● Behavioral component: Conveying wishes to others and personally acting upon those wishes based on personal values ● Spiritual component: Interpreting life’s purpose, unraveling its mystery, and leaving a legacy that explains it all As individuals face dying, they may attempt to find meaning in their losses, their lives, their illness, and most importantly, in their own deaths (Smith, 2017). For example, they may attempt to find meaning by asking themselves what it means to be near the end of life, or they may attempt to find meaning by exploring what it means to no longer exist (Smith, 2017). ● Could my attitudes toward the patient be based on something to do with my own experiences, anxieties, or fears? ● Does my attitude toward my job help or hinder my ability to treat this patient with care, openness, and respect? In a study by De Swardt and Fouché (2017), healthcare professionals reported that safeguarding the integrity of the patient was a priority and that providing professional and quality care to the patient and the family was seen as significantly important. Stress reduction techniques can be helpful for clinicians during this process and delivery of care. Jordan and colleagues (2016) maintain that healthcare professionals can use problem-based educational strategies to promote learning about ways to cope with stress while ensuring personal safety during this complex professional practice situation. Moreover, using a problem-solving approach as a coping strategy can help with finding meaning in the stressful part of the experience (Alsarqri, 2017). Techniques include deep-breathing exercises to reduce some of the stress (American Holistic Nurses Association, 2017). This type of diaphragmatic breath starts in the belly and draws the diaphragm downward into the abdominal cavity. Take slow, full breaths instead of short, shallow ones from the chest (American Holistic Nurses Association, 2017). Healthcare professionals can also consider thinking about a soothing activity, positive thinking, or silence to maintain self-control; rather than paying attention to negative feelings, divert bad thoughts (American Sentinel University, 2017). In addition, the practice of mindfulness while focusing attention on the experiences of the present moment can help with coping (American Sentinel University, 2017). gives us time to absorb news of change before moving on to other stages” (Connelly, 2020, p. 1). 2. Anger: "Why me? It's not fair!" "NO! I can't accept this!.” The anger stage reflects how our denial usually turns to anger. We then attempt to blame others (Connelly, 2020). 3. Bargaining: “Just let me live to see my children graduate.” “I’ll do anything if you give me more time. A few more years?” This stage is “an attempt to postpone what is inevitable [and] we start bargaining in order to put off the change or find a way out of the situation” (Connelly, 2020, p. 1). 4. Depression: "I'm so sad, why bother with anything?" "What's the point of trying?" According to Connelly (2020), this occurs “when we realize that bargaining is not going to work [and] the reality of the change sets in. At this point we become aware of the losses associated with the change and what we have to leave behind.” 5. Acceptance: "It's going to be OK." "I can't fight it; I may as well prepare for it." This last stage occurs when a person realizes that “fighting the change is not going to make it go away” (Connelly, 2020, p. 1). It is important to note that this is not the same as being happy, but rather a resigned attitude toward change and a sense that they must get on with it (Connelly, 2020).
In 1969, Viktor Frankl argued that the main goal in a person’s life is to actively create and find meaning and value in life. This reflective process at the end of life includes emotional, physical, cognitive, behavioral, and spiritual exploration, and it helps many to find understanding and positive transformation (Frankl, 1969). ● Emotional component: Exploring one’s feelings about a diagnosis with a terminal prognosis ● Physical component: Coping with bodily changes and any significant suffering ● Cognitive component: Thinking about adapting to what is and leaving behind what was Supporting Colleagues Following the Death of a Patient Providing care for patients with a life-limiting illness can be stressful for clinical staff, yet it has not been well studied (Rodenbach et al., 2016). As clinicians support those with a life- threatening illness, barriers remain in the care, communication, and relationship with the patient (Rodenbach et al., 2016). Studies have shown that physicians who personally have a fear of death have patients with longer terminal hospital stays, and those physicians “who have not accepted their own mortality are more likely to focus solely on biomedical issues rather than dying patients’ emotional concerns” (Rodenbach et al., 2016). Among hospice and palliative care clinicians this is especially relevant, as frequent exposure to death and suffering can evoke intense emotions and can lead to anxiety, disengagement from patients, and compassion fatigue—all of which impact clinician burnout (Cross, 2019). However, such exposure also can yield several positive outcomes, such as greater personal fulfillment and enhanced meaning in life (De Swardt & Fouché, 2017). Therefore, clinicians should focus on the relationship that is shared with the patient but also on their own beliefs about death, dying, and suffering (Rodenbach et al., 2016). To offer effective communication and support, the clinician should understand and be comfortable with their own attitudes about what the patient is going through by asking: ● How would I be feeling in this patient’s situation? ● What is leading me to draw these conclusions? ● Have I checked whether my assumptions are accurate? ● Am I aware of how my attitudes toward the patient may be ffecting them? Theoretical Models In addition to finding meaning, a variety of theoretical perspectives can help guide the way in which clinicians provide support to those coping with death and dying. These theories can be applied from the time of diagnosis to the time of death. Theoretical models of the dying process help clinicians intervene appropriately and offer the best quality of life for these patients. Theoretical models of the dying process include stage-based, awareness-based, task-based, phase-based, landmarks-based, and spirituality-based models. The stage-based approach to coping with dying is the most familiar to healthcare providers. This groundbreaking work by Elisabeth Kübler-Ross (1969) outlined the emotional stages of the dying process and includes the five stages of grieving, or accepting death: Denial, anger, bargaining, depression, and acceptance (Kübler-Ross, 1969). What this model can teach clinicians is that the underlying philosophy of the stage-based model is not to manipulate and move those with a life- threatening disease through transitions and milestones as death approaches; stages do not occur in a fixed sequence or timeline (Connelly, 2020). More specifically, the Kubler-Ross Five State Model described is: 1. Denial: "I can't believe it,” "This can't be happening,” "Not to me!,” "Not again!" This stage is the initial numbness and shock phase and is usually temporary. It is a “defense that
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Book Code: PYFL4024
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