copyright © 2008 delmar learning. all rights reserved. unit 32 death and dying

Copyright © 2008 Delmar Learning. All rights reserved.

Unit 32

Death and Dying


Objectives

• Spell and define terms.• Describe how different people handle

the process of death and dying.• Describe the nursing assistant’s

responsibilities for providing supportive care.


Objectives

• Describe the spiritual preparations for death practiced by various religious denominations.

• Describe the hospice philosophy and method of care.

• List the signs of approaching death.


Introduction

• Death is the final stage of life• It may come suddenly, without warning• Or it may follow a long period of illness• Death sometimes strikes the young, but

it always awaits the old


Introduction

• As a nursing assistant– You will be providing care throughout the

period of dying and into the after-death, or postmortem, period.


Fives Stages of Grief

• Dr. Elisabeth Kübler-Ross• Five stages of grief:

– Denial– Anger– Bargaining– Depression– Acceptance


The Grieving Process

• Begins when someone receives a terminal diagnosis

• Anticipatory grief: – Mourning before someone dies



• Patients and families grieve for the past, present and future losses, as well as their former way of life.– Life will never be the same– Returning to a former way of life will be

impossible



• Each loss triggers the grieving process– Causes feelings of isolation, abandonment,

anger, and depression– Roles and responsibilities within family

change– Illness may change body image



• Each loss triggers the grieving process– Friends and family may separate

themselves from the dying person• Making the patient feel very sad and lonely


Preparation for Death

• Knowledge of impeding death comes to a patient directly from the physician or indirectly from the staff

• A diagnosis of terminal illness is very difficult to conceal from the patient


Preparation for Death

• You must realize that most terminally ill patients do eventually accept that death is part of their near future.

• Upon being told of the terminal diagnosis:– Patient may proceed through several

stages of emotional adjustment


The Patient Self-Determination Act

• Patient Self-Determination Act of 1990 – Requires health care providers to supply

written information about state laws regarding advance directives.

– An advance directive is a document that is put into effect if the patient later becomes unable to make decisions for himself or herself.



• Person designated as the agent may also be called the proxy, or health care proxy

• Health care proxy must make decisions in keeping with the patient’s wishes

• Health care proxy makes decisions on medical care only– Not financial matters



• Proxy can make decisions if the patient cannot make them

• If his or her decision-making ability returns– Patient will again make the decisions


Common Fears

• The dying person is losing everything– Family, friends, pets, and belongings

• Other common fears are:– Fear of the unknown– Fear of dying alone– Fear of severe, unrelieved pain– Fear about the inability to finish personal

business or manage affairs


The Role of the Nursing Assistant

• As a nursing assistant:– You spend a great deal of time with

patients– You have a unique opportunity to be a

source of strength and comfort for them– You must also provide for their spiritual

needs


Hospice Care

• Has evolved around the philosophy that death is a natural process that should neither be hastened nor delayed

• The dying person should be kept comfortable

• Pain relief is an important part of the hospice philosophy of care


Physical Changes as Death Approaches

• As death approaches:– There are notable physical changes in the

patient– As these changes occur, report them to the

charge nurse immediately


Signs of Death

• After death:– Changes continue to take place in the body– These changes are called moribund, or

dying, changes


Postmortem Care

• The patient’s body should be treated with respect at all times.

• Before death occurs, the limbs should be straightened and the head elevated with a pillow.


Postmortem Care

• The body should be cleaned by gentle washing with warm water.

• Discharges must be washed off and wiped away.


Organ Donations

• Some people desire to share their organs with others after death.

• They use an organ donor card that is part of the driver’s license.

• The card specifies if particular organs are being donated or if the whole body is being donated.


Postmortem Examination (Autopsy)

• In certain situations– Law requires a medical postmortem

examination, or autopsy, of the body.

copyright © 2008 delmar learning. all rights reserved. unit 32 death and dying

Documents

delmar learning

patient slide

process of death

lonely slide

impossible slide

old slide

introduction death

body image slide