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.The subject remindsus of our human weaknesses despite all technological advances.Death is the lasthuman experience, a fact which makes it difficult to help those who are terminally ill.Asa medical specialist, you will be faced frequently with the reality of another person'sdeath.This experience can be very painful and stressful.It is only natural for fears ofdeath and personal concerns to intensify whenever you are in contact with someonewho is dying.6-2.REACTIONS OF HEALTH CARE PERSONNEL TOWARD TERMINALLY ILLOR INJURED PATIENTSTo work effectively with a dying patient, you must recognize and understand theindividual's needs, feelings, tension, and discomfort.Coming to terms with yourself willbe your greatest asset.a.Denial.Some personnel may tend to deny the reality of death or try to avoidpatients who are terminally ill.Death is seen as a failure because it cannot beprevented.Some personnel may even "tune out" or "tune off" terminally ill patients bymaintaining an objective, professional approach.b.Common Inappropriate Actions/Responses to Terminally Ill PatientsWho Wish to Talk about Death.The medical specialist should avoid the followingexpressions:(1) Reassurance."Everything will be all right."(2) Denial."You're not going to die."(3) Fatalism."We all have to die sometime."(4) Changing the subject."Let's think of something else to talk about."c.Appropriate Actions/Responses to Terminally Ill Patients.(1) Gentle discussion.Be aware of how you talk to the patient.MD0586 6-2 (2) Exploration of feelings.Allow the patient the time and opportunity toventilate his feelings.(3) Active listening.Be attentive when the patient talks.6-3.PSYCHOLOGICAL RESPONSES TO THE DYING PROCESSResearch has been done by interviewing terminally ill patients and their familiesto gain information about psychological responses to the dying process.Theconclusions of the research are that there are five basic stages of dying: denial, anger,bargaining, depression, and acceptance.A patient may or may not follow these stagesin a fixed pattern.He may stop, regress, or not even progress beyond the first stage.Iffamily members are present, they will usually pass through the same stages as thepatient, not necessarily at the same time.a.Denial.(1) Patient reactions.The patient may:(a) Seek opinions of other physicians.(b) Request repeat of certain tests.(c) State that the test results belong to someone else.NOTE: These actions are usually characterized by "No, Not me!" "It can't be true!"or "There must be some mistake!"(2) Health care provided by the medical specialist.(a) Listen.Do not contradict the patient.(b) Reinforce prescribed medication/diet routine as prescribed by thephysician.(c) Respect the patient's wish to deny impending death.b.Anger.(1) Patient reactions.The patient may:(a) Replace denial with questions, feelings of anger, rage, resentment,and envy.(b) Blame, complain, find fault, and be extremely critical of the care heis receiving.MD0586 6-3NOTE: These actions may be characterized by "Why me?" "Why should this behappening to me?" or "What have I ever done to deserve this punishment?"(2) Health care provided by the medical specialist.(a) Have patience and tolerance.(b) Acknowledge to the patient that you understand how he feels.(c) Allow the patient to express anger and other feelings.(d) Respect the patient's need to rage against his fate.Do not take theattack personally.c.Bargaining.(1) Patient reactions.This stage may be quite short, intermittent, or noteven apparent.The patient may:(a) Bargain to postpone death, seek reward for good behavior, orexchange places with someone else.(b) Replace the previous question of "Why me?" to "yes, it is me, but ifyou will just let me live, I will never say an unkind word to anyone or never lose mytemper, or etc."NOTE: This stage may be done privately.(2) Health care provided by the medical specialist.(a) Understand that bargaining is helpful to the patient.(b) Keep the patient comfortable.(c) Listen and be available.d.Depression.(1) Patient reactions.The patient:(a) May be anxious to put affairs in order.(b) Sense a great loss (income, business, hair, limb, function, life).(c) Have feelings of sadness and guilt over not having provided for hisfamily, makes a will, or updates a will.MD0586 6-4 (2) Health care provided by the medical specialist.(a) Allow the patient to mourn, cry, and talk about losses.(b) If possible, help the patient take care of putting affairs in order.(c) Provide emotional support.e.Acceptance.(1) Patient reactions.The patient:(a) Is prepared to die.(b) Is at peace.(c) Is tired.(d) May withdraw from all except a special loved one.NOTE: The patient wants to be left alone or have someone sit near, but in silence.Family often needs more support than the patient.This is the time when it istoo late for so many words.It is also the time when relatives cry hardest forhelp--with or without words.(2) Health care provided by the medical specialist in a medical treatmentfacility.(a) Respect the patient's need for quietness and offer reassurance bybeing there as much as possible.(b) If the patient is unresponsive, do not discuss the patient in hisroom--hearing is the last sense to cease function.(c) If the patient does not want to talk, communicate nonverbally toindicate a sense of caring and concern.(d) Keep the patient as comfortable as possible.(e) Maintain emotional support for the family.NOTE: The medical specialist can be of great help during those final moments if hecan understand the family's conflicts at this time and help select the oneperson who feels most comfortable staying with the patient.Those who feeltoo uncomfortable can return home knowing the patient will not die alone withno guilt for avoiding the moment of death.MD0586 6-56-4.COPING WITH DEATH AND DYING IN A COMBAT ENVIRONMENTHealth care provided by the medical specialist includes the following:a.Make the casualty as comfortable as possible.b.If possible, find someone who can sit with the soldier (hopefully, a buddy fromhis unit).c.Offer to take care of unfinished business or notify his family, if possible [ Pobierz całość w formacie PDF ]