Nursing Assistant Death & Dying

Stages of Grieving (Dr. Elizabeth Kubler-Ross) Denial Anger Bargaining Depression Acceptance

Emotional Needs of the Dying Contact with loved ones Encourage family to visit Provide privacy Communication Listening Touching Expression of emotions Guilt, anger, frustration, anxiety, depression Reminiscence

Approach to meeting emotional needs Respect religious & cultural practices Provide physical, emotional, & spiritual comfort to resident & family Accept resident’s emotions Report any emotional, social, or spiritual needs to licensed nurse

Rights of the dying residents I have the right to be treated as a living human being until I die I have the right to maintain a sense of hopefulness, however changing its focus it may be I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this may be I have the right to express my feelings & emotions about my approaching death in my own way

Rights of the dying residents I have the right to participate in decisions concerning my care I have the right to expect continuing medical care and nursing attention even though “cure” goals must be changed to “comfort” goals I have the right not to die alone I have the right to be free from pain I have the right to have my questions answered honestly I have the right not to be deceived

Rights of dying residents I have the right to have help from and for my family in accepting my death I have the right to die in peace & dignity I have the right to retain my individuality & not be judged for my decisions which may be contrary to the beliefs of others I have the right to discuss & enlarge my religious &/or spiritual experiences, whatever those may mean to others I have the right to expect that the sanctity of the human body will be respected after death

Rights of dying residents I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death

Impending signs of death Decreased level of consciousness Cold hands & feet Diaphoresis Pale skin Loss of muscle tone Labored or Cheyne-Stokes respirations Death rattle

Impending signs of death Weak, irregular pulse, slow pulse Blank, staring expression Jaw drops Mottling of skin

Signs of biological death No pulse No breathing No blood pressure Pupils may be fixed & dilated

Care & comfort measures for the dying resident Notify licensed nurse for change in condition Determine code status (DNR) in order to act at appropriate level of care Resident can usually hear, even when they appear unconscious

Care & comfort measures Pain management Hygiene Oral hygiene Communication & support Positioning & turning Provide comfort Attend to psychosocial needs Spiritual support

Philosophy of hospice Providing comfort care for the dying & allowing them to die with dignity Looks at QUALITY not quantity of life Role of hospice nurse

Postmortem care Assist as directed by licensed nurse Follow facility rules (may be as follows) Place body on back, head & shoulders on pillow Close eyes (grasp eyelashes to pull over eyes) Place clean dentures in mouth (if needed) Close mouth May close by placing a towel under the chin to keep the jaw closed Bathe soiled areas with plain water, comb hair, straighten arms & legs Put a blue pad under buttocks If needed, wear gloves

If family is to view the body Put a clean hospital gown on resident Cover body to shoulders with clean sheet Make room look tidy & neat Remove all soiled linens Adjust light to subdued level & allow family to visit privately

After family leaves Apply shroud (if applicable) – this may be done by funeral home Collect all belongings, make list, store, label or give to family Fill out identification cards & fasten to foot of resident & one on each of the resident’s belongings May need to bring body to morgue Remove all linens & supplies from room Report & record Completion of procedure & time Where body was transported & by whom What was done with personal belongings

Postmortem care Always provide privacy, support, & comfort Respect family members beliefs in regard to postmortem care