When Life Changes Catherine R. Seeley, M.A. [email protected] Catherine R. Seeley All Rights...

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When Life Changes Catherine R. Seeley, M.A. [email protected] Catherine R. Seeley All Rights Reserved

Transcript of When Life Changes Catherine R. Seeley, M.A. [email protected] Catherine R. Seeley All Rights...

Page 1: When Life Changes Catherine R. Seeley, M.A. cseeley4@verizon.net Catherine R. Seeley All Rights Reserved.

When Life Changes

Catherine R. Seeley, [email protected]

Catherine R. Seeley All Rights Reserved

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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

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Crisis: Greek κρίσις (krisis) < κρίνω (krinō)

to decide; to choose.

requirement & liability

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Crisis:

danger

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Crisis: State of temporary disequilibrium brought about by a major

life-changing event.

Off balance over-responsive;Out of proportion under-functioning

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The Predictable Patterns of Crisis Behavior

Impact Turmoil/

Recoil

Adjust-

ment

Recon-struction

Emotions

Thoughts

Will

(Volition)

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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

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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

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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

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IMPACT

RECOIL/

TURMOIL

ADJUST-

MENT

RECON-

STRUCTION

EMOTIONS

Talk

Read SG Conf. Conf. Prof.

THOUGHTS

WILL VOLITION

Catherine R. Seeley All Rights Reserved

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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

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When Patients Die

A STUDY OF 10,163 TERMINALLY ILL CANCER PATIENTS January 1995 – December 1999

New York

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Study investigated assumptions about

when the time of death typically occurs.

4 assumptions were investigated

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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”?

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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.

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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.

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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.

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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

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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.

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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.

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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.

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Christian scripture reminds about the moment of death:

We “will know neither the day nor the hour…”

This ancient insight visits us daily.

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“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.

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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.

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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.