This document discusses various topics related to death and dying, including definitions, the stages of dying, fears patients may experience, how to talk to patients and their families, hospice care, and advanced directives. It defines terms like terminally ill and imminently dying. It outlines the stages of dying as denial, anger, bargaining, depression and acceptance. It provides guidance on discussing death with patients, addressing their fears, and responding to grieving families. It also describes hospice services and the interdisciplinary team that provides end-of-life care.

1. Death and Dying Nur 448

2. Definitions Terminally ill Imminently dying

3. … in Modern Society The Death-Dying Relationship Dying: Denial and Beyond Denial

4. … Fears of the Patient Fear of Isolation Fear of Pain Fear of Dependence Fear of Death Itself Death and Immortality Death as the End

5. Stages of Dying Denial and isolation Anger Bargaining Depression Acceptance

6. Setting Treatment Priorities Information sharing Responsivity and responsibility How much and what kind? Treating losses and fears Maintaining hope

7. When Death Is Imminent Maximizing comfort Saying good-bye Accepting rejection

8. When You Don ’t Know What To Say Avoid rote responses – each person is unique. Avoid common greetings (e.g. “ Hi! How are you?). Be sincere, genuine and honest. Admit you don ’ t know what to say. Don ’ t be afraid to discuss death.

9. When You Don ’t Know What To Say Don ’ t lecture or preach. Let the person talk. Ask what you can do and do it. Keep your promises. Watch your tone of voice. Avoid “ cutesy ” baby talk and condescension. Don ’ t abandon the patient.

10. Responses of the Patient ’s Family Anticipatory grief Phases of grief Shock and numbness Yearning and searching Disorganization and despair Reorganization

11. What to Say to the Family How are you doing with all of this? What can I do for you? You must really be hurting You must feel angry This must be hard for you Take all the time you need Thank you for sharing your feelings

12. What NOT to Say I understand how you feel Death was a blessing It was God ’ s will It all happened for the best You ’ re still young Be strong! You have your whole life ahead of you You ’ ll feel worse before you feel better You can have other children You can always remarry Call me when I can help Something good will come out of this At least you have another child He/she led a full life It ’ s time to put it behind you now

13. Hospice Cares for people approaching death Respects and values the dignity and worth of each person Philosophy is to cherish and emphasize life

14. Hospice Services Interdisciplinary approach Palliative care Pain management Support for family (respite care) Death with dignity Grief and bereavement Funeral and memorial planning

15. Hospice Personnel Case manager Nurses Home health aides and homemaker services Social workers Spiritual counselors Volunteers Medical director and attending physician Dietitians PT, OT, ST

16. Preparing for Death – Advanced Directives Health Care Surrogate Living Will Legal Proxy

17. Everyone should have a living will Preparing a Living Will