Leticia Bustamante

Concept Analysis Paper

NUR 501
Bradley University
 Resignation can also be defined as the act of giving up a position. In the health care

setting this is one of the most commonly found psychological states in which a patient who has

been diagnosed with a chronic or life ending disease has no other decision to make but giving up

the position of having a healthy life style. Elizabeth Kubler-Ross described in her book "On

Death and Dying the different stages of grief (Stage of grief model, 2017). The concepts

described in her book not only apply to those that have lost a love one, but also to those that have

lost something they love as “health” can be. For instance, patients who have been diagnosed

with heart failure, diabetes, cancer, HIV among other diseases usually face all the stages of grief.

As part of the stages of grief the last stage is named acceptance (in other words “resignation”).

The main purpose of choosing this concept is to analyze it based on the circumstances that many

of the heart failure patients face, not only the heart failure patients but also anyone who has been

diagnosed with a chronic disease.

The analysis of the concept of resignation, can help me to better understand the different

phases that this population of patients face when having to learn how to cope with this illness

and at the same time having to move forward in life. These patients must learn how to cope

with an illness that little by little takes away from their strength, a disease that cause them to be

considered constant incoming “patients” in the hospitals, a disease that cause them to end up

developing other health issues due to treatment options. This is a concept that no only applies to

heart failure patients but also to other populations of patients that in a daily basis must learn how

to cope and resign to the idea of adopting a new living style after being diagnosed with a chronic

disease.
 It is important to describe that despite advances in cardiac therapy, heart failure is still a

progressive, highly symptomatic, and deadly disease that places great demands on patients

(Allen, 2017). Patients that have been diagnosed with heart failure often experience severe

symptoms that cause them to become disabled due to the severity of the symptoms (Dulay,

2017). The process of resignation in heart failure patients starts when they start experiencing new

symptoms such as shortness of breath and fluid accumulation. They start becoming constant

patients in different hospitals to receive treatment. They accept the position of needing to be in

the hospital in a very constant manner. Which takes away from them the ability to work as a

normal and healthy person would. It takes from them the ability to take vacation outside of their

comfort area because they fear that they might experience an exacerbation when they are out.

Also, patients that have planned vacations but their vacations are postponed because they must

be hospitalized due to a sudden unexpected exacerbation, these are many of the positions that

patients must give up due to heart failure.

As heart failure advances thru the different stages, patient’s health status worsens, heart

ejection fraction decreases, symptoms are worse every time, number of times in the hospital

increases, patient then end up experiencing resignation. As this disease moves into advance heart

failure, patients must be placed on inotropes such as milrinone and dobutamine, these patients

must resign to the live with the status of being a constant incoming patient, due to CHF

exacerbations, in which they experience severe shortness of breath or fluid accumulation in the

extremities, causing them to be in disabled position (Allen, 2017). These patients leave the

hospital having to learn a new living style, they are taught how to program a “carry everywhere

pump for the medication.” Probably when going out to the shopping centers (if they have the

strength), they might experience having to be observed by others as a “sick person.” Also, they
might start experiencing depression due to not being able to go out as they used to, or having to

perform the different tasks that they used to, or even to just see all the adjustments in their

lifestyle (Allen, 2017). Then, throughout all the process of experiencing these symptoms they

start accepting that this is a new form of living that they would have to cope with.

Due to the decreased ejection fraction of the heart, they experience more fatigue than

they used to, the heart is more weak and prone to go into a cardiac arrhythmia therefore, part of

the treatment for the cardiac arrhythmias is having an implantable cardioverter defibrillator. At

this point patient have gone thru several procedures, exams, treatments and probably they expect

to get better but at this point they are moving towards the end stages of this disease. Moreover,

once the inotropes stop working, they start experiencing worsening of the symptoms, and they

are placed in a list to evaluate if they are candidates for a left ventricular assistive device

(Chatterjee, 2014). Once inotropes are increased to the highest levels and they stop working,

patients might experience going into cardiogenic shock, probably one of the worse experiences

for a patient. Once patients have been considered candidates to receive a LVAD, at that point of

weakness, illness, they experience resignation as they know that their life can only be prolonged

with a very delicate surgery but while they understand that will need to overcome the healing

process (Chatterjee, 2014). Heart failure patients experience acceptance throughout the years that

this disease develops in their life, as every step of the disease worsen they move into a new level

of acceptance that symptoms can be treated however the disease cannot be cured.

Once heart failure patients complete their LVAD surgery and overcome the rehabilitation

process, then they start experience a total new living style, they start coping with a new device

that is implanted in their system which does part and most of the work the heart is supposed to

do, but with the short relief that this device can prolong their life for more years. On the other
hand, we have the patients that are not candidates for surgery, at this point patients with advance

heart failure with no other treatment option, might end up going into hospice or palliative care,

their code status is changed from Full code to DNR/DNI, family members if not the patient make

the decision to turn off the ICD that was once placed (Allen,2017). At this point patients and

family start experiencing resignation again accepting that they have received all treatment

options but realize that life cannot be prolonged for longer (Dulay,2017).

Heart failure patients experience the burden of having a decreased living expectancy, hey

experience a higher rate of developing other diseases, they become patients that are hospitalized

very often, they received several treatments options, including surgical procedures, inotropes,

diuretics and other cardiac medications. Throughout the whole process, they experience

resignation as they observe their life style disappear in front of their eyes, entire families being

affected once a patient is diagnosed with heart failure. And throughout the entire process even

though they might experience the stages of grief, they also experience acceptance (or

resignation) to learn how to cope with such a highly destroying disease (Stage of grief model,

2017).
 References

Allen, L. (2017). Experts focus on prognosis, symptom management, and supportive care

for patients with advanced heart failure. PsycEXTRA Dataset. doi:10.1037/e556302006-018

Chatterjee, K. (2014). Chapter-03 Systolic Heart Failure (Heart Failure with Reduced

Ejection Fraction). Manual of Heart Failure, 45-95. doi:10.5005/jp/books/12199_3

Dulay, S. (2017). Management of refractory heart failure with reduced ejection fraction.

45-95. doi:10.5005/jp/books/12199_3

Narayan, S. M. (2010). Cardiac Resynchronization Therapy: Indications for Treatment

and Strategies for Optimizing Results. Management of Heart Failure, 197-215.

doi:10.1002/9780470669402.ch9

Stage of Grief Models: Kubler-Ross. (n.d.). Retrieved October 01, 2017, from

http://www.amhc.org/58-grief-bereavement-issues/article/8444-stage-of-grief-models-kubler-

ross