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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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  • Hospice Care
  • Clergy and Faith Communities
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    Back to Module 14: Table of Contents
    Part II: Common Needs and Goals

    Click here for a Special Note
    Finding Hope
    The Search for Meaning
    Sustaining Personhood and Community
    Coping with Change and Uncertainty
    Taking Care of Unfinished Business/The Need for Forgiveness Fear of Death, Questions About Life After Death & Spiritual Care at the Time of Death

    Taking Care of Unfinished Business and the Need for Forgiveness

    Facilitating Life Review

    • Life review is a natural part of the end of life
    • As persons face their own death, they naturally ask questions such as:
      • “Was my life well-lived?”
      • “How will I be remembered?”
    • The process of reviewing one’s life provides the opportunity to affirm the unique contributions and value of the person who is dying
    • Physicians, nurses, nursing assistants, volunteers, occupational therapists, and counselors have many opportunities to assist in this developmental task
      • Asking the person to share a piece of their story or what they are most proud of are simple ways to begin

      • You may also encourage family members and friends to identify what they have learned from the dying person or how that person has made a difference to them

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    Attending to Unfinished Business

    • Coming to terms with one’s past is an important task at the end of life
    • The end of life represents a chance for persons to resolve or come to terms with their mistakes, failures, regrets, and unfinished business
    • How the dying person or family feels about or perceives their past matters far more than the judgment or perception of anyone else

    Examples

    • Religious and spiritual frameworks play a role in this process
      • Framework from which to assess life
      • Means to “make right” or be released from sins or failures

    Examples

    • The end of life care team also plays an important role in this process
      • All members of the interdisciplinary team may be called upon to help persons gain a sense of peace with the life they have lived, when that is the goal (explicit or implicit) of the dying person and their family

      • However, when strong negative or judgmental feelings about a person’s past arise, members of the team with professional expertise in this area should be brought in if possible

      • Social workers, chaplains, and psychologists can:
        • Use life review, confession, and reframing techniques in addition to an accepting, non-judgmental presence

        • Facilitate communication between the dying person and family/friends as needed to bring closure and reconciliation

        • Encourage the dying person to take specific actions to make amends for their past actions or complete an unfinished task to attain the peace they desire

      • Words of forgiveness and rituals of reconciliation may occur with the assistance of a professional spiritual caregiver or member of the clergy
    • Unresolved past issues may manifest themselves in physical or psychological symptoms
      • Agitation
      • Restlessness
      • Sleeplessness
      • Pain that is not lessened with appropriate medications
      • Resistance to taking pain medication
      • Even shortness of breath or panic should be regarded as possible indications of spiritual distress
    • Unresolved issues from the past or a need for forgiveness may also cause psychological or emotional symptoms such as:
      • Fear of dying
      • Concerns about salvation or the after life, and
      • General despair
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