FINDING MEANING
● 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 helps explain 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 by asking themselves what it means to be near the end of life, or by exploring what it means to no longer exist. 30 patient learns that death is imminent to the actual death, during which the patient oscillates between denial and acceptance of the prognosis. 34 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. 34 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 Doka describes another theory of life-limiting illness that includes the pre-diagnostic, acute, chronic, terminal, and recovery landmarks. 35 Each landmark then has an associated task of coping. In the pre- diagnostic landmark, individuals suspect an illness and seek out medical attention. 35 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. 35 The chronic phase involves managing the symptoms and side effects while carrying out health regimens, normalizing life, maximizing social support, expressing feelings, and finding meaning in the suffering. 35 Doka’s model is based on the work of Ira Byock, who identified the importance of patients with a life- threatening disease attaining certain landmarks before death. 36 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. Spirituality-based A patient’s spiritual perspective across the dying trajectory stems from their belief system; faith; values; moment of death. 34 Landmarks-based life’s purpose; and perception of the meaning of their existence in relation to others, including family members and close friends, nurses, physicians, social workers, and pastoral counselors. 37 Spiritual distress is just as critical as body and mind distress. 37 A spiritual approach to coping with dying can enhance the
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. :9 ● 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. 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. Stage-based The stage-based approach to coping with dying is the most familiar among healthcare providers. This groundbreaking work by Elisabeth Kübler- Ross 31 outlined emotional stages of the dying process and includes five stages of grieving, or accepting death: denial, anger, bargaining, depression, and acceptance. 31 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. 32 Task-based 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, which have been divided into four areas of taskwork. 33 ● 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 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. Phase-based The phase-based theory of dying process focuses on the living-dying interval that occurs from when the address the social implications of dying. ● Spiritual tasks address meaningfulness, connectedness, and transcendence.
Book Code: MI24CMEB
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