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Unit 32
Death and Dying
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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.
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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.
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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
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Introduction
• As a nursing assistant– You will be providing care throughout the
period of dying and into the after-death, or postmortem, period.
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Fives Stages of Grief
• Dr. Elisabeth Kübler-Ross• Five stages of grief:
– Denial– Anger– Bargaining– Depression– Acceptance
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The Grieving Process
• Begins when someone receives a terminal diagnosis
• Anticipatory grief: – Mourning before someone dies
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The Grieving Process
• 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
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The Grieving Process
• 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
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The Grieving Process
• Each loss triggers the grieving process– Friends and family may separate
themselves from the dying person• Making the patient feel very sad and lonely
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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
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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
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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.
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The Patient Self-Determination Act
• 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
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The Patient Self-Determination Act
• Proxy can make decisions if the patient cannot make them
• If his or her decision-making ability returns– Patient will again make the decisions
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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
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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
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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
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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
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Signs of Death
• After death:– Changes continue to take place in the body– These changes are called moribund, or
dying, changes
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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.
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Postmortem Care
• The body should be cleaned by gentle washing with warm water.
• Discharges must be washed off and wiped away.
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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.
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Postmortem Examination (Autopsy)
• In certain situations– Law requires a medical postmortem
examination, or autopsy, of the body.