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Death and dying

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Death and dying

  1. 1. GRIEF LOSS DEATH DYINGGERALD REY O. COQUIA, RN ACLC COLLEGE TACLOBAN
  2. 2. GRIEF AND LOSS  LOSS = something of value is gone  GRIEF = total response to emotional experience related to loss  BEREAVEMENT = subjective response to by loved ones  MOURNING = behavioral response
  3. 3. GRIEF AND LOSS Loss is a universal experience that occurs throughout the lifespan. Grief is a form of sorrow involving feelings, thoughts and behaviors caused by bereavement. Responses to loss are strongly influenced by one’s cultural background.
  4. 4. GRIEF AND LOSS The grief process involves a sequence of affective, cognitive and psychological states as a person responds to and finally accepts a loss.
  5. 5. STAGES OF GRIEVING Stages Behaviors D A B D A Refuses to believe that loss is happening Retaliation Feelings of Guilt, punishment for sins Laments over what has happened Begins to plan (e.g. wills, prosthesis)
  6. 6. STAGES OF GRIEVING DENIAL
  7. 7. STAGES OF GRIEVING DENIAL: interventions
  8. 8. STAGES OF GRIEVING ANGER •“Why me?” •This stage often occurs in an explosion of emotion, where the bottled –up feelings of the previous stages are expulsed in a huge outpouring of grief. •Whoever is in the way is likely to be blamed.
  9. 9. STAGES OF GRIEVING ANGER: interventions •Give space allowing them to rail and below. The more the storm blows the sooner it will blow itself out. •Try not to respond in “kind” •When anger is destructive , it must be addressed directly. Remind the person of appropriate and inappropriate behavior.
  10. 10. STAGES OF GRIEVING BARGAINING • “Yes me, but…” • The patient attempts to negotiate a postponement with God and is generally kept a secret.
  11. 11. STAGES OF GRIEVING BARGAINING: intervention • Spend time with patients • Discuss importance of valued objects and people.
  12. 12. STAGES OF GRIEVING DEPRESSION The inevitability of the news eventually (and not before time) sinks in and the person reluctantly accepts that it is going to happen.
  13. 13. STAGES OF GRIEVING DEPRESSION: intervention • Be available • Don’t attempt to cheer person up • Find out any religious support
  14. 14. STAGES OF GRIEVING ACCEPTANCE • Restful time, but not necessarily happy. • Often begin putting their life in order, sorting out wills and helping others to accept the inevitability.
  15. 15. STAGES OF GRIEVING ACCEPTANCE: intervention • Plan care to allow the person with whom patient is comfortable to care for him or her • It is important that you don’t withdraw
  16. 16. DEATH  "cessation of heart- lung function, or of whole brain function, or of higher brain function.  "either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem
  17. 17. DEATH CONCEPT AMONG AGE 1-5 immobility and inactivity; wishes and unrelated action responsible for action 5-10 final but can be avoided 9-12 understands own mortality and fears death 12-18 fears and fantasizes avoidance 18- 45 increased attitude awareness 45-65 accepts mortality Above 65 multiple meanings; encounters and fears
  18. 18. FEARS OF DYING PERSON • Distancing by support people and caregivers can occur • Debilitation, pain, and incapacitation • Hospital, a place that can be very lonely • Fear of dying alone FEAR OF LONELINESS
  19. 19. FEARS OF DYING PERSON • Sadness • Letting go of hopes, dreams, the future • Awareness of own mortality • Grief about future losses • Anticipatory grief that involves mourning, coping skills • Grief related to diagnosis that has a long term effect on the body such as cancer • Patient may feel well at time of diagnosis FEAR OF SORROW
  20. 20. FEARS OF DYING PERSON • Death is an unknown state • What will happen after death? • What will happen to loved ones, those left behind FEAR OF THE UNKNOWN
  21. 21. FEARS OF DYING PERSON • Mutilation via therapy and body image changes • Loss of role or status • Loss of standard of living LOSS OF SELF CONCEPT AND BODY INTEGRITY
  22. 22. FEARS OF DYING PERSON • Ego is threatened • Physical deterioration may occur • Mental deterioration may occur • Unable to care for self • Become dependent on others for care FEAR OF REGRESSION
  23. 23. FEARS OF DYING PERSON • May be many different types of pain or suffering such as physical, emotional, social, or spiritual in nature • Altered relationships with others • Anxiety related to the disease and consequences of the disease FEAR OF SUFFERING AND PAIN
  24. 24. TAKING CARE OF DYING PERSON •The role of the nursing staff is fundamentally supportive •Accept the physical and mental state he is in •Show him that they will not abandon him •Responds to the persons needs in a physical, psychological, social and intellectual level
  25. 25. TAKING CARE OF DYING PERSON •Biological needs, reduction and control of pain •Pain is a subjective experience •Acute pain: usually temporary •Chronic pain: interrupts normal everyday functioning •Medication is more effective in the context of a holistic intervention PHYSICAL LEVEL
  26. 26. TAKING CARE OF DYING PERSON • Feelings of anger, sadness, depression are part of a wider process of “anticipatory grief”, useful for the patient’s psychological preparation to die • Nursing staff has to comprehend and the person to express these feelings • The only way for the person to reconcile with these feelings is to talk to someone who is willing to listen • Support has to respond to the person’s need for safety, autonomy and self-control PSYCHOLOGICAL LEVEL
  27. 27. TAKING CARE OF DYING PERSON • Emotional and social withdrawal • Need of emotional withdrawal co-exists with the need of belonging to an accepting and supportive social environment • When family/medical nursing staff keep their distance in order to protect themselves, the person experiences a “social death”, which is sometimes more painful than the actual death • Nursing staff must treat the dying person without fear, encourage relatives to be close to him, act as a liaison with the outside world SOCIAL LEVEL
  28. 28. TAKING CARE OF DYING PERSON •Need to evaluate his life as meaningful, important, useful •Nursing staff should stand by him without being judgmental, let him decide where he wants to spend his last days, and interact with him as a person who LIVES INTELLECTUAL LEVEL
  29. 29. NURSING RESPONSIBILITIES • Nurses need to take time to analyze their own feelings about death before they can effectively help others with terminal illness • Understand that you may experience grief • Nurses have to be strong to control their feelings to be able to tolerate pain, illness, and death, and to keep their distance
  30. 30. NURSING RESPONSIBILITIES • Provide relief from illness, fear and depression • Help clients maintain sense of security • Help accept losses • Provide physical comfort
  31. 31. ROLE OF THE CHAPLAIN • Can be a member of the health care team • Assist with religious practices • Perform rites • Provide prayer, support, and comfort • Assist with mobilizing other support systems that are important to the client • Support family members
  32. 32. COMMUNICATING WITH CLIENT • Right to know • Time frame • Nurse needs to assess whether or not the patient/family have been told and what was told to them • THE PHYSICIAN WILL TELL THE CLIENT FIRST, NOT THE NURSE
  33. 33. COMMUNICATING WITH CLIENT • Clarifies what was said • Listens to concerns • Fosters communication between MD, client, and family • Allows patient to express loss • Facilitate grief through nursing process • Be available for patient • Assist patient to identify needs/hopes for remainder of life • Connect patient with proper resources
  34. 34. ASSIST FAMILY • Explain procedures and equipment • Prepare them about the dying process • Involve family and arrange for visitors • Encourage communication • Provide daily updates • Resources • Do not deliver bad news when only one family member is present
  35. 35. PHYSICAL SIGNS OF DYING • Confusion – about time, place, and identity of loved ones; visions of people and places that are not present • A decreased need for food and drink, as well as loss of appetite
  36. 36. PHYSICAL SIGNS OF DYING Drowsiness – an increased need for sleep and unresponsiveness Withdrawal and decreased socialization Skin becomes cool to the touch Loss of bowel or bladder control
  37. 37. PHYSICAL SIGN OF DYING • Rattling or gurgling sounds while breathing or breathing that is irregular and shallow, decreased number of breaths per minute, or breathing that switches between rapid and slow • Involuntary movements (called myoclonus), changes in heart rate, and loss of reflexes in the legs and arms also mean that the end of life is near
  38. 38. PRONOUNCEMENT OF DEATH •Absence of carotid pulses •Pupils are fixed and dilated •Absent heart sounds •Absent breath sounds
  39. 39. STAGES OF DECOMPOSITION • paleness of death • almost immediately after death a body of a person with light skin will begin to grow very pale. this is caused by a lack of blood in the Capillary region of the blood vessel. PALLOR MORTIS
  40. 40. STAGES OF DECOMPOSITION • cool of death • after death a human body will no longer be working to keep warm, and as a result will start cooling • about an hour postmortem (after death) a human body will have decreased around 2 degrees celcius, and will continue to decrease one degree celcius until it reaches the temperature of the environment around it ALGOR MORTIS
  41. 41. STAGES OF DECOMPOSITION • death stiffness • about three hours after death a chemical change in the muscles of a human corpse causes the limbs of the corpse to become stiff and difficult to move. RIGOR MORTIS
  42. 42. STAGES OF DECOMPOSITION • decomposition of proteins in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs. It is caused due to bacterial or fungal decomposition of organic matter and results in production of noxious odors PUTREFACTION
  43. 43. POSTMORTEM CARE • Needs to be done promptly, quietly, efficiently, and with dignity • Straighten limbs before death, if possible • Place head on pillow
  44. 44. POSTMORTEM CARE •Remove tubes • Replace soiled dressings • Pad anal area •Gently wash body to remove discharge • Place body on back with head and shoulders elevated
  45. 45. POSTMORTEM CARE • Grasp eyelashes and gently pull lids down • Insert dentures • Place clean gown on body and cover with clean sheet
  46. 46. POSTMORTEM CARE •Note time of death and chart •Notify attending physician •Chart any special directions •Notify family members •Allow time with loved one •Gather eyeglasses and other belongings •Prepare necessary paperwork for body removal
  47. 47. POSTMORTEM CARE • Call funeral home (or other appropriate personnel) for body transport • Note on chart • What personal artifacts were released with the body • What belonging were released • Who received the belongings • Tag or provide body identification as per policy

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