Palliative Care and Death Anxiety

Abstract

Diminishing treatment alternatives, losing hope for a possible recovery, insufficient control of pain and inability to provide the necessary technical support lead palliative care to bring multiple problems with itself. Along with technical and professional challenges, palliative care can put a humanitarian strain on the nurse. Caring for a dying patient is a worrisome experience which causes spiritual pain. An increase in nurses' death anxiety may cause unwillingness to be together with a dying patient. In terms of the end of life, it is expected that the nurse stands by patient's family to help them in sustaining their psychosocial wellness. In order to meet this expectation, nurses should get a qualitative training for end of life care along with good interpersonal communication skills and coping strategies.

Keywords

• Death anxiety, palliative care, nursing

Palyatif Bakım ve Ölüm Kaygısı

Öz

Palyatif bakım, tedavi seçeneklerinin azalması, prognozun giderek kötüleşmesi, ağrı ve diğer belirtilerin kontrolünün yetersiz kalması ve gerekli teknik desteğin sağlanamaması nedeniyle çoklu sorunları beraberinde getirmektedir. Palyatif bakımın karmaşık yapısı, yaşamın son dönemindeki hastanın kaliteli bakımının nasıl sağlanabileceği konusunda sıkıntı yaratmaktadır. Ölmekte olan hastaya bakım vermek duygusal olarak acı veren, üzüntülü bir deneyimdir. Ölen hastaya bakım verirken hemşire korku, üzüntü, düş kırıklığı, anksiyete gibi duygular hissedebilir. Hemşirenin kendi ölüm kaygısı fazla ise bu durum ölmekte olan hasta ile birlikte olmakta isteksizlik yaratabilir. Palyatif bakımda hemşireden, hastanın ailesine destek olması, psikososyal açıdan iyilik hallerini sürdürmelerine yardım etmesi beklenir. Bu beklentinin karşılanabilmesi için, hemşirenin nitelikli bir eğitim ile yaşam sonu bakıma hazır-lanması, yeterli kişilerarası iletişim becerilerine ve baş etme stratejilerine sahip olması gerekir.

Anahtar Kelimeler

• Ölüm kaygısı, palyatif bakım, hemşirelik

Kaynakça

1. Çimete G. Yaşam Sonu Bakım: Ölümcül Hastalarda Bütüncül Bakım. İstanbul, Nobel Kitapevi, 2002.
2. Lederberg MS, Joshi N. End-of-life and palliative care. In Kaplan&Sadock’s Comprehensive Textbook of Psychiatry, 8th edition (Eds BJ Sadock, VA Sadock):2336-2365. Baltimore, Lippincott Williams & Wilkins, 2005.
3. Super A. The context of palliative care in progressive illness. In Textbook of Palliative Nursing (Eds BR Ferrel, N Coyle):27-36. New York, Oxford University Press, 2001.
4. Taylor GJ, Kurent JE. A Clinician’s Guide to Palliative Care. Oxford, UK, Blackwell Science, 2003.
5. Singer PA, Martin DK, Kelner M. Quality end-of-life care patients’ perspectives. JAMA 1999; 281:163-168.
6. Glass E, Cluxton D, Rancour P. Principles of patient and family assessment. In Textbook of Palliative Nursing (Eds BR Ferrel, N Coyle):37-50. New York, Oxford University Press, 2001.
7. Kalischuk RG. Nurses’ perception of death education (Master’s thesis). Lehtridge, Alberta, University of Lethbridge, 1992.
8. Özaltın G. Ölümcül hastaya yaklaşım. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi 1996; 4(ek 3):40-42.

9. Cherlin E, Schulman-Green D, McCorkle R, Johnson-Hurzeler R, Bradley E. Family perceptions of clinicians’ outstanding practices in end-of-life care. J Palliat Care 2004; 20:113-116.
10. O’Gorman SM. Death and dying in contemporary society: an evaluation of current attitudes and the rituals associated with death and dying and their relevance to recent understandings of health and healing. J Adv Nurs 1998; 27:1127-1135.
11. Kawagoe H. Death education in home hospice care in Japan. J Palliat Care 2000; 16:37-45.
12. Roman EM, Sorribes E, Ezquerro O. Nurses’ attitudes to terminally ill patients. J Adv Nurs 2001; 34:338-345.
13. McClement S, Care D, Dean R. Evaluation of education in palliative care: determining the effects on nurses’ knowledge and attitudes. J Palliat Care 2005; 21:44-48.
14. Leary LA. Qualitative analysis of student’ perception of changes in death anxiety and death competency in the context of a death education course (Doctoral thesis) . Virginia, George Mason University, 1997.
15. Çavuşoğlu H. Çocuk Sağlığı Hemşireliği, 8. Baskı. Ankara, Sistem Ofset, 2004.
16. Hopkinson JB, Hallet CE, Luker KA. Caring for dying people in hospital. J Adv Nurs 2003; 44:525-533.
17. Hurting WA, Stewin L. The effect of death education and experience on nursing students’ attitude toward death. J Adv Nurs 1990; 15:29-34.
18. Mok E, Lee WM, Wong FK. The issue of death and dying: employing problem- based learning in nursing education. Nurse Educ Today 2002; 22:319-329.
19. Ferrel B, Virani R, Grant M, Juarez G. Analysis of palliative care content in nursing textbooks. J Palliat Care 2000; 16:39-47.
20. Öz F. Sağlık Alanında Temel Kavramlar. Ankara, İmaj İç ve Dış Ticaret, 2004.
21. Cowell DD, Farrell C, Campbell NA, Canady BE. Management of terminal illness: a medical school-hospice partnership model to teach medical students about end-of-life care. Acad Psychiatry 2002; 26:76-81.
22. Mallory JL. The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students. J Prof Nurs 2003; 19:305-312.
23. Eddy JM, Alles WF. Death Education. St. Louis, Mosby, 1983.
24. Mok E, Chiu PC. Nurse-patient relationships in palliative care. J Adv Nurs 2004; 48:475-483.
25. Downe-Wamboldt B, Tamlyn D. An international survey of death education trends ın facultıes of nursing and medicine. Death Stud 1997; 21:177-188.
26. Knight KH, Elfenbein MH. Relationship of death education to anxiety, fear, and meaning associated with death. Death Stud 1993; 17:411-425.
27. McGovern M, Barry MM. Death education: knowledge, attitudes, and perspectives of ırısh parents and teachers. Death Stud 2000; 24:325-333.
28. Shoemaker RK, Burnett GF, Hosford RE, Zimmer CE. The effects of death education course on participant attitudes toward death and dying. Teach Psychol 1981; 8:217-219.
29. Wass H. A Perspective on the current state of death education. Death Stud 2004; 28:289-308.
30. Tanhan F, İnci FA. Ölüm Eğitimi. Ankara, Pegem Akademi, 2009
31. Lally MT. Death anxiety and fear of death attitudes: a death education program for student nurses (Doctoral thesis). Chicago, Loyola University, 1983.
32. LeRoy MA. The effects of instruction in death and dying on the death anxiety level of nurses and their attitudes toward death and dying patients (Doctoral thesis). Philadelphia, Temple University, 1986.
33. Thompson LE. attitudes toward death and dying: an educational intervention for reduction of death anxiety (Doctoral thesis). Vermillion, South Dakota, University of South Dakota, 1983.
34. İnci F, Öz F. Ölüm eğitiminin hemşirelerinin ölüm kaygısı, ölüme ilişkin depresyon ve ölümcül hastaya tutumlarına etkisi. Anadolu Psikiyatri Dergisi 2009; 10:253-260.
35. Figen İnci, Yrd.Doç.Dr., Niğde Üniversitesi, Niğde; Fatma Öz, Prof.Dr., Hacettepe Üniversitesi, Ankara