Social Support, Du Pre’ and others

 A lot of health communication occurs informally—with family, friends, etc.  Spouses, friends, children, co-workers, etc. often have as much influence as our health care professionals.

Social support is defined as “behaviors that, whether directly or indirectly, communicate to an individual that she or he is valued and cared for by others. “

Examples of social support may include comforting someone in pain or experiencing grief, listening to someone as they discuss his/her health, doing health related research on the internet, participating in support groups, discussing ailments, illnesses, treatments, etc. with others. Social support can aid in healing, lessen pain, reduce stress, and build self-esteem and benefit the person offering support as well.

Coping:  “Process of managing stressful situations.” Involves (1) changing what can be changed and (2), adapting to what can not be changed.

Use of coping strategies often depends on how much control people believe they have over their situation.

Health self-efficacy occurs when people believe they can manage their health successfully, which enhances the likelihood of maintaining a healthy lifestyle. A related concept is ‘locus of control.’ An ‘internal locus of control’ is when we believe we can control our own fate.  An ‘external locus of control’ occurs when we believe our lives are controlled by outside forces, which may lead to ‘fatalism.’ A fatalistic person may take no steps to improve their lifestyle or well being believing things like, “When it is my time to die, I’ll die and there is nothing I can do about it,’ or “It is God’s will that I am ill and I should accept it.” An internal locus of control may help us be proactive and motivate us to take care of our health. However, an external locus of control may help us accept fate. Thus, some combination of both may be necessary to cope.

Crisis: “Crisis is an occurrence that that exceeds a person’s normal coping ability.” The first sign of crisis may occur when a person feels that things are out of control. A common first response to crisis may be panic and denial. People may also feel that things have changed and will never be the same again. Often during difficult times, people may take comfort in the simple routines of everyday life. Oftentimes, crisis may serve as a turning point in our lives. Out of the difficult experience, strength, courage, and even happiness may arise as people are able to appreciate life in a way they could not before.

Normalcy: A sense of crisis dissipates as people feel that things are getting normal again.  Being normal requires the cooperation of others. For example, people with disabilities may find that others are willing to help them but often feel excluded from everyday conversation about politics, sports, etc.

Types of Social Support:

‘Action-facilitating social support’ refers to instrumental and informational support—performing tasks and collecting and sharing information.  Performing tasks and favors are called ‘instrumental support.’ Examples are doing shopping for someone who is home-bound, serving as exercise companions, doing chores for someone who is unable to, providing respite care for a family member who cares for someone ill, etc.  People receiving instrumental support appreciate it when they have a chance to participate in the decision making.

Sharing and providing is called ‘informational support.’  Examples include sharing personal experiences, doing internet research for someone or passing along news, etc.  People receiving informational support may feel a sense of control over what is happening to them.

Nurturing social support refers to ‘emotional support’—building self-esteem, acknowledging and expressing emotions, and providing companionship. Esteem support involves efforts to make a distressed person feel valued, appreciated, and competent. Examples are statements of unconditional positive regard such as, “We are with you through this and will support you all the way whatever you decide” and simply listening. Often people are not looking for advice but want an active listener.

Tips for listeners:

·         Focus on the other person. Give them a chance to talk freely.

·         Remain neutral. Let person describe experiences and feelings and resist the urge to label them as good or bad.

·         Concentrate on feelings. Sometimes it is best to focus on someone’s feelings about an event, rather than the event itself.

·         Legitimize the other person’s emotions. Avoid telling someone how to feel but instead say “I understand how you might feel that way.”

·         Summarize what you hear. Summarize what the speaker is saying will let them know you have been listening and may give them a chance to clarify meaning. 

Emotional support refers to attempts to acknowledge and understand what the other feelings from his/her point-of-view. In a health crisis people may feel a range of emotions from bafflement to anger to sadness, to relief, etc. People may suppress emotions which may lead to depressing. People may also avoid topics that are difficult to discuss with others but may wish others would give them an opportunity to talk.

Tips for allowing emotions:

·         Don’t assume people are OK because they do not seem emotional. This applies to “quiet” people especially.  Also, males may have difficulty discussing emotions for fear they will be overcome with emotion.

·         Keep in mind that people usually benefit from opportunities to take openly and honestly.

·         People in grief often find it insensitive and unhelpful when others try to minimize their losses or to cheer them up.  People often need to accept pain, strong and conflicting emotions as part of healing.

·         In Western cultures, seriously ill patients typically appreciate honesty.  For example, people usually want to know if they have an incurable condition so they may put their affairs in order.

Social network support is another type of support and refers to ongoing support when no crisis exists. People benefit from having a network of people with whom they can stay in close contact, display liking and respect, and handle conflict effectively. Positive social support offers a buffer against grief, encourages us to engage in healthy behaviors and manage stress better.

Tips for keeping social networks alive:

• People need social support even when they seem OK. Women receive more social support than men. People with limited education receive more than people with higher education because people may believe those with greater education know how to handle things efficiently.
• Friends are important. People need a sense of fun, entertainment, and a sense that others have the same joys and concerns too. Friends may be more helpful than family members because family members may be overwhelmed by emotion.
• Emotional support can be just as important as doing favors or running errands (instrumental support).
• Even simple gestures mean a lot. Brief visits and favors can help a lot like dropping off food or mowing someone’s lawn.
• Keep family members well informed. People are able to help more easily if they are informed as to what is going on.
• Make family members and loved ones feel welcome. Presbyterian Hospital in North Carolina has expanded its critical care unit so that a family room adjoins the patient room and comes equipped with a sofa bed, recliner, phone, a view of nature, etc. Kitchen and shower are also available. Patients feel comfort and are less anxious when family is near and it is easier for nurses to keep families informed and answer questions.
• Health professionals can assist with communication strategies as well as treatment regimens. Health professionals may offer strategies that people would not think of on their own.

Death and Dying

From: Potter, P.A., & Perry, A. G., (2001). Fundamentals of Nursing, (5^th edition). St. Louis, MO: Mosby.

Phases of Grief and Dying, Kubler-Ross and Rando

Signs of Dysfunctional Grief:

·         Overactivity without a sense of loss.

·         Alteration in relationships with family and friends.

·         Hostilities against specific persons.

·         Agitated depression with tension, insomnia, feelings of worthlessness, extreme guilt, and even suicidal tendencies.

·         Diminished participation in religious and ritual activities related to the client’s culture.

·         Inability to discuss the loss without crying (particularly more than a year after the loss).
False sense of well-being.

Suggestions for Involving the Family in the Care of a Dying Client:

·         Assist planning a visitation schedule for family members to prevent the client and family from becoming fatigued.

·         Allow young children to visit a dying parent when the client is able to communicate.

·         Be willing to listen to family complaints about the clients care and feelings about the client.

·         Help family members learn to interact with the dying person (e.g., using attentive, avoiding false assurances, conducting conversations about normal family activities or problems).

·         Allow family members to help with simple care procedures such as feeding, bathing, and straightening bed linen. Recognize that family members are often more successful than nursing staff in persuading the client to eat.

·         When the family becomes with care activities, relieve them from their duties so that they can acquire needed rest and support. Refer them to resources for meals and lodgings.

·         Support the mutual act of grieving by the client and family. Provide privacy when preferred. Do not discourage open expression of grief by the family and client.

·         Provide information daily with regard to the client’s condition. Prepare the family for sudden changes in the client’s appearance and behavior.

·         Communicate news of impending death when the family is together, if possible. Remember that members can provide support from one another. Convey the news in private areas and be willing to stay with the family.

·         As death nears, help the family stay in communication with the dying person through short visits, caring silence, touch, and telling the client of their love.

·         After death, assist the family with decision making, such as selection of a mortician, transportation of family members, and collection of clients belongings.

Care after Death: (For nurses)

1.       Physicians must certify death—time pronounced, therapy used, actions taken.

2.       Physicians may request an autopsy, especially for unusual circumstances.

3.       Trained staff members provide an option for donation of organs or tissue—personal, religious, and cultural needs should be included in the process. Tissues and organs used for transplantation:

a.       Nonvital tissues: Corneas, skin, long bones, middle ear bones.

b.      Vital organs: Heart, liver, lungs, kidneys, pancreas.

4.       Nurses provide dignity and sensitivity to the client and the family

a.       Check orders for any specimens or special orders needed by the physician.

b.      Make arrangements for staff, minister, or others to stay with the family while preparing the body for viewing; ask for special requests for viewing (e.g., shaving, a special gown, Bible in hand, rosary at bedside).

c.       Shaving of male clients must be done before removal of beard. The family may want the client left in the current unshaven state if it was his custom to wear a beard.

d.      Remove all equipment, tubes, supplies, and dirty linens according to protocol (unless organ donation is to take place; in that case, leave support systems in place.

e.      Cleanse the body thoroughly, apply clean sheets, and remove all trash from the room.

f.        Position according to protocol—the eyes should be closed by gently holding them down for a few minutes; dentures should be in the mouth to maintain facial alignments; packing should not be visible during viewing. Hairpieces may be in place, but no make up is required.

g.       Cover with a clean sheet up to the chin with arms outside covers if possible.

h.      Lower the lighting and spray a deodorizer if possible to remove unpleasant orders.

i.         Give the family the option to view or not view and go with them.

j.        Clarify that either option is acceptable.

k.       Encourage the family to say goodbye through both touch and talk.

l.         Do not rush this process. Once the family is more comfortable, ask if they would like to be left alone. Remind them they can call you if needed.

m.    Clarify personal belongings that are to stay with the body or who has taken personal items; documentation will require both a descriptor of he objects and the name of who received it, with the time and date.

n.      Discard nothing is items are found after the family is gone—call the family and tell them what was found and ask who might pick it up—describing the articles will be helpful in the decision-making process for the clients family.

o.      Apply name tags according to protocol—such as the wrist, right big toe, or outside the shroud.

p.      Complete documentation in the nursing notes.

q.      Remain sensitive to other hospitalized clients or visitors when transporting the body, such as covering the body with a clean sheet and watching to avoid visitors when moving the body to another part of the hospital or to exit for the funeral home.

r.        Follow all protocol and policies to meet all legal requirements in caring for the body.

 

This website is maintained by Marceline Thompson Hayes, mhayes@astate.edu

This page last updated August 21, 2007

Arkansas State University