthat most patients die with loved ones present?
Only 30% of all patient deaths occurred while family members were present.
60% died alone.
10% died in the presence of a staff person.
This seems to contradict portrayals of family and friends gathered around the bedside
at the moment of death that set up unrealistic expectations for families.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
3. Of 10,163 patients, how many actually die alone?
60% percent of patients who died, died alone.
This, in a facility where patients were visitedinnumerable times by nurses, doctors, chaplains, social
workers, recreational therapists, dieticians, and volunteers.
Additionally, in many instances, family members were actually in the hospital at the time of death
but had stepped out of the room for various reasons.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
4. Of the 6,126 patients who died alone, how many had been placed on ‘critical’?
(the determination that a patient’s vital signs are indicating that death is imminent)
55% of patients who died alone had not been placed on critical.
This finding may seem confounding.
One might ask why a medical staff --dealing exclusively with end of life cancer patients--
might “miss” a determination of “critical” for over half of the dying population
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
The answer is not found in an absence of skill.
Instead, the answer may reside in the presence of mystery.
Exact as it may be, science cannot measure the negotiations of a soul.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
Implications for Mourners
For the bereaved, knowledge that the majority of patients actually die alone
-and that it is the norm rather than the exception-
actually helps reduce guilt assumed by loved ones for being absent at the time of death.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
Implications for Educating Families
about Dying Patients
Accurate information about the progression of the disease remains essential and important.
However,
families equally need to be apprised that, at the end-phase of a disease, the rate of unpredictability about when death will occur
is very high.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
Christian scripture reminds about the moment of death:
We “will know neither the day nor the hour…”
This ancient insight visits us daily.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
“What is a good death?”
A good death is not necessarily compromised by the absence of loved ones
at the time of death.
A good death is promoted with all that precedes the actual and truly solitary act of expiration.
Catherine R. Seeley, Mary T. O’Neill All Rights Reserved
Readings
Barlow, C. A., & Phelan, A. M. (2007). Peer collaboration: A model to support counselor self-care. Canadian Journal of Counseling,Bonanno, G. A, (2009). The other side of sadness: What the new science of bereavement tells us about life after loss. New York: Basic Books. Bonanno, G. A. & Kaltman, S. (2001). The varieties of grief experience. Clinical Psychology Review, 21, 705-734,Cerel, J., Padgett, J. H., Conwell, Y., & Reed, G. A. (2009). A Call for Research: The Need to Better Understand the Impact of Support Groups for Suicide Survivors. Suicide and Life threatening Behavior, 39(3), 269-281.Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2006). Sense-making, grief, and the experience of violent loss: toward a mediational model. Death Studies, 30(5), 403-428. Currier JM, Neimeyer RA, Berman JS (2008). The effectiveness of psychotherapeutic interventions for the bereaved: a comprehensive quantitative review. Psychological Bulletin 134 648−661.Frances, Allen. (August 15, 2010) Good Grief. Op Ed. NY Times Health InformationHogan, N., Worden, J. W., & Schmidt, L. (2003). An emperical study of the proposed complicated grief disorder. Omega(48)Kato, P. M., & Mann, T. (1999). A synthesis of psychological interventions for the bereaved. Clinical Psychology ReviewLamb, K., Pies, R., & Zisook, S. (2010). The bereavement exclusion for the diagnosis of major depression: To be, or not to be. Psychiatry, 7(7), 19-25.Lynn, Joanne and Harrold, Joan. Handbook for Mortals: Guidance for People Facing Serious Illness
Mead, S., Hilton, D., & Curtis, L. (2001). Peer Support: A theoretical Perspective. Psychiatric Rehabilitation Journal, 25(2), 134.Mead, S., & MacNeil, C. (2006). Peer support: What makes it unique?International Journal of Psychosocial RehabilitationParkes, C. M. & Prigerson, H. G. (2009). Bereavement: Studies of grief in adult life (4th ed.). New York: RoutledgeSoloman, P. (2004). Peer Support/Peer Provided Services Underlying Processes, Benefits, and Critical Ingredients. PsychiatricRehabilitation Journal, 27(4), 392-401. Stillwell, Elaine. The Death of a Child: Reflections for Grieving Parents. ACTA publications. Jan 2004.
Tomarken A, Holland J, Schachter S, et al.: Factors of complicated grief pre-death in caregivers of cancer patients. Psychoocology 17 (2): 105-11, 2008. Wills, T., & Shinar, O. (2000). Measuring perceived and received social support. In S. Cohen, L. G. Underwood & B. Gottlieb (Eds.),Social support measurement and intervention. Toronto, ON: Oxford University Press.
WEB RESOURCES
Aahpm.org American Academy of Hospice and Palliative MedicineADEC.org Multi-disciplinary professional organization, death education, bereavement counseling, and
care of the dying.
Aquariusproductions.com KIDS to KIDS When Someone Special Dies
Capc.org Center to Advance Palliative Care (CAPC) is the leading resource for palliative care
program development and growth. Compassionbooks.com Nearly 400 books, DVDs, and audios to help children and adults through
serious illness, death and dying, grief, bereavement, and losses of all kinds
Growthhouse.org Internet's leading portal for information about end-of-life care. Resources for
death and dying, hospice and palliative care, grief, and related topics. (+Inter-Institutional
Collaborating Network On End Of Life Care)
Supportivecarecoalition.org assisting Catholic health care organizations and their health care
professionals to address the physical, emotional, psychosocial and spiritual needs of those suffering from life-
threatening and/or chronic illness as well as those approaching the end of life.