Death as part of life Inevitable

Death as part of life Loss – Something removed

Death as part of life Coping – process

Death as part of life Grief – Expression of loss

Death as part of life Mourning – Process following loss

Elisabeth Kubler-Ross’s stages 1.Denial 2.Anger 3.Bargaining 4.Depression 5.Acceptance

John Bowlby’s stages of separation 1.Protest 2.Despair 3.Detachment

Bowlby’s Phases of Mourning 1.Numb stage 2.Painful stage 3.Disorganized & despair 4.Reorganization stage

Types of lose Physical – Death of spouse – Death of parent – Death of child – Death of friend Symbolic losses – Loss of work – Loss of status – Loss of mobility – Loss of independence

Loss of a Spouse Great magnitude Risk of death – >2yrs Men – Feel alone Women – Feel abandoned Widows younger than widowers

Loss of a parent Age?

Loss of a child One of most difficult Blame

Loss of unborn child Hold child

Loss of sibling Blame self

Facing one’s own death Terminal illness

Signs of approaching death Withdraw  senses Cheyne-Stokes Respirations BP –  Pulse –  Temp – 

Development of concept of death Infant –N–No concept Toddler –S–Separation anxiety Preschool –P–Pain avoidance 5-6 –P–Punishment School-age –H–Have capacity to understand!

Advanced directive Legal document Wishes for medical treatment is they cant make these decisions

Living Will Form of advanced directive States wishes regarding life-sustaining treatment

Durable power of attorney for health care Appoint someone to make their wished known in the event they can’t any longer

Do not Resuscitate (DNR)

Euthanasia Assisted suicide “Mercy killing” Oregon

Right to die Can refuse medical treatment

Palliative care Relieve suffering

Hospice Care Part of Medicare/medicaid Emphasizes comfort