interactions- upset or comfort
	communications - inform or confuse
	self-evaluation - undermine or strengthen identity
	meaning - thought and behavior

It has been observed that nurses take more time before going to patients who are terminally ill.

Psychosocial Event

Death begins: facts are recognized facts are communicated may never be told patient realizes or accepts facts

An awareness of one's terminal illness that floats from one level of consciousness to another at various times

Lingering Trajectory

	Glaser & Strauss
	People are most likely to be regarded and treated as socially dead if they are on a lingering trajectory this death is more acceptable

Placing a patient on the "D. L."

The hospital staff is acting with a sense of urgency, treatment efforts are intense, and interactions between staff and family are tense

Hospital staff are taking the death of this patient especially hard because they had worked so hard trying to save her. Personnel called in for immediate life-or-death measures

According to Glaser & Strauss, hospital staff may engage in institutional evasions in order to do what they think really needs to be done for the patient. Not enough time to do the "official"

A condition that arises from a defect in the blood coagulation process

	Four times out of five, physicians misunderstood what the patients wanted with respect to CPR.
	Half of patients who died had moderate or severe pain in final three days of life.
	Poor communication with patients 41% never discussed CPR
	Did not follow patients stated preference for DNR

	No communication increase between physicians and patients.
	No improvement in pain control
	Physicians continued to disregard patients' preferences with respect to CPR resuscitation.
	Computer projections no more accurate than physician’s
	Patient information failed to reach physicians

	age comprehension control perception and treatment by others
	gender roles
	interpersonal relationships

Than others with the same physical condition Had fewer friends Had more distant relationships with their families More often expressed the wish to die.

	The impermanence of human existence at all times.
	The first four stages: A diminishment of the senses, followed by cessation of breathing.
	The last four stages: Involve a series of visionary experiences, concluding with the pure light of death.

	Are said to begin when the patient becomes aware that the illness is terminal
	Denial-anger-bargaining-depression-acceptance
	Have not been verified by subsequent research.

	When confronted by death or loss, one may respond with avoidance or denial or by suppressing it
	"The test results must be someone else's; there must be a mistake."

	Often manifest as displaced hostility
	"If it isn't safe, why doesn't the government put a stop to it!"
	Caregivers become the object of hostility
	Anger at God

	Attempting to strike a deal with fate or with God
	Good behavior for extension of life
	Quest to alleviate suffering and to postpone the dreaded outcome

	Reactive depression To dying Sense of loss by burdens of treatment and hospitalization and the financial costs Disruptions of job and family
	Predatory depression Final separation with world

	Establish productive ways of dealing with the changed circumstances of their lives.
	Not giving up or losing hope

	These are not strict categories.
	A variety of emotions may be experienced at any time.
	Although style in dying is like style in living, coping strategies may be modification of coping with other stresses.

Kubler-Ross

Does not pay systematic attention to: The patient's physical condition at the time, including pain and other symptoms. The type of treatment being received. The interpersonal climate and communication network that exists around the patient.

	Greater empowerment for the dying person.
	Attention to how the dying person is influenced by the immediate environment.
	Doing away with the concept of stages.

	journal entries indicate that his last weeks "centered on a relief from pain and his determination to exercise his will power as long as possible"
	intellectual effort against pain

	restricted activity model
	distorted or altered body image model
	disempowerment model
	time anxiety model
	journey model