The End of Life: Death, Dying, Grief, and Loss Chapter 14: The End of Life: Death, Dying, Grief, and Loss

Death Final stage of growth and development Part of life, an extension of birth Compared with the process of labor Fear and anxiety of the unknown Priority for the dying person Basic human needs**

Palliative Care Versus Curative Care Improve the quality of life by providing for relief of symptoms such as pain, nausea, anxiety, and depression Curative care: Focus on recovery from one or more physical or emotional issues with the expectation of lengthening the lifespan.

Influence of Culture, Ethnicity, and Religion Beliefs shape people’s attitudes toward death. Culture determines how one responds to death. Religion and spirituality help individual and family meet the challenging concepts related to death. Spiritual support may be expressed as Compassionate care Specific religious practice or ritual

Normal Processes of Dying Withdrawal from the external environment Visions and hallucinations Loss of appetite Changes in bowel and bladder function Changes in vital signs Changes in mental acuity Fatigue and sleep

Normal Processes of Dying (cont.) Changes in sleep–wake patterns Pain Congestion in lungs or throat Skin changes

Impact of Death on the Family Unit Often, the family experiences stress more keenly than the dying client. Efforts to appear hopeful and cheerful may confuse the dying client. Crying in front of dying loved ones can be therapeutic. Absence of advance directives can result in a sense of guilt if family has to dictate life and death decisions.

Impact of Death on the Family Unit (cont.) The family must handle everyday problems at a time often marked by shock, loneliness, and sadness. Occasionally, the stress becomes difficult for families to handle, resulting in increased conflicts and outbursts of emotion or domestic violence. Support from friends, neighbors, and coworkers can also be a tremendous help. Children –adults should talk honestly and clearly with children about illness and death when it occurs, children should be allowed to see the body*

Culture Arrange for individuals to come and pray (from same religious affiliation)* Some cultures refuse to leave body after death *contact supervisor to resolve issue Box 14-1 Mandatory Baptism Roman catholic Russian orthodox Greek orthodox *AMISH *Christian Science

Physical Care Versus Emotional Care Usually some form of treatment that can be observed and quantified Emotional care: Relates to psychological support Effects cannot be measured and may seem less immediately obvious than physical care Equally important to well-being of the client

Kübler-Ross: Stages of Grief and Loss Coping with this physical and psychological pain has the potential to heal and to strengthen those going through this process. Loss Can include grief; related to any emotional suffering; realization that one’s personal ambitions will not or cannot be achieved

Stages of Dealing With Death Denial Shock and disbelief, often followed by a feeling of isolation *don’t believe the DX is correct Anger Rage, acting-out physically or verbally at family or health professionals *feeling of hopelessness Bargaining Guilt and developing awareness of the situation

Stages of Dealing With Death (cont.) Depression Grief and realization that death is certain “I am so sad” “I have no hope of recovery” Recognize the individual concentrates on past losses* Acceptance Self-reliance and a feeling of peace

TABLE 14-2 Denial Anger Listen Do not take clients anger personally Do not let yourself become angry Bargaining Depression Allow person to rest Acceptance