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

2. 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**

3. 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.

4. 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

5. 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

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

7. 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.

8. 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*

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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