Tuesday, March 1st, 2022

Fatigue, Pain and Suffering

● Comfort is a response to human needs

● Comfort is a fundamental human need associated with food, rest, sleep and
communication
● Comfort is essential to the care process
● Importance of psychological comfort

Comfort is….

● Synonymous with “well-being” and quality of life

● Aid and solace in moments of affliction
● Feeling strong, safe, supported and cared for

NANDA

● Readiness for enhanced comfort (00183)

● Impaired comfort (00214)
● Pain
● Chronic pain (00133)

Comfort Theory

“The immediate state of being strengthened by having the needs for relief, ease, and
transcendence addressed in the four contexts of holistic human experience: physical,
psycho-spiritual, sociocultural, & environmental.” (Kolcaba, 1991).

Comfort Strategies

● Therapeutic nursing interventions bring comfort

● Strategies for comfort may create discomfort

Fatigue

● Cardinal symptoms experienced by 40-74% of older adults living with a chronic

health challenge
● An overwhelming sense of decreased capacity for activity, physical or mental,
due to an imbalance in the availability, utilization, or restoration of resources
Risk Factors of Fatigue

● Disease-specific: COPD, Cancer, CHF

● Biophysical: age, BMI, comorbidities, gender, sleep
● Sociodemographic: social support, education, economic status, marital status
● Psychological: depression, anxiety
● Lifestyle: physical activity, medication use

Consequences of Fatigue

● Mental: emotional and cognitive domains

● Physical: weakness, loss of energy, sleepiness, tiredness
● Depression, anxiety, symptom burden of health problems, number of physician
visits in part-year correlation with fatigue consequences
● Fatigue is a predictor of poor self-care and not consulting with an HCP as
needed

Lived Experience…

● In a state of loss of energy, optimal rest could not be achieved, regardless of

hours of sleep
● Unfamiliar body sensations: numbness, breathlessness
● Unpredictable; physical ability varied - impact on planning, activities; the need for
help; feeling of loneliness
● “Feebleness” and “listlessness”
-Perceived as severe (women); mild (men)
● Appreciate what still able to do; adjust the frequency and timing of activities;
accept help; use assistive devices; be as active as possible

Management of Fatigue

● Engage in physical activity - exercise and diet

● Maintain normal hemoglobin level if anemic
● Acetyl-L-carnitine (ALC) supplementation

Fact or Fiction?

1. Pain is expected with aging

2. Pain sensitivity and perception decrease with aging
3. If an elderly person does not complain of much pain, they must not be in pain
 4. A person who appears to have no functional impairment and is occupied in daily
living must not have significant pain
5. Narcotic medications are inappropriate for the elderly with non-malignant pain
6. Potential side effects of narcotic medication make them too dangerous to use in
the elderly

Pain Assessment

Place (location)
Amount (pain intensity)
Intensifies (what makes it worse)
Nullifiers (what makes it better)
Effects (quality of life)
Descriptors (quality e.g throbbing)

Consequences of Pain

● Isolation
● Depression
● Sleep and overall function disturbances
● Untreated pain; cognitive impairment; functional loss
● Reduce dignity

Beyond INtensity, Location, Duration…

● Age bounded: common physical nature of pain in chronic problems - more or less
disturbing - always present
● Life bounded: non-physical nature - one’s emotions and mood can cause or
worsen physical pain

Suffering is…

● “The unspeakable”
● “Loss, present or anticipated”
● “Another instance of nothing, an absence”
● “The reality of what is not”
● “To lose grip”
● “The wound that does not kill but cannot be healed”
● Universal - used in all disciplines and contexts
 ● Unique to each individual - only the individual can put into context his/her
suffering
● A deeply personal state
● Associated with loss of control and deep emotional distress
● An emotion which can include physical symptoms such as pain
● A subjective emotion that is only lived by the person who is suffering

Nursing Response

● Compassionate presence: being fully present, attentive and supportive

● Providing communication that enables patient expression
● Deep listening: understand the emotions and feeling behind the words
● Eliminating physical pain

Tuesday, March 8th, 2022

Loss and Grief

Trajectory of Life

“The dying process has been compared to the birthing process and the analogy is
useful. Both birthing and dying are natural parts of life that involve physical,
psychological and spiritual dimensions. There’s nothing clean or easy about either one.
And these natural processes have been going on as long as life has existed;
medicalization is but a recent trend.”

Loss: Critical Attributes

● Signifies that someone or something one has had or ought to have in the future
has been taken away
● What is taken away must have been valued by the person experiencing the loss
● The meaning of loss is determined individually, subjectively and contextually by
the person experiencing it

Key Terms

● Bereavement
○ The period after loss - a sense of deprivation generated by the death of a
valued other
● Mourning
 ○ Process of adapting to loss - social customs & cultural practices carried
out following the death
○ Incorporating the experience of loss into the lives of the bereaved
● Grief
○ Reacting to the loss - normal, dynamic, multifaceted response to loss
(physical, symbolic or social) - a mental, physical, social or emotional
reaction
○ Influenced by cultural beliefs, religious influences or spiritual beliefs,
individual value system
○ The intensity of grief is driven by the strength of the relationship with the
dying person, concurrent life crises, coping resources, support systems
○ Can be adaptive, uncomplicated, anticipatory, complicated, unresolved,
disenfranchised

Caregiver Anticipatory Grief

● Stems from the expectations surrounding the relative's death, giving rise to a
wide range of manifestations that are socially and culturally associated with grief
in response to the loss of a significant other
● Complex risk factors for prolonged grief disorder in combination with the
caregiver's perceived loss during caregiving, their reaction to the patient, and the
caregiver's attachment style, coping mechanisms, and emotional regulations

Historical Perspective on Grief

Emerging Conceptualization of Grief

● Grief is a lifelong experience that changes over time

● Rather than letting go, the meaning of loss is negotiated and negotiated over
time

Caregiving Through Illness into Bereavement

● Grief is a reaction
● Anticipatory mourning reveals the complexities of intra/interpersonal struggles
through loss
● Intense periods when holding in and letting go are most intense:
○ Time of diagnosis
○ Transition to hospice palliative care, as death nears
○ Immediately post-death
○ First few weeks of bereavement

Anticipatory Grief

● Complex transition in midst of illness with the tension between holding on and
letting go
● Multidimensional; reaction
● The complexity of this experience of grieving within the illness was much more
than simply anticipation

“What are the nuclear characteristics of family AG at the end of life and palliative
care setting?

● Anticipation of death
● Emotional distress
● Intrapsychic and interpersonal protection
● Exclusive focus on the patient
● Hope
● Ambivalence
● Personal losses
● Relational losses
● End-of-life relational tasks
● Transition
AG in the Context of EOL Caregiving

End-of-Life Canadian Experience

● Most people indicate a preference to die at home in the presence of loved ones
(CIHI, 2007)
● About 61% of Canadian deaths occur in hospitals (Statistics Canada, 2015.)
● 16-30% of Canadians who die have access to/received hospice palliative and
EOLC services; even fewer received grief and bereavement services (CIHI,
2007)
● For children, only 5%-10% access palliative care services; 86% of Canadians
have not heard of advance care planning (Ipsos Reid, 2012)

Tuesday, March 15, 2022

Stigma

“The phenomenon whereby an individual with an attribute which is deeply discredited by

society is rejected as a result of the attribute.”

● Disqualifies person from full social acceptance

Stigma in Families

● A degree of unusualness in the family unit becomes public information

○ Perceptions and beliefs of others - family stigma
○ Blame, harmful, dangerous, contaminated
● Emotional, social and interpersonal consequences for the family

Kinship Stigma

● Experienced as a lack of acknowledgement from family members

○ feel/are invisible
○ Seen as being or becoming their illness
○ Amplification of suffering and loss
● Stigma from intimate/close family may cause more profound distress than from
other sources
○ Feelings may be rarely disclosed
○ May negatively affect self-acceptance and adjustment

Tuesday, March 29th, 2022

Resilience

What is Resilience?
 ● Withstanding adversity & bouncing back from difficult circumstances
● Finding hope & meaning even while confronting obstacles
● Thriving no matter what life throws at you
● Maintaining/regaining well-being & progress toward goals

Positive adaptation/realistic optimism

What Contributes to One’s Resilience?

● Adaptability
● mental/emotional flexibility to adjust
● God interpersonal communication
● Good problem-solving abilities
● Ability to tolerate strong negative emotions
● Good impulse control
● Self-efficacy
● Curiosity - attempt to understand things
● Humour
● Creativity
● Realistic optimism
● Initiative - tendency to seek challenges

Definitions of Resilience: key-themes

● Rising above to overcome adversity

● Adaptation & adjustment
● Ordinary magic
● Good mental health - a proxy for resilience
● Ability to bounce back

Ability to recover and return from unfavourable changes or adversities