NATCEP Day Thirty Six

Discuss attitudes of American society about death Identify the stages of dying & grieving Recognize the emotional needs of the dying person Identify the physical signs of approaching death Caring for persons when death is imminent Recognition and consideration for the family Describe spirituality and the impact of these beliefs on

the emotional needs of the dying Define post-mortem care and the steps involved in

providing List possible response of others to the death (other

residents, staff) Acknowledge the death of a person

Attitude toward own death is influenced by

age, cultural background and past

experience

Talking about death is frequently avoided

Dying person may become institutionalized

and cared for by strangers

Society is more accepting of the dying’s wishes• Hospice Palliative Care Care that involves relieving or reducing the intensity of

uncomfortable symptoms without producing a cure.

“Keeping them comfortable”

• Advanced Directives Document stating a person’s wishes about health care

when that person cannot make their own decisions Living Will: speaks for you when you cannot speak for yourself Outlines the measures that a person wishes to be taken to support or

maintain their life when death is likely and they are not able to communicate their wishes

DNR Orders – do not resuscitate No action should be taken should death come or to prevent death

When does grieving begin?• Immediately when someone is diagnosed with a

terminal illness

• Anticipatory grief: mourning that begins before someone dies.

• Roles and responsibilities within a family may begin to change

• Friends and family may begin to separate themselves from the dying person in an attempt to deal with the loss

• Losses are many. . . . . . .

Stage 1: Denial• “The lab tests can’t be right – I don’t have cancer”

• Behaviors Unrealistically cheerful

Asks lots of questions

Disregards medical orders

NA Response• Listen, be accepting

• Be available and open but do not probe

• Be honest; do not encourage denial

• “It must be difficult for you to learn the results of your test.”

Stage 2: Anger• “This food is terrible – it’s not fit to eat!”

• Behaviors Complaining

Unreasonable requests

Anger at family, physician & nursing staff

NA Response• Listen

• Remain open and calm

• Don’t try to place blame

• “Let me see if I can find something that you would like more.”

Stage 3: Bargaining• “If only God would spare me this, I’ll go to church

every week.”

• Behaviors May be difficult to observe

Person vacillates between doubt & hope

NA Response• Listen, do not contradict plans

• Promote a sense of hope

• Promote a sense of acceptance

• “Would you like a visit from your clergy?”

Stage 4: Depression• “There just isn’t any reason to go on.”

• Behaviors

Person may separate themselves from the world

Person may turn their face away from people

Person may not speak, or speak in an expressionless voice

NA Response• Stay with person as much as possible

• Avoid cheery phrases and behaviors

• Encourage person to express their feelings

• “I understand you are feeling very sad/depressed.”

Stage 5: Acceptance• “I feel so alone.”

• Behaviors

Person may be serene, calm & accepting

May be apathetic

Behavior may be dependent on how well the former

stages were resolved

Some may not reach this stage

NA Response• Listen, show acceptance

• “I am here with you. Would you like to talk?”

Social interaction

Self-expression

Control over one’s life

Privacy

Spiritual support, if appropriate

Empathy, understanding

Respect

Finalization of relationships

Encourage prayer

Encourage visits from person’s clergy

Respect person’s religious beliefs

whether or not they are compatible with

the beliefs of the staff/facility

Respect & encourage the use of religious

symbols

Allow the person to express feelings

Allow the person as much control over

situation as possible

Respect need for privacy

Allow for spiritual support

Touch shows caring & concern

Circulation slowsFeet & hands cold, pale, “mottling”

Perception of pain reduced

Eye movement reduced or absent

Perspiration, even though body is cold

Loss of muscle tone• Body limp

• Jaw may drop open

• Loss of control of feces & urine

Respirations slow &/or may be difficult• “Rattling” due to mucus collecting

Pulse weak, rapid &/or irregular

B/P falls

Urine output may decrease

Swallowing ability may decrease

May have periods of confusion &/or anger

Physician must certify death

Physical care to meet needs

Keep warm

Consider their wishes = honor them• Unable to communicate, involve family

Provide for skin cleanliness• perspiration or incontinence

Change positions to prevent skin

breakdown

Special attention to mouth care (comfort)

Speak to person in normal tone; assume

they can always hear you (one of last

senses to go)

Provide for spiritual support respecting

their personal wishes

Communicate through touch

Continue to explain procedures when

performing

Family may also experience the 5 stages

Help the family identify the person’s

functioning level

If present, assure time with the person

before and after death

Be a good listener

Purpose• Family viewing

• Transfer to morgue or funeral home

Care involves• Bathing body

• Closing eyes & mouth

• Placing body in position of rest

Do not put pressure on skin, cause visible bruising

• Follow facility policy for dentures, prothesis

• Account for personal belongings

Allows staff and residents to grieve

Helps reassure residents person is not

forgotten

Memorial Service

Journaling

Letter to family