Death, Society, and
Human Experience
9th Edition
Robert Kastenbaum
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Copyright © Allyn & Bacon 2007
Chapter Fourteen:
How Can We Help?
The Promise of Death
Education and Counseling
This multimedia product and its contents are protected under copyright law. The following are prohibited by law:
•Any public performance or display, including transmission of any image over a network;
•Preparation of any derivative work, including the extraction, in whole or in part, or any images;
•Any rental, lease, or lending of the program.
•
Copyright © Allyn & Bacon 2007
Burnout and the
Health Care Provider
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Burnout – prolonged response to chronic
emotional and interpersonal stressors on the job
• Three dimensions: exhaustion, cynicism, and inefficacy
• Occurs often in helping professions: teachers,
counselors, police officers, health care workers
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Compassion fatigue
• Term used in health care settings for burnout
• Develops after repeated experiences of frustration and
disappointment in which circumstances have interfered
with providing the needed level of care
Copyright © Allyn & Bacon 2007
Signs of Burnout
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Exhaustion, lack of energy,
feeling rundown
• Tension headaches
• Sleep disturbances
• Appetite and digestive
disturbances
• Increased errors at work
becoming irritable and
negative
• Anger flare-ups
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Self-criticism
Feeling helpless
Feeling depersonalized
and distant in relationships
Reduced immune function
increased secretion of
stress hormones
Elevated blood pressure
Metabolic dysfunctions
Copyright © Allyn & Bacon 2007
Burnout and the
Health Care Provider
•
Survey of 600 professionals who worked in death-salient
situations (Vachon, 1987)
• Dying patients are not the source of stress
• Most stressed by work environment, occupational roles,
particularly in terms of communication and continuity
within the health care facility
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Study of hospice staff (Addington-Hall & Karlsen, 2005)
• About half were considering leaving because of lack of
respect from colleagues in other disciplines and lack of
support from management
Copyright © Allyn & Bacon 2007
Burnout and the
Health Care Provider
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Effects on Patients (Study by the Joint Commission on
Accreditation of Healthcare Organizations, 2002)
• Risk of death increases 7% for surgical patients for each
additional patient over 4 in a nurse’s workload
• Risk of death increases 31% in hospitals where nurses
have 8 as compared to 4 patients each
How can health care workers protect themselves?
• Develop a peer network to support caregivers
• Develop consensus for shared decision making
• Learn relaxation techniques useful within and out of
work settings
Copyright © Allyn & Bacon 2007
Death Education in
Historical Perspective
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Ancient texts focused on preparing for judgment
• Both the Old Testament and The Arabian Nights
emphasize the brevity of life
• Christianity emphasizes release from death
• Three current themes (with Christian roots)
• Death is punishment for Adam and Eve’s disobedience
• Death is a test that separates the worthy and unworthy
• Life on earth is something we must endure (and death is
a blessing)
Copyright © Allyn & Bacon 2007
Death Education in
Historical Perspective
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Ars Moriendi (The Art of Dying Well), 15th century
• Christian guidebooks for priests and others to help
people in the last hours of life
• Principles in the guidebooks:
• How a person dies is a significant matter
• Some deaths are better than others
• “Good death” is a real achievement
• Good death flows more readily from a life that has
been lived in recognition of mortality
• Good death comes with the support of caring people
Copyright © Allyn & Bacon 2007
Association for Death Education
and Counseling (ADEC)
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Incorporated in 1976
Conducts national training workshops
• Teachers have much clinical experiences
• Teachers draw information from key journals,
such as Omega, Death Studies, Illness, Crisis,
and Loss, and Mortality
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Offers certification procedures
• Designed to maintain high quality care
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Death Education and Counseling
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Kalish’s observations that death educators came
along at a time when
• Society was no longer enthusiastic accepting an afterlife
as a substitute for life on earth
• Society realized that physicians couldn’t always provide
the means to a long healthy life
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Death educators need to be careful of:
• Role conflicts with other professionals
• Promising more than they can give
• Creating unrealistic expectations
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Contemporary Death Education
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Effective death educators come from established
fields, such as psychology, psychiatry, medical
ethics, nursing, sociology, and ministry
• Adult education can come through continuing
education courses, workshops, professional
conferences, clinical pastoral education, hospice
training sessions, and other special programs
• Nursing and other students in health care
programs are using SimMan to learn to care for
dying patients
Copyright © Allyn & Bacon 2007
Counseling and Psychotherapy
for Dying Patients
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Address the whole situation before focusing
only on psychotherapy
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Time with loved ones and friends
Financial security
Medical insurance issues
Competent nursing and medical care
Effective pain management
A comfortable environment
Copyright © Allyn & Bacon 2007
How We All Can Help
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Realize that prosocial action is well within our
capabilities
• Recognize our own potential for helping, and not
leave everything to the “experts”
• Become more competent in communicating with
each other about sudden, unexpected deaths
• Improve our awareness of the total family
response to death
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Glossary: New Terms
•
Ars Moriendi
• Artificial Hydration
• Burnout
• Compassion Fatigue
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Danse Macarbre
• Death Threat Index
• Prosocial
Copyright © Allyn & Bacon 2007