Awareness-based theory by Glaser and Strauss (1968) provides a theoretical model for coping with dying that is based on a context of awareness and how the situation is perceived by significant others in the person’s life. For decades, the Glaser and Strauss awareness-of-dying model has guided research on patients’ awareness of their conditions. The model describes four types of awareness contexts: Closed awareness, suspected awareness, mutual pretense, and open awareness. ● In closed awareness, the patient does not know they are dying, but everyone else is aware. Often, family members keep the news from the patient. In close awareness, the nurse and social worker do not discuss the patient’s illness directly with the patient. ● In suspected awareness, the patient suspects what others know and attempts to find out more information about the prognosis. The patient becomes suspicious as they become increasingly ill. Although the patient may want to know how sick they really are, they are not told that they are dying. A patient’s context of awareness will influence how they communicate with family members, friends, and clinicians who care for them. Communication depends on the patient’s level of awareness. With closed awareness, communication is restricted. The more aware the patient is, the greater the opportunity to share concerns, issues, and needs. ● In mutual pretense, the patient, family members, and clinicians pretend they do not know the prognosis. Unless the patient initiates the conversation about impending death, no one talks about it. Everyone involved acts as though the patient is going to live. Although clinicians can explore a life review and reminisce with the patient, it is difficult to do so if everyone is pretending that the patient is not going to die. ● In open awareness, the patient is aware of impending death and is both preparing for it and discussing it. During open awareness, the patient can talk openly about forgiveness, gratitude, and love. Although open awareness allows those who are dying to become aware of their approaching death, not everyone wants to know when they will die. This awareness allows clinicians to review not only the patient’s life, but also the meaning of their dying and death (Glaser & Strauss, 1968). What this model can teach clinicians who work with those who are living with a life-limiting illness is that the context of awareness will influence how people communicate with their family members, friends, and clinicians who care for them. Any communication about the terminal illness or the dying process with the patient depends on the patient’s level of awareness. If the patient has closed awareness, communication will be restricted. Conversely, the more the patient is aware, the greater the opportunity to share concerns, issues, and needs. While dealing with each phase that brings the patient closer to death, there are certain tasks that need to be accomplished while living with life-threatening illness. In 1992, Charles Corr created a model that focuses on how people with a life- threatening disease cope with dying by completing four areas of taskwork (Kilcrease, 2021). These dimensions include physical, psychological, social, and spiritual tasks (Kilcrease, 2021). ● Physical tasks involve managing bodily needs and minimizing physical distress, such as by controlling pain and constipation. ● Psychological tasks maximize psychological security, autonomy, and richness in living. ● Social tasks enhance significant attachments and address the social implications of dying. ● Spiritual tasks address meaningfulness, connectedness, and transcendence. This model teaches clinicians who work in palliative care and hospice care that as individuals find ways to manage their bodily changes, attempt to maintain a healthy mental perspective, and cherish their relationships, they are also exploring what is sacred to them in the time they have left.
The phase-based theory of dying was developed in the late 1970s by Pattison for people with a life-limiting disease. This theoretical model of the dying process focuses on the living– dying interval that occurs from when the patient learns that death is imminent to the actual death, during which the patient oscillates between denial and acceptance of the prognosis (Pattison, 1978). Three clinical phases take place during the living–dying interval phase: Acute, chronic, and terminal. As the patient moves through each of the phases, the dying process is determined by their feelings and reactions, which can continually change (Pattison, 1978). What this model can teach clinicians who work in palliative care and hospice care is to recognize how the varying changes emotionally affect the patient from the very first moment of learning of the terminal illness to the moment of death (Pattison, 1978). ● During the acute crisis phase, the patient is challenged by understanding that a dying process beyond their control influences the death. Close friends and family help the patient deal with the reactions to the news. ● During the chronic phase, the patient has a keen awareness of concurrently living and dying. Friends and family help the patient respond appropriately to what is happening. ● During the terminal phase, the patient withdraws from the outside world and becomes aware of the need to conserve their internal energies. Friends and family compassionately prepare the person to move into this last phase Doka (1996) describes another theory of life-limiting illness that includes the prediagnostic, acute, chronic, terminal, and recovery landmarks. Each landmark then has an associated task of coping. In the prediagnostic landmark, individuals suspect an illness and seek out medical attention (Doka, 1996). The acute landmark, initiated by the diagnosis, is when individuals attempt to understand the disease, maximize health, develop coping strategies, explore the effects of the diagnosis, express feelings, and integrate the present reality into their sense of past and future (Doka, 1996). The chronic phase involves managing symptoms and side effects while carrying out health regimens, normalizing life, maximizing social support, expressing feelings, and finding meaning in the suffering (Doka, 1996). Those who have a life-threatening disease can inform a family member or close friend of the location of insurance documents and important papers, contact people in their address books, renew old friendships, and express their love to others. By addressing unfinished business, whether practical or emotional, dying individuals feel in control. In the terminal phase, individuals cope with dying by managing pain, symptoms, health procedures, and related stress. Dying persons prepare for death by saying goodbye and finding meaning in life and death. Some individuals experience a recovery phase during which their disease is cured or in remission. What Doka’s model (1996) can teach clinicians who work in palliative care and hospice care is that there are tasks to complete in each phase of dying, from setting up the first appointment with a physician to learning how to adjust to the new reality to managing the physical, emotional, cognitive, behavioral, and spiritual changes and preparing for death. Landmarks and taskwork for the end-of-life clinicians who work with patients who have a life-threatening disease can help them to review their lives, find meaning in their lives, complete important tasks, and accept the reality of death. This approach is based on the work of Ira Byock (1996), who identified the importance of patients with a life-threatening disease attaining certain landmarks before death. At each landmark, individuals have taskwork to complete. These landmarks include completing one’s affairs, resolving relationships, finding a sense of meaning in one’s life, experiencing love of self and others, acknowledging the finality of life and a sense of a new self, and letting go.
EliteLearning.com/Psychology
Book Code: PYFL4024
Page 252
Powered by FlippingBook