1. 1 Good Aging Gerontology Geriatrics

2. 2 Lecture no. 12 Death & Dying By Dr. Hala Yehia

3. 3 Objectives At the end of this lecture the student will be able to: Define death & dying Identify special needs of dying client Mention nursing role for dying client Describe stages of dying List signs of death explain nursing role in spiritual preparations for death Discuss nurse's role in meeting family needs Define hospice care

4. 4 Death & Dying Thanatology Study of death The description of study of the phenomena of death, and of psychological mechanisms for coping with death

5. 5 Definitions  Death  absolute cessation of vital functions  Dying  process of losing these functions  Good death  Free from avoidable distress and suffering

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7. 7 Special Needs Of Dying client Visits with family/significant others Features of Client's room: –pleasant as possible –well ventilated –odor free

8. 8 Special Needs Of Dying Resident (continued) Features of client’s room: –Contains personal items which provide comfort and reassurance Pictures Mementos Cards Flowers Religious objects

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10. 10 Caring For client When Death Is Imminent Nurse Role Open and receptive Know own feelings about death and do not project those feelings on to client.

11. 11 Caring For client When Death Is Imminent and Following Death Nurse Role (continued) Empathetic Calm and efficient Normal tone of voice Good listening skills Non-judgmental

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13. 13 How Do Most People Cope With Dying and Death? DENIAL –Defense mechanism –Buffer against reality –client may request another opinion

14. 14 Five Stages of Grief, Death and Dying as Described DENIAL (continued) –client may avoid discussion of death –Feeling of, “This can’t be happening to me.”

15. 15 Five Stages of Grief, Death and Dying as Described ANGER –Confused and anger –Sense of unfairness –Blame of others such as health care workers –Feeling of, “Why me?”

16. 16 Five Stages of Grief, Death and Dying as Described BARGAINING –Turn to religious and spiritual beliefs –Promises to God and others –Comfort and hope when all seems lost

17. 17 Five Stages of Grief, Death and Dying as Described BARGAINING (continued) –Generally know this won’t work –Frustration and anger dissolve into depression –“If only...I will”

18. 18 Five Stages of Grief, Death and Dying as Described DEPRESSION –Belief that hope is lost –Overwhelming despair –Introverted and withdrawn –Remembering and reviewing life –Sleeplessness –“I always wanted to”

19. 19 Five Stages of Grief, Death and Dying as Described ACCEPTANCE –Calm –Strives to complete unfinished business –Helps loved ones accept death –Needs others to validate worth of life –“I’ve had a good life.”

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21. 21 Signs Of Approaching Death Changes in sensory functions and ability to speak –Vision increased secretions in corner of eyes blurred vision failing vision no eye movement/staring

22. 22 Signs Of Approaching Death Changes in sensory functions and ability to speak (continued) –Speech becomes difficult hard to understand may be unable to speak –Hearing - last function to be lost

23. 23 Signs Of Approaching Death Changes in circulation and muscle tone –Circulation fails heat gradually lost from body hands and feet cold to touch and mottled face becomes pale or gray and mottled perspiration may increase (diaphoresis)

24. 24 Signs Of Approaching Death Changes in circulation and muscle tone (continued) –Muscle tone body limp jaw may drop mouth may stay partly open

25. 25 Signs Of Approaching Death Changes in Vital Signs –Respirations slower shallow labored may experience dyspnea, apnea, mucous collects in the throat and bronchial tubes (death rattle)

26. 26 Signs Of Approaching Death Changes in Vital Signs (continued) –Pulse rapid weak and irregular –Blood pressure drops –Temperature elevated subnormal

27. 27 Signs Of Approaching Death Urinary and anal incontinence Decreased peristalsis, abdominal distention Release of flatus Decreased pain Loss of consciousness

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29. 29 Nurse ’s Role In Spiritual Preparation For Death clergy may be contacted at request of client or family Privacy to be provided when clergy with client

30. 30 Nurse ‘s Role In Spiritual Preparation For Death (continued) Support client’s religious/spiritual practices even if different from that of nurse. Listen respectfully to religious/spiritual beliefs Participate in religious practices if asked and acceptable

31. 31 Nurse’s Role In Spiritual Preparation For Death (continued) Treat religious objects with care and respect: –medals –pictures –statues –Encourage family and friends to be included

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33. 33 Nurse’s Role In Meeting Family Needs Available for support Use touch as appropriate Respect right to privacy Let family assist with care, if they desire, where appropriate

34. 34 Nurse’s Role In Meeting Family Needs (continued) Use good communication skills Listen and provide understanding throughout the grief/loss stages Answer questions or refer to supervisor

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36. 36 Hospice Care Health care service offered: –in hospitals and extended care facilities –by special facilities –usually in the individual’s home Continuing care provided by team of health professionals Designed for clients with terminal illness

37. 37 Hospice Care (continued) Acceptance of death as imminent (6 months or less) Assures that individual dies with dignity and comfort Not concerned with cure or life- saving procedures Emphasis on pain relief Trained volunteers and professionals make regular visits.

38. 38 Hospice Care (continued) Provides counseling for individual and family: –Emotional –Psychological –Spiritual –Financial –Bereavement Family included in all aspects of care as desired

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40. 40 Postmortem Care Care Of Body After (Post) Death (Mortem) –Begin care when instructed by supervisor –Treat body to privacy, respect and gentleness –Give care before rigor mortis sets in

41. 41 Postmortem Care (continued) Reasons for Postmortem Care –Prevent discoloration and skin damage –Maintain good appearance of body –Identify body and prepare for transportation –Position body in normal alignment –Arrange time family to view the body

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