Chapter 22 PA- Issues for the death care professional - exam 3

Question 1

True or false:

The separation of the aged, the ill, and the dying in our society creates problems for loved ones in processing their grief.

Answer 1

True

Question 2

True or false:

It is widely recognized that those professionals and volunteers to whom the care and ministry of dying people fall need to grieve as well.

Answer 2

False - it is not widely recognized.

Question 3

Takes a physical, mental, emotional and spiritual toll on people.

Answer 3

Stress

Question 4

True or false:

The consequences of burnout may include loss of health and well-being as well as a decline in professional performance.

Answer 4

True

Question 5

• A condition
• A loss
• A state

Answer 5

Characterizations of burnout

Question 6

A debilitating psychological condition brought about my unrelieved work stress, which results in depleted energy reserves, lowered resistance to illness, increased dissatisfaction and pessimism, increased absenteeism and inefficiency at work.

Answer 6

Burnout

definition by:
“The work stress connection: how to cope with job burnout”
by Robert Veninga and James Spradley

Question 7

A progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of the conditions of their work.

Answer 7

Burnout

Definition by:
“Burnout” by Jerry Edelwich and Archie Brodsky

Question 8

A state of physical, emotional, and mental exhaustion caused by long-term involvement in situations that are emotionally demanding.

Answer 8

Burnout

Definition by:
“Career Burnout Causes and Cures” by Ayala Pines and Elliot Aronson

Question 9

Increases as stress occurs in several or consecutive fashion with little or no time to grieve one loss before the next one happens.

Answer 9

The potential for burnout

Question 10

A term coined by Dr. Ronald Barrett, a situation that develops when there is such an accumulation of unresolved, compounded grief that an individual may simply grow numb.

Answer 10

Bereavement burnout

Question 11

• burnout
• Expectations for caregivers
• Organizational hazards

Answer 11

Risks for death care professionals

Question 12

• Begin the career with naive enthusiasm, which may include the expectation of making a difference, may soon become overwhelmed by the sheer volume and urgency of need confronted on a daily basis.
• Visiting nurses or home hospice workers may become deeply emotionally invested in families they serve, when a death occurs the isolated nature of their work often leaves them bereft of opportunities to interact with colleagues and process feelings. In addition, these individuals are constantly adjusting to diverse settings as they move from patient to patient, creating even more stress.

Answer 12

Expectations of caregivers

Question 13

The factors of systemic design and organizational procedures under which many death care professionals work.

• Often unclear expectations for those who are working with the dying.
  
  • makes caregivers more open to stress because they are unable to ascertain the criteria against which they will be assessed. (Rando)
• Mechanisms to reduce stress, manage the threat of burnout, and process grief are frequently absent from an organization’s overtaxed resources.
• lowering of morale
• sense of being alone with one’s feelings
• reduction of job satisfaction
• negative interpersonal dynamics

Answer 13

Organizational hazards

Question 14

All resources are devoted to simply coping. Often happens when professionals become caught in a cycle of attachment and loss.

Answer 14

Emotional disinvestment

Question 15

• Exhaustion
• Despair
• powerlessness
• Apathy
• Alienation
• Depression
• Loss of self-esteem
• Irritability
• Loss of energy
• Cynicism
• Poor concentration
• Nightmares
• Loss of creativity
• Negative attitudes

These can be reflected in behavioral changes that not only affect coworkers and quality of client care but may seriously affect an individual’s personal relationships.

Answer 15

Symptoms of burnout

Question 16

• decrease in physical, social and professional effectiveness

Answer 16

Serious threat that burnout poses

Question 17

1. Characterized by the initial stimulation of a new job and the enthusiasm and desire to succeed and prove oneself.
2. Stress has started to build and fatigue and job disappointment have set in.
3. Chronic exhaustion
4. The emergency, or crisis point
5. The crossroads between help or hopelessness

Answer 17

The 5 stages of burnout

Question 18

This is the positive, if perhaps unrealistic, time when a death care worker feels read, willing, and able to “do it all.”

Answer 18

1. The initial stimulation of a new job and the enthusiasm and desire to succeed and prove oneself.

Question 19

• Professional may come to believe (correctly or incorrectly) that the organization or agency doesn’t share the same level of commitment to the work and its urgency.
• Particularly the case with health and human services personnel serving the AIDS community.

Answer 19

2. Stress has started to build and fatigue and job disappointment have set in.

Question 20

Brings a higher intensity of emotion and possible physical symptoms.

• anger
• depression
• proneness to accidents
• conscious or unconscious guilt
• less communicative
• Begin to withdraw socially
• Use of addictive coping mechanisms such as caffeine, alcohol, nicotine, or other drugs may increase substantially during this stage.

Answer 20

3. Chronic exhaustion

Question 21

If no intervention has taken place, the death care professional is at risk for opportunistic illness and is likely to demonstrate averse behavior on the job:

• coming in late
• leaving early
• taking longer breaks
• becoming angry when demands are made
• treating clients impersonally

Simultaneously, the professional is experiencing feelings of failure and pessimism and may obsess over his or her disappointments and loss of values that were held so brightly in the first stage.

Answer 21

4. The emergency, or crisis point

Question 22

It should be a goal of every death professional and their managers to prevent this stage. Funeral directors suffering symptoms of critical incident stress revealed that those in the group reporting increased symptomatology (30-39 years of age) were also most likely to “drop out” of the funeral business.

Answer 22

5. The crossroads between help and hopelessness

Question 23

“Charting” of normative stages reflects the understanding and conflict-resolution ability caregivers must develop so they can care humanely for dying people, build their capacity to help, and enjoy freedom from the incapacitating effects of burnout. Developed by Harper.

Answer 23

Schematic Growth and Development Scale in Coping with Professional anxieties in Terminal Illness

Question 24

True or false:

It has been noted that the increased “kinship” between terminally ill patients and their network of caregivers results in death care professionals becoming “surrogate grievers.” This notion may soon be disabused as it becomes more widely recognized that caregivers’ grief is neither a substitute nor a replacement for a faraway family’s grief but an authentic response to loss - particularly if the person was in some way special or memorable in the professional’s life.

Answer 24

True

Question 25

These stages are likely to be encompassed in the maturing of the professional who copes with stress in caring for the dying.

1. Intellectualization
2. Emotional survival
3. Depression
4. Emotional arrival
5. Deep compassion

Answer 25

Harper’s 5 stages - Schematic growth and development scale in coping with professional anxieties in terminal illness.

Question 26

Knowledge and anxiety - Caregivers are uncomfortable with death and manage anxiety by focusing on professional knowledge and factual issues of policies and procedures. Conversations with the patient are not personal.

Answer 26

1. Intellectualization

Question 27

Trauma- The caregiver feels death on an emotional level and grieves his or her own mortality. This is accompanied by pity for patients whose death is unavoidable, guilt at their own health, and trauma at the reality of death.

Answer 27

2. Emotional survival

Question 28

Pain, mourning, grieving- This is the “grow or go” stage where caregivers must accept the fact that death does exist and is painful. Mastery of self is a challenge, if the reality of death is not accepted, workers may leave the field.

Answer 28

3. Depression

Question 29

Moderation, mitigation, and accommodation - No longer preoccupied with their own death or incapacitated by depression, caregivers’ emotional responses are appropriate. They are sensitive enough to grieve and resilient enough to recover.

Answer 29

4. Emotional arrival

Question 30

Self- realization, self-awareness, and self- actualization - Caregivers are able to relate compassionately to the dying patient, in full acceptance of the impending death. Behavior and performance are enhanced by the dignity and self-respect they afford themselves, enabling them to give dignity and respect to the dying patient.

Answer 30

5. Deep compassion

Question 31

1. Be readily-oriented : accept the “givens” of a system.
2. Develop reinforcement alternatives; look for different ways to “validate” your success.
3. Use time management techniques.
4. Conduct routine attitude tests or assessments.
5. Seek information that might making the job easier.
6. Establish and maintain support systems.
7. Take time out.
8. Monitor diet and physical fitness.
9. Learn to delegate
10. Nurture and cultivate spirituality.

Answer 31

Barrett’s “prescriptions” that death care professionals might wish to practice to keep their stress levels within reasonable bounds.

Question 32

Parallel to leading a well-balanced, harmonious life. The difficulty for death care professionals is their emotional, physical, and mental resources are often stretched beyond “normal” limits due to the trauma, pain and suffering, serial losses, and compounded grief they deal with on a regular basis.

Answer 32

Managing burnout

Question 33

Identifies 5 major arenas of life that death care professionals must attend to in order to minimize their potential of likelihood for burnout.

• Intentionally circular “a wheel is meant to go somewhere” If one area of the wheel is flat, the wheel doesn’t go anywhere.

Answer 33

Canine’s model illustrating management of burnout

Question 34

1. Spiritual
2. Mental
3. Emotional
4. Physical
5. Social

Answer 34

5 categories in Canine’s model

Question 35

• Is the central diamond on in the wheel
• Does not require religious affiliation
• Unique world perspective, philosophy of life
• Death care workers - aware of their spiritual filter, purpose in life, and how to best exercise their spiritual muscles:
  
  • prayer
  • meditation
  • journal writing
  • communing with nature
  • self-examination and reflection
  • practicing the tenets of a particular religious faith

Answer 35

1. Spiritual

Question 36

• Relates to self-image, self-esteem, and self-criticism
• honor one’s talents and accomplishments
• live as much as possible to one’s personal moral/ethical code
• not being afraid to answer our inner critic when it has something to say.
  - listen carefully to inner critic and adjust behavior
  - reaffirm you are worthwhile when you are down

Answer 36

2. Mental

Question 37

• Good feelings that are a result when emotions are identified and expressed.
• remove cognitive distortion
• emotions should be identified, expressed and locked onto the appropriate object.
• be aware of anxiety and anger
• embrace forgiveness

Answer 37

3. Emotional

Question 38

Accepting the core of every human being as the same as yourself, and giving them the gift or not judging them.

Answer 38

Joan Borysenko’s definition of forgiveness

Question 39

• Consult a physician before exercise regimen
• 20 mins of exercise 4 times a week
• avoid alcohol, drugs, tobacco, caffeine
• monitor sodium and fat intake
• incorporate recommended percentages of protein, carbohydrates, vitamins, minerals and fibers

Answer 39

4. Physical

Question 40

• Primary relationships - personal and professional- as well as the casual ones
• satisfying hobbies and/or social activities
• ability to communicate and respond to others’ needs in a dependable fashion that creates trust.
• reaching out to others socially throughout life affords an opportunity to build sustaining bridges with others that are rewarding and meaningful.

Answer 40

5. Social

Question 41

1. Fitness and exercise
2. Avoid substances
   - alcohol/drugs
   - tobacco
   - caffeine
3. Diet and nutrition

Answer 41

Physical

Question 42

1. Self- appreciation
2. Idealized and actualized self
3. Answering the “inner critic”

Answer 42

Mental

Question 43

1. Identification and expression of feelings
2. Anxiety and anger
3. Forgiveness

Answer 43

Emotional

Question 44

1. Communication
2. Bonding and trust
3. Building bridges to others

Answer 44

Social

Question 45

1. Philosophy of life
2. Purpose in life
3. Prayer and higher power

Answer 45

Spiritual

Question 46

Warns that death care professionals often neglect their own need to get emotionally “caught up” and that unresolved grief becomes “excess baggage” that may lead to mental health complications, physical distress, and problems with interpersonal relationships.

Answer 46

Barrett