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Good Aging

GerontologyGeriatrics

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• Lecture no. 12

Death & Dying

By

Dr. Hala Yehia

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Objectives

• At the end of this lecture the student will be able to:• Define death & dying• Identify special needs of dying client• Mention nursing role for dying client• Describe stages of dying• List signs of death • explain nursing role in spiritual preparations for death• Discuss nurse's role in meeting family needs • Define hospice care

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Death & Dying

ThanatologyStudy of death The description of study of the phenomena of death, and of psychological mechanisms for coping with death

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Definitions

Death absolute cessation of vital functions

Dying process of losing these functions

Good deathFree from avoidable distress and suffering

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Special Needs Of Dying client• Visits with family/significant others

• Features of Client's room:

–pleasant as possible

–well ventilated

–odor free

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Special Needs Of Dying Resident(continued)

• Features of client’s room:–Contains personal items which

provide comfort and reassurance• Pictures• Mementos• Cards• Flowers• Religious objects

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Caring For client When Death Is Imminent

Nurse Role

• Open and receptive• Know own feelings about

death and do not project those feelings on to client.

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Caring For client When Death Is Imminent and Following Death

Nurse Role(continued)

• Empathetic• Calm and efficient • Normal tone of voice• Good listening skills• Non-judgmental

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How Do Most People Cope With Dying and Death?

• DENIAL–Defense mechanism–Buffer against reality–client may request

another opinion

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Five Stages of Grief, Death and Dying as Described

• DENIAL (continued)

–client may avoid discussion of death

–Feeling of, “This can’t be happening to me.”

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Five Stages of Grief, Death and Dying as Described

• ANGER

–Confused and anger

–Sense of unfairness

–Blame of others such as health care workers

–Feeling of, “Why me?”

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Five Stages of Grief, Death and Dying as Described

• BARGAINING

–Turn to religious and spiritual beliefs

–Promises to God and others

–Comfort and hope when all seems lost

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Five Stages of Grief, Death and Dying as Described

• BARGAINING (continued)–Generally know this

won’t work–Frustration and anger

dissolve into depression

–“If only...I will”

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Five Stages of Grief, Death and Dying as Described

• DEPRESSION–Belief that hope is lost–Overwhelming despair–Introverted and withdrawn–Remembering and reviewing life–Sleeplessness–“I always wanted to”

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Five Stages of Grief, Death and Dying as Described

• ACCEPTANCE–Calm –Strives to complete unfinished

business–Helps loved ones accept death–Needs others to validate worth of life–“I’ve had a good life.”

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Signs Of Approaching Death

• Changes in sensory functions and ability to speak–Vision

• increased secretions in corner of eyes

• blurred vision• failing vision• no eye movement/staring

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Signs Of Approaching Death

• Changes in sensory functions and ability to speak (continued)

–Speech• becomes difficult• hard to understand• may be unable to speak

–Hearing - last function to be lost

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Signs Of Approaching Death

• Changes in circulation and muscle tone–Circulation

• fails• heat gradually lost from body• hands and feet cold to touch and mottled

• face becomes pale or gray and mottled

• perspiration may increase (diaphoresis)

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Signs Of Approaching Death

• Changes in circulation and muscle tone (continued)–Muscle tone

• body limp• jaw may drop• mouth may stay partly open

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Signs Of Approaching Death

• Changes in Vital Signs–Respirations

• slower• shallow• labored• may experience dyspnea, apnea, mucous collects in the throat and bronchial tubes (death rattle)

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Signs Of Approaching Death

• Changes in Vital Signs (continued)–Pulse

• rapid• weak and irregular

–Blood pressure drops–Temperature

• elevated• subnormal

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Signs Of Approaching Death

• Urinary and anal incontinence

• Decreased peristalsis, abdominal distention

• Release of flatus

• Decreased pain

• Loss of consciousness

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Nurse ’s Role In Spiritual Preparation For Death

• clergy may be contacted at request of client or family

• Privacy to be provided when clergy with client

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Nurse ‘s Role In Spiritual Preparation For Death(continued)

• Support client’s religious/spiritual practices even if different from that of nurse.

• Listen respectfully to religious/spiritual beliefs

• Participate in religious practices if asked and acceptable

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Nurse’s Role In Spiritual Preparation For Death(continued)

• Treat religious objects with care and respect:–medals–pictures–statues– Encourage family and

friends to be included

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Nurse’s Role In Meeting Family Needs

• Available for support• Use touch as appropriate• Respect right to privacy• Let family assist with

care, if they desire, where appropriate

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Nurse’s Role In Meeting Family Needs

(continued)

• Use good communication skills

• Listen and provide understanding throughout the grief/loss stages

• Answer questions or refer to supervisor

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Hospice Care

• Health care service offered:– in hospitals and extended care

facilities–by special facilities–usually in the individual’s home

• Continuing care provided by team of health professionals

• Designed for clients with terminal illness

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Hospice Care(continued)

• Acceptance of death as imminent (6 months or less)

• Assures that individual dies with dignity and comfort

• Not concerned with cure or life-saving procedures

• Emphasis on pain relief• Trained volunteers and professionals

make regular visits.

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Hospice Care(continued)

• Provides counseling for individual and family:–Emotional–Psychological–Spiritual–Financial–Bereavement

• Family included in all aspects of care as desired

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Postmortem Care

• Care Of Body After (Post) Death (Mortem) –Begin care when instructed by

supervisor–Treat body to privacy, respect and

gentleness–Give care before rigor mortis sets in

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Postmortem Care(continued)

• Reasons for Postmortem Care–Prevent discoloration and skin

damage–Maintain good appearance of body–Identify body and prepare for

transportation–Position body in normal alignment–Arrange time family to view the body

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