coping
constantly changing cognitive and behavioral efforts to manage specific external or internal demands that are taxing or exceeding the resources of the person
three categories of coping skills
- appraisal-focused coping
- Problem-focused coping
- reaction-focused coping / emotion focused coping
appraisal-focused coping
how do I understand or make sense of the situation?
problem-focused coping
what will I do about the situation?
reaction-focused coping / emotion-focused coping
what will I do about my reactions to the situation?
coping with dying is multifaceted and involves more than one …
person
set of perceptions
set of motivations
active, empathetic listening is necessary to ….
identify each person involved
listen carefully to what his/her coping reveals
understand what coping means for each person in the situation
Dying Trajectories
pattern of dying
- duration
- shape
awareness contexts
the backdrop for social interactions among those who are coping with dying
four forms of awareness contexts
- closed awareness
- suspected awareness
- mutual pretense
- open awareness
three main points about the forms of awareness contexts
these are different contexts, not steps in a linear progression
each has potential costs and benefits
each affects how individuals cope with dying, as well as the social interactions among all ppl involved
stages of coping with dying in the Kübler-Ross - Stage Model
- denial (“Not me!”)
- anger (“Why me?”)
- bargaining (“Yes me, but…”)
- depression
- reactive (responding to past and present losses)
- preparatory (anticipating and responding to losses yet to come)
- acceptance (describes as “almost void of feelings”)
critique of Kübler-Ross - Stage Model
- existence of these stages has not been demonstrated
- no evidence that people move from stage one to stage five
- limitation of method have not been acknowledged
- the totality of persons life is neglected
- environment not taken into account
- suggest human response to stress of dying independent of any social or cultural influence
three lessons to learn from the legacy of Elisabeth Kübler-Ross
- individuals who are coping with dying are still alive and often have unfinished business that they want and need to address
- we cannot be effective providers of care unless we listen actively to those we seek to serve and identify with them, thier own tasks and needs.
- we need to learn from those who are coping with dying in order to know ourselves better
Coping with dying Corr’s Task-Based Model
Physical
- satisfy bodily needs; minimize physical distress consistent with other values
Psychological
- maximize psychological security, autonomy, and richness in living
Social
- sustain and enhance interpersonal attachments; maintain selected interactions with social groups and society
Spiritual
- address issue of meaningfulness, connectedness, and transcendence; foster hope
Corr’s Task - Based Model
the four areas describe potential work for all who are coping with dying (not just the dying)
tasks may or may not be necessary or desirable and it is not a requirement
individual tasks can be completed, but it is not possible to finish all of the task work that confronts the individual before death
Doka’s Account of 5 phases in living with life threatening illness
- prediagnostic Phase
- Acute phase
- Chronic Phase
- Recovery Phase
- Terminal Phase
associated tasks with Prediognostic phase
- recognizing danger and risks of illness
- managing anxiety
- developing and following thru on health-seeking strategies
associated tasks with Acute phase
- Understanding disease
- maximizing health
- fostering coping strengths and limiting weakness
- arranging for cure-oriented interventions
- assimilating illness into one’s self-concept
associated tasks with chronic phase
- managing symptoms and side effects
- evaluating stress and coping efforts
- maximizing social support and minimizing isolation
- redefining relationships with others
associated tasks with the recovery phase
Dealing with the aftereffects of illness and anxieties about reoccurrence
reconstructing one’s life redefining relationships with caregivers
associated tasks with the terminal phase
Dealing with ongoing challenges from disease, side effects, treatments
making treatment decisions regarding curative versus comfort care
saying goodbye
preserving self-concept and social relationships
finding meaning in life and death
How should theories about coping with dying help us?
- should never be barriers between us and those we are trying to understand or help
- should guide us in good directions
- help us listen carefully and learn important things about the individuals whoa re coping with dying and their situations
