Help with getting pts to accept death

As someone who worked hospice for 4 years I don't think there is a way to do this. they have to go thru the stages of grief some people skip some and others never accept they just die.... it is a very personel thing and allot depends on where they are at in there life. The family members sometimes have a harder time accepting this sometimes than the patient ....maybe I am misunderstanding what you want

Rhonda

I am a nursing student and a have to do a presentation on Kubler-Ross's stage of acceptance. I am wanting to find tools, or exercises that can be done to facillitate a pt to accept their impending death? I would like any suggestion no matter how small!!!!!!!!!! Thanks

are you trying to find materials that reflect kubler-ross's findings or are you trying to challenge them? i am unclear as to what exactly you need.

leslie

hi, I don't believe there are any tools as such, supporting the patient to express his/her feelings whatever they may be and gentle honesty I have found to be the best way. Everybody has different experiences so no one approach works.

does this help??

My humble opinion: this is an internal process, some people never come to "acceptance" Personally, I think you just support the person where they are.

Well, tools to help them through the acceptance stage - I would imagine like the other threads have touched on, these would be communications tools. First of all, listening - this includes empathy , using communication skills such as reflection, clarification , etc. There is also the concept of learning readiness - these include assessing factors such as past experiences, personal values, culture, physical and emotional status. Also spiritual care is ++important, being able to refer to appropriate lay/pastoral counsellors. I hope this helps

Here is something else to consider in writing your paper. Patients do not have to accept death. In some cases it may be the only thing that make the difference in thier survival.

I have been in this business long enough and in critical care long enough to NEVER predict who will make it and who won't.

Getting people to accept death is based on a presumption that WE in our great experience and knowledge know that someone is going to die.

Many times we are right. This is paternalistic to deside that they must be helped to accept the inevitable.

Often it is a fighing spirit of the patient that is the only thing that pulls them through. I have see miracles.

If that patient accepted death and allow it to come it would have.

On the other hand I love it when a patient and family accept it. Usually the patient will accept it LONG before the family and loved ones.

So it is seldom a case of getting the patient to accept it. More often the problem lies with the family.

As one poster said. It is not out job to gain acceptance. It is our job to support them through the process at the stage they are at now. As I am sure your text tells you everyone must go though at thier own pace.

You cannot hurry it.

Often the problem lies with us because we are uncomfortable. Because it would make our job easier when they accept it. (remember my remark about loving it when they accept?)

I worked hospic and critical care. paliative care is far easier to give. There is less stress for us if we don't have to try and save a patient whom we know we cannot save.

Sometimes we mislead people (albite unintentionally) about thier ability to survive or get better. Sometimes we need to have that hard talk with them. We mislead when we are unwilling to talk about our limitations. I see this all the time. So naturally they expect us to do the impossible.

Acceptance is not necessary, is not our place to lead the patient to it. They will either go there or not according to thier time table.

Acceptance may not come until years after a loved one dies. So how can you effect it? It is NOT going to happen on your time table.

Finally acceptance may be inappropriate in some cases. (sorry we cannot pretict which cases, even though we think we know better and insist this case is appropriate)

Some tools that we use are

allow people to talk about it.

encourage reminissing.

Assisting to get things in order. (financial, wills, child care, etc, etc)

Pain control.

Encourage visits from friends and family.

Making memor or scrapbooks, writing or recording memories.

Finishing old business with people in thier life.

Control of symptoms like nausia etc. (things related to quality of life and comfort so that they can live what is left of thier life as well as possible)

Taking a trip. Doing things they alway wanted to.

One patient may just want to go to Walmart one more time. No kidding this was it for one patient. So we arranged it for a quiet sunday morning with Walmart. We took the patient complet with an entarage, of paramedics, nurses etc on a gurney though walmart with $100 and Walmart kick in some more $ and freebies.

Another wanted to go fishing one more time. and we had to get him well enough to tollerate it and made the arrangement and he went.

Some of these things may be beyond your ability as a hospital staff nurse. However, they are not beyond your ability to effect.

check out this site for guidelines on terminal illnesses and death/dying:

http://www.guidelines.com

I agree with the other posts. The training has to be done by YOU, not the patient. You have to learn how to assess the situation, decide which stage the patient is likely to be in, and intervene appropriately. This is called nursing process.

One of the "tools" I use at times when working with people with a new diagnosis of diabetes, is to use a "feelings" ball. This was in an article I read some time ago. Get a good sized orange plastic ball. Why orange? I'm not sure. That's what was suggested. On the ball write in permanent marker various feelings the person might have. My ball has on it: angry, sad, worried, scared, so what?, relieved, why me?, hopeful, anxious, hopeless... the list could go on. If you have someone who you are trying to get in touch with their feelings, give them the ball and ask them to select one word that they associate with. That gives you an idea where they are at that time. I don't think there is any way to help someone through the stages. When working with someone who is having a difficult time coping with diabetes, I explain the stages, just like the stages of death and dying, and make them aware that it is normal to go through these stages. Hopes that helps a little. Good Luck, Audrey