1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 32 Death and Dying

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Describe how different people handle the process of death and dying. Describe the nursing assistant’s responsibilities for providing supportive care.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe the spiritual preparations for death practiced by various religious denominations. Describe the hospice philosophy and method of care. List the signs of approaching death.

4. Copyright © 2008 Delmar Learning. All rights reserved. Introduction Death is the final stage of life It may come suddenly, without warning Or it may follow a long period of illness Death sometimes strikes the young, but it always awaits the old

5. Copyright © 2008 Delmar Learning. All rights reserved. Introduction As a nursing assistant –You will be providing care throughout the period of dying and into the after-death, or postmortem, period.

6. Copyright © 2008 Delmar Learning. All rights reserved. Fives Stages of Grief Dr. Elisabeth Kübler-Ross Five stages of grief: –Denial –Anger –Bargaining –Depression –Acceptance

7. Copyright © 2008 Delmar Learning. All rights reserved. The Grieving Process Begins when someone receives a terminal diagnosis Anticipatory grief: –Mourning before someone dies

8. Copyright © 2008 Delmar Learning. All rights reserved. The Grieving Process Patients and families grieve for the past, present and future losses, as well as their former way of life. –Life will never be the same –Returning to a former way of life will be impossible

9. Copyright © 2008 Delmar Learning. All rights reserved. The Grieving Process Each loss triggers the grieving process –Causes feelings of isolation, abandonment, anger, and depression –Roles and responsibilities within family change –Illness may change body image

10. Copyright © 2008 Delmar Learning. All rights reserved. The Grieving Process Each loss triggers the grieving process –Friends and family may separate themselves from the dying person Making the patient feel very sad and lonely

11. Copyright © 2008 Delmar Learning. All rights reserved. Preparation for Death Knowledge of impeding death comes to a patient directly from the physician or indirectly from the staff A diagnosis of terminal illness is very difficult to conceal from the patient

12. Copyright © 2008 Delmar Learning. All rights reserved. Preparation for Death You must realize that most terminally ill patients do eventually accept that death is part of their near future. Upon being told of the terminal diagnosis: –Patient may proceed through several stages of emotional adjustment

13. Copyright © 2008 Delmar Learning. All rights reserved. The Patient Self-Determination Act Patient Self-Determination Act of 1990 –Requires health care providers to supply written information about state laws regarding advance directives. –An advance directive is a document that is put into effect if the patient later becomes unable to make decisions for himself or herself.

14. Copyright © 2008 Delmar Learning. All rights reserved. The Patient Self-Determination Act Person designated as the agent may also be called the proxy, or health care proxy Health care proxy must make decisions in keeping with the patient’s wishes Health care proxy makes decisions on medical care only –Not financial matters

15. Copyright © 2008 Delmar Learning. All rights reserved. The Patient Self-Determination Act Proxy can make decisions if the patient cannot make them If his or her decision-making ability returns –Patient will again make the decisions

16. Copyright © 2008 Delmar Learning. All rights reserved. Common Fears The dying person is losing everything –Family, friends, pets, and belongings Other common fears are: –Fear of the unknown –Fear of dying alone –Fear of severe, unrelieved pain –Fear about the inability to finish personal business or manage affairs

17. Copyright © 2008 Delmar Learning. All rights reserved. The Role of the Nursing Assistant As a nursing assistant: –You spend a great deal of time with patients –You have a unique opportunity to be a source of strength and comfort for them –You must also provide for their spiritual needs

18. Copyright © 2008 Delmar Learning. All rights reserved. Hospice Care Has evolved around the philosophy that death is a natural process that should neither be hastened nor delayed The dying person should be kept comfortable Pain relief is an important part of the hospice philosophy of care

19. Copyright © 2008 Delmar Learning. All rights reserved. Physical Changes as Death Approaches As death approaches: –There are notable physical changes in the patient –As these changes occur, report them to the charge nurse immediately

20. Copyright © 2008 Delmar Learning. All rights reserved. Signs of Death After death: –Changes continue to take place in the body –These changes are called moribund, or dying, changes

21. Copyright © 2008 Delmar Learning. All rights reserved. Postmortem Care The patient’s body should be treated with respect at all times. Before death occurs, the limbs should be straightened and the head elevated with a pillow.

22. Copyright © 2008 Delmar Learning. All rights reserved. Postmortem Care The body should be cleaned by gentle washing with warm water. Discharges must be washed off and wiped away.

23. Copyright © 2008 Delmar Learning. All rights reserved. Organ Donations Some people desire to share their organs with others after death. They use an organ donor card that is part of the driver’s license. The card specifies if particular organs are being donated or if the whole body is being donated.

24. Copyright © 2008 Delmar Learning. All rights reserved. Postmortem Examination (Autopsy) In certain situations –Law requires a medical postmortem examination, or autopsy, of the body.