- Unfinished Business
Example: I want to tell my father/mother that I love them but I'm
still to angry to do it. I haven't spoken to my
brother/sister for years, and I want to heal our broken
relationship before I die. I haven't seen my son/daughter
for years. I want to be at peace with my
children. I left the church years ago and want to
return. Is it to late? Ten years ago I stole some
money and now I want to make it right. How can I do it?
Intervention: Unfinished business is a powerful conern for
the dying. We need to listen to the dying and help them
identify areas of unfinished business, and encourage resolutions.
Example: I wanted to have children and never did. I
wanted to see my children grow up. I wanted to accomplish more
at work. I wanted to travel with my spouse and finally have
time to enjoy life after I retired. I wanted to be successful.
Intervention: Supportive listening and acknowledgement of
the pain of unfilled dreams are helpful. life review and
identifying goals and dreams that were realized can help the patient
re-focus on positive accomplishments.
Example: I shouldn't have to die so young. It isn't fair
that I have to die and other people who are mean and break the law
get to live.
Intervention: Feelings of resentment and envy are normal for
terminally ill patients. Listening and acknowledging the
unfairness are therapeutic. On some occasions the use of humor
is appropriate.
- Limitation of Time
Example: Now I don't have time to finish what I started. now
I don't have time to watch my children/grandchildren grow
up. Now I don't have time to do all the things I was going
to do.
Intervention: Listening and acknowledging the pain of limited
time, and then helping patients decide how they want to use the time
they have left, are therapeutic.
Example: This isn't how it is supposed to be: you're supposed to
die when you're old, not young.
Intervention: Acknowledging the pain and listening are helpful.
Example: Will my family be angry with me because I'm dying
and can no longer take care of myself or them? will the hospice
staff continue to care for me if I get angry?
Intervention: The terminally ill frequently fear that
family members and staff will become angry with them for
dying. They are afraid expressions of anger or depression or sorrow
may irritate those around them and result in retribution when they
become helpless. Reassurance is needed that anger, rage, envy,
and all the other so-called "negative" feelings are normal
and to be expected. Provide reassurance of continued care and
support.
Example: I feel guilty about dying and leaving everything in such
a mess. I know I would have taken better care of myself.
If I had been a better person, I wouldn't have been punished with
this illness.
Intervention: We feel guilty when we don't behave in accordance
with our own ethical principles or when we don't live up to our own
self-image or expectations. We expect punishment and devalue
ourselves. We can help patients by listening, acknowledging
their feelings of guilt, and helping them determine if their
feelings of guilt are based in reality or are the result of
unrealistic expectation. We can reassure when appropriate but
must refrain from belittling real causes for guilt. Helping
patients figure out ways to atone for past harmful actions is
important, as is helping them achieve self-forgiveness.
Example: I'm ashamed because I can't control my body. I
have to depend on everyone else. I have no sense of dignity
anymore.
Intervention: We fell shame when we are observed in
situations in which we are not living up to our own
self-image. Terminally ill patients are frequently faced with
situations in which they are dependent or not allowed to maintain
any sense of control or dignity. Hospice staff members can
ensure privacy and honor their patient's need for dignity.
Helping arrange the environment to encourage continued independence
for as long as possible is important, as is patient involvement in
decision making.
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