A healthy person rarely thinks about when and where death will come, because that moment is still far away. For the terminally ill, death is almost within reach. The end of life inevitably comes when the body becomes more and more out of its own control and drugs and instruments are no longer able to help. It is a difficult path, which each person has only once, accompanied by physical pain and psychological suffering: anger, fear, despair, depression, inevitability …… How to let terminal patients face death? This has been a major challenge in psychological care for the dying.
The psychology of those approaching death is generally difficult to calm. The terminally ill need special psychological care. One is anger, refusing to acknowledge that there is no cure for their illness, feeling that it is not fair, why should they be the ones to die and not others? The person always says, “I’ve always been fine, how could this happen”? You can’t help but vent your anger, lose your temper with your family, drive away the doctors and nurses, and wonder if the doctors made a mistake. The anger period will last for a week or so. During this time, the patient has very little anger, is grumpy, and sees everything as if the whole world is against him. The second is the struggle. When the anger subsides, the desire to live makes him struggle in his heart, looking at the doctors, praying to his relatives, saying “you must find a way to save me”, asking for the best treatment plan, the best medicine, whatever it takes, as long as he is kept alive, he has a lot of unfinished business. This stage is as long as several months, and as short as a few days. Third, he was desperate and ignored everyone he saw. When his relatives came to see him, he turned his back, and when the doctors and nurses asked him, he didn’t say anything, and when they asked him again, he said, “I’m like this anyway. His eyes were desperate and his head was buried, as if he had resigned himself to his fate, but he was unwilling to do so. The fourth is to admit death, after complete despair, generally high fever does not go down, body pain, swallowing disorder, then want to end life quickly, “doctor, you a needle to kill me”, “you have any medicine, let me drink a sleep over”, even very cheerful patients will also Even a very cheerful patient would say this. Finally, exhausted by the physical ordeal, he calms down and inevitably goes on his way alone.
What is the psychology of dying?
According to medical psychologists, when a person is terminally ill and knows that he or she is going to die soon, the psychological development can be divided into five stages.
1. Period of doubt and denial
”I’m not going to die! ” is exactly the psychological state of the patient in this period, thus showing dissatisfaction and suspicion towards the doctor, and this negativity temporarily relieves him/her from the melancholy feeling of death.
2.Wrathful period
Once the patient learns that death is inevitable, irritability, unwarranted anger, aggression and hostility are the prominent behavioral manifestations in this period. At this time, we should help the patient patiently and channel his or her emotions.
3. Self-blame period
With the recognition of the inevitability of death, the patient’s emotions are repetitive and temperamental. The patient likes to look back on the past, blaming or regretting the mistakes of the early years, and feels that there are still many things to do, such as hoping to see the completion of the marriage of children and the birth of grandchildren.
4.Depression period
The patient’s senses and reactions are dull, depressed and speechless, with long sighs and numbness to everything. At this time, if you try to comfort the patient, often counterproductive, causing rebellion, and even lead to psychotic episodes.
5. Desperate period
Patients quietly waiting for death, fear of loneliness but do not want to make noise, emotions tend to calm and even a sense of euphoria. Most of them do not want to die in a foreign country or hospital, and hope to return home and stay with their loved ones.
4 common psychological problems of oncology patients
1. Role disorder
When a person has a disease, it forces him to convert from a normal social role to the role of a patient. In clinical practice, many patients are reluctant to accept such a role and make their roles conflicting. The sense of responsibility for the career, the attachment to the family, and the worry about the disease they are suffering from cause fear and anxiety in the patient.
2.Degeneration and dependence
Out of the fear of the disease, the patient becomes degenerate in behavior. They ask their family members to do what they can do themselves, and are overly dependent on their family members.
3.Anxiety
Anxiety is a natural response to fear and is experienced by most patients in the disease process. “Fear not relieved in a timely and effective manner will develop into uncontrollable anxiety, such as palpitations and sweating, insomnia, headache and vertigo. Patients often lose control of their behavior, become easily agitated, lack patience, lose their temper, blame themselves and condemn others.” Yu Baofa points out that the degree of anxiety is related to the individual’s psychological quality, education, life experience and ability to cope.
4, Depression
”Depression can lead to reduced appetite and sleep disturbances, and the intensity of depressive reactions is related to the individual’s psychological quality; individuals who are insensitive to external reactions are more likely to become depressed.” Yu Baofa said, “If anxiety and fear are not lifted in time and last too long, it is easy to cause depression. Heavy family burdens, long periods of time without family care, lack of good social interpersonal relationships, negative emotions are not timely catharsis can also aggravate the degree of depression.”
Based on this complex psychology, how to let the dying patient face it openly? If the doctor says before the patient’s death that there is no cure for the disease, it will cause the patient’s psychological breakdown, and in serious cases, he will commit suicide; if he coaxes him with good intentions and lies that he will get better, when he understands one day that he will face death, he will also have a psychological breakdown and death will come faster. Therefore, in the face of terminal patients, psychological care at the end of life is to provide corresponding psychological care according to different psychological stages and different individual characteristics of terminal patients.
Strengthening psychological care and accompanying the deceased on the road are the best consolation for the dying. The first thing is to listen to the patients and help them to overcome the psychological difficulties. For example, there was an old woman with extensive metastasis of intestinal cancer and incontinence. Half a month before her death, she was silent, ignored questions and refused to take medicine. The nurse chatted with her and finally found out her psychological problem, that no one had visited her for several days and she felt too lonely. The next morning, the nurse brought a large bouquet of flowers and told the granny that they were from a friend. The heart monitor immediately showed that the granny’s heartbeat suddenly increased and a smile appeared on her face. After that she no longer closed herself up and spent her last days in peace. The second thing is to terminate resuscitation at the right time, leaving time for loved ones. An elderly man with advanced lung cancer was in a terminal state, his breathing was irregular and he was only breathing a little. At that time, his oldest son came from overseas and called “Dad! Dad!” The son’s hand grabbed his father’s hand, and the old man suddenly had a full-body convulsion. It was time for the doctors to do the usual resuscitation! But the doctor said the reflex of the old man’s whole body convulsions, because the oldest son came back heart excited, if the conventional resuscitation to toss, even if the broken chest ribs, the final or not, it is better to leave time to relatives, he needs to be the last moment of communication with his son. When the son came out, he said that the old man did not bring a trace of regret, and finally calmly went away. Thirdly, he should be touched at the end of his life, so that he will not be alone and helpless. People are most sensitive to their own names before they die, so they should call him/her over and over again; massage the nerves in the eyes with their hands, if they frown, it means they are clear inside; gently pat the shoulders, put his/her hands in the heart, and keep touching; whether they can speak or not, they should ask “where are you not feeling well?” “What do you want to eat” and so on. Even if the corner of the mouth moves a little, the corner of the eye rolls a tear, it is the return of affection. When they know that their loved ones are always with them, their expressions begin to calm down, their orbital nerves no longer react, and their pupils begin to dilate and become fixed. Finally, they die peacefully, without loneliness or regret.
Psychological requirements of the dying patient before the end of life
In addition to the psychological support mentioned at the time of first hearing the death message, the terminally ill patient will have the following psychological needs in general before dying.
1. the desire to maintain the integrity of one’s image, believing that if one’s image is not as usual, it will affect the way one is treated and the patient’s affirmation of oneself; therefore, maintaining the integrity of one’s image is not only a source of one’s self-esteem, but also a basis for respect from others
2. A strong sense of loss leads to a strong sense of need. Patients may think that the wealth, career, family, and friends they had in the past will disappear due to the approach of death. family members feel excessive emotional pressure.
Although patients sometimes have the idea of being quiet, they do not want to be misunderstood as a reaction of liking solitude. This reaction of wanting and fearing is what family members should pay special attention to when providing loving support and care.
4. The patient does not want to become a burden to his family because he has his own independence and value of contribution, so he does not want to become a burden to his family because of his illness and lose his autonomy. This is the time when the family must be involved and involved in the patient’s life, from thoughts and actions to caregiving, so that the patient can regain self-assurance and practice his or her life.
Psychological reactions of the terminally ill and nursing measures
(1) Denial period Patients do not admit that they are terminally ill or that their condition has deteriorated, and they believe that the doctors may have misdiagnosed them, trying to escape from reality. Patients are anxious, restless, requesting for review, and in a few cases, suicidal behavior. Countermeasures: Do not reveal all the facts of the disease, so as to keep a little “hope” in the patient’s heart and gradually adapt to the existing facts. Seek the cooperation of family members and observe closely to prevent unfortunate events.
(2) Anger phase The patient shows that he is aware of his condition but cannot understand it, and is angry at the fate that is playing tricks on him and the health and life he will lose. The patient is bitter, resentful, and often uses abusive or destructive behaviors to vent his frustrations on family members or caregivers. Response: Provide time and space for the patient to freely express or vent his pain and dissatisfaction, apply sedatives if necessary, and stop and prevent destructive behavior.
(3) Agreement period The patient shows that he acknowledges the existence of facts and no longer complains, but keeps making demands and expecting good treatment results. He expresses remorse for past wrongdoings and asks for forgiveness. Countermeasures: To the patient’s various “agreements” or “begging”, we can adopt a moderate “deception” method, make positive treatment and care of the willful attitude, and give more care and consideration in life.
(4) Depression stage Patients show that they remember that their disease is hopeless, their body is getting weaker and weaker, their pain is growing, and they are depressed, low and desperate, and they are eager to give an account to their families and wish their relatives to keep watch. Response: Encourage and care for patients, solve practical problems, try to bring happiness and increase their sense of hope.
(5) Acceptance period The patient shows that he feels that everything in his life has been completed and important things have been arranged. He is no longer afraid and sad about death, and his emotions become calm and peaceful. Countermeasures: Provide a quiet, clean and comfortable environment and atmosphere, help the patient to fulfill his unfinished wishes and things, and let family members accompany the patient more and participate in the care, so that the patient’s soul can be comforted.
The above 5 stages do not necessarily develop in sequence, sometimes interlaced, sometimes missing. The length of time of each stage also varies. Our scholars found that due to the influence of Chinese traditional documents, there is an avoidance period before the denial period of terminal patients, i.e., both patients and family members know the truth, but they conceal it from each other and deliberately avoid it. Countermeasures: Adopt a corresponding avoidance attitude, do not rush to tell the patient the true condition, and can look for opportunities to slowly penetrate with hinting methods, and even some patients need to keep avoiding until the end.