A healthy person seldom thinks about when and where death will come, because that moment is still far away. For dying patients, death is almost within reach. When the body is getting out of control, drugs and instruments are powerless, and the end of life is inevitable. This is a difficult road, everyone has only one time, accompanied by physical pain and psychological suffering: anger, fear, despair, frustration, helplessness ... How to make terminally ill patients face death? This has always been a big problem in the psychological nursing of dying.
It is usually difficult to calm down when approaching the dead. Dying people need special psychological care. The common psychology of dying people: First, they are angry and refuse to admit that their illness is incurable, and feel unfair. Why do they die of themselves and not others? Always say, "I've always been fine. How did this happen?" I can't help venting my inner anger, losing my temper with my family, driving away doctors and nurses, and wondering if the doctor is wrong. The anger period will last about a week. During this period, the patient was very narrow-minded and grumpy, and everything was not pleasing to the eye, like people all over the world had a hard time with him. Second, struggle. When the anger gradually subsided, the desire to survive kept his heart struggling. He looked at the doctor, prayed for his relatives, said, "You must find a way to save me" and asked for the best treatment plan and the best medicine. Anyway, as long as he is alive, he will lose a lot. This stage is as long as a few months and as short as a few days. The third is despair, ignoring everyone when you see it. Relatives came to see him, and he turned his back. The doctor and nurse asked him, but he didn't speak. He asked him again, and he said, anyway, I am like this. With despair in his eyes, his head has been buried low, as if he had resigned himself to fate, but he didn't want to feel it. The fourth is to admit death. After complete despair, you will generally have a high fever, general pain and difficulty swallowing. At this time, I want to end my life quickly. "Doctor, you can kill me with a needle." "What medicine can you give me to sleep?" Even a very cheerful patient would say that. Finally, exhausted by physical hardships, he became calm and set off alone inevitably.
What is deathbed psychology?
Medical psychologists believe that psychological development can be divided into five stages when people are terminally ill and know that they are about to die.
Doubt and denial period
"I won't die!" It is the patient's psychological state during this period that shows his dissatisfaction and doubt about the doctor, and this negative emotion can temporarily relieve him of his melancholy feeling about death.
Resentment period
Once the patient knows that death is inevitable, irritability, unprovoked anger, aggression and hostility are the outstanding behavioral manifestations in this period. At this point, we should patiently help patients and ease their emotions.
Self-blame period
With the awareness of the inevitability of death, patients are emotional and moody. I like to look back, blame or regret my early mistakes, and feel that there are still many things to do, such as hoping to see my children get married and grandchildren born.
Depressive period
The patient's feelings and reactions are slow, depressed, silent and sighing, and they are not sensitive to anything. At this time, if you try your best to comfort patients, it will often backfire, cause rebellious psychology and even lead to mental illness.
Desperate period
Patients quietly wait for the arrival of death, fear loneliness but don't want to make noise, and their emotions tend to be calm and even happy. Most people don't want to die in a foreign land or hospital, but want to go home and be with their relatives.
Four common psychological problems of tumor patients.
Role obstacle
When a person is ill, he is forced to change from a normal social role to a patient role. In clinical practice, many patients are unwilling to accept such a role, which conflicts with their roles. The sense of responsibility for the cause, attachment to the family and worry about the disease make patients feel fear and anxiety.
Degeneration and dependence
The patient's behavior degenerated because of fear of disease. Let your family do what they can and rely too much on your family.
Anxious
Anxiety is a natural reaction of fear, and it is also the experience of most patients in the process of illness. "If fear is not relieved in time and effectively, it will develop into uncontrollable anxiety, such as palpitation, sweating, insomnia, headache and dizziness. Patients often lose control of their behavior, get excited easily, lack patience, lose their temper, blame themselves and condemn others. " Yu Baofa pointed out that the degree of anxiety is related to personal psychological quality, education level, life experience and coping ability.
depressed
"Depression can lead to loss of appetite and sleep disorders, and the intensity of depression reaction is related to the individual's psychological quality. Individuals who are insensitive to external reactions are more likely to be depressed. " Yu Baofa said, "If anxiety and fear are not relieved in time and last too long, it will easily lead to depression. Heavy family burden, long-term lack of family care, lack of good social interpersonal relationship, failure to vent negative emotions in time, will also aggravate the degree of depression. "
Based on this complex psychology, how to make terminally ill patients face it calmly? Before the patient dies, if the doctor says that the disease can't be cured, it will cause the patient's psychological collapse and serious suicide; If you coax him kindly, he will get better. When he realizes it one day, he will face death, his spirit will collapse and death will come faster. Therefore, in the face of dying patients, the psychological care of dying patients is to carry out corresponding psychological care according to their different psychological stages and individual characteristics.
Strengthening psychological care and accompanying the deceased on the road is the best comfort for the dying. The first is to listen to patients' voices and help them through psychological difficulties. If there is an old lady with extensive metastasis of bowel cancer and incontinence, she will be silent half a month before her death and ask her to ignore it and refuse to take medicine. The nurse has been chatting with her and finally knows her psychological crux. It turned out that no one came to see her for several days and thought she was too lonely. The next morning, the nurse sent a big bouquet of flowers and told grandma that it was from a friend. The ECG monitor showed that the grandmother's heart rate suddenly increased and a smile appeared on her face. After that, she no longer closed herself up and spent her last days peacefully. Secondly, it is necessary to terminate the assistance in a timely manner and leave the time to relatives. An elderly man with terminal lung cancer was dying, breathing irregularly and had to vent his anger. At this time, his eldest son came from other places and called out, "Dad! Dad! " The son grabbed his father's hand and the old man suddenly twitched all over. It is customary for doctors to do rescue! But the doctor said that the old man was convulsing all over because his eldest son was emotional when he came back. If you toss it according to the routine rescue, even if you break your chest rib, it won't work in the end. It's best to leave time to his relatives. What he needs is the last communication with his son. The son came out and said that the old man left peacefully without a trace of regret. The third is to touch him at the end of his life and not let him be lonely and helpless. People are most sensitive to their own names before they die, so they should call him (her) again and again; Massage the supraorbital nerve with your hand. If you frown, it means that he or she knows clearly. Pat your shoulder gently, put his (her) hand in your palm and keep touching it; Whether you can speak or not, you should ask "What's the matter?" what would you like to eat? Even if the corners of the mouth move and a tear rolls out of the corner of the eye, it is also a reward for the family. When you know that the person you love has been with you, your expression tends to be calm, your orbital nerves no longer respond, and your pupils begin to enlarge and fix. Finally, I left safely, without loneliness and regret.
Psychological needs of dying patients before they die.
In addition to the psychological support mentioned in the first news of dying, dying patients generally have the following psychological needs before dying:
First, I hope to maintain the integrity of the image. I feel that if my image is not as usual, it will affect the way I am treated and the patients' affirmation of myself. Therefore, maintaining the integrity of my image is not only the source of my self-esteem, but also the basis of others' respect;
Second, a strong sense of loss leads to a strong sense of demand. Patients will think that their past wealth, career, family and friends will disappear with the arrival of death. This kind of intense deprivation experience makes patients feel that they will get nothing in the end and have a strong sense of loss. At the same time, patients will have a kind of obsession and love for everything in the world, so sometimes they will have excessive emotional pressure on their families.
Third, the nursing needs caused by loneliness, although patients sometimes have quiet thoughts, basically, patients do not want this quiet reaction to be misunderstood as loneliness. In fact, patients are very worried about being abandoned by their families because they are afraid of loneliness, but they don't want to cause emotional burden and disappointment to their families because they are afraid of loneliness. This kind of thinking and fear reaction is the place that family members should pay special attention to when providing love support and care;
Fourthly, I don't want to be a burden to my family, because the patient has his own independence and his own contribution value. Of course, I don't want to be a burden to my family, because I am sick and completely lose my autonomy. At this time, my family must find ways to make patients have a sense of participation from the concept, method and action of nursing, so that patients can reaffirm themselves and actively practice their lives.
Psychological reaction of dying patients and nursing countermeasures
(1) Denial period: The patient refuses to admit that he is terminally ill or his condition is getting worse, thinking that the doctor may make a wrong diagnosis and try to escape from reality. Patients were anxious and asked for reexamination, and a few committed suicide. Countermeasures: Don't expose all the symptoms, so as to keep a little "hope" in the patient's mind and gradually adapt to the existing facts. Strive for the cooperation of family members and pay close attention to prevent unfortunate incidents.
(2) Anger period: Patients show known diseases, but they can't understand them. Angry fate plays tricks on yourself and will lose health and life. He is resentful and often vents his inner dissatisfaction to his family or caregivers with reckless or destructive behavior. Countermeasures: Provide time and space for patients to freely express or vent their inner pain and dissatisfaction, and use sedatives appropriately when necessary to stop and defend the destructive behavior of patients.
(3) Agreement period: The patient's performance is: admit the existing facts, stop complaining about others, but constantly make demands and expect good treatment results. He regretted his past wrong behavior and asked for forgiveness. Countermeasures: For all kinds of "agreed" or "begging" patients, we can adopt a moderate "cheating" way, carry out active treatment and nursing, and give more care and consideration in life.
(4) Depression: The patient's performance is that he thinks that his illness is hopeless, his body is getting weaker and weaker, his pain is getting bigger and bigger, and he is depressed, depressed and desperate. He is eager to explain his affairs to his family and is willing to wait for his relatives. Countermeasures: Encourage and care for patients, solve practical problems, try to bring happiness and increase their sense of hope.
(5) Acceptance period: Patients feel that they have completed everything in their lives and arranged the important things properly. He no longer felt fear and sadness about death, and his mood became calm and serene. Countermeasures: provide a quiet, clean and comfortable environment and atmosphere, help patients complete unfinished wishes and things, let family members accompany patients, participate in nursing, and comfort patients.
The above five stages do not necessarily develop in sequence, sometimes staggered and sometimes missing. The duration of each stage is also different. Chinese scholars' clinical observation found that due to the influence of Chinese traditional literature, there was an avoidance period before the denial period of dying patients, that is, both patients and their families knew the truth, but concealed it from each other and deliberately avoided it. Countermeasures: Take the corresponding avoidance attitude, don't rush to tell patients the real condition, and slowly infiltrate through hints to find opportunities, and even some patients need to avoid it until the end.
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