Death & dying theories

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DEATH & DYING THEORY 13/7/2017

Death & Dying Theory
Presented by: N/C Sana Sultan
Faculty: Maj. Farhat Jabeen

Ground Rules
Be attentive
Please switch off your laptops
Don’t talk & leave the room during presentation
Ask questions without any hesitation at the end of
presentation

Objectives
At the end of presentation the learner will be able to:
Introduce death & dying
Define loss& grief , bereavement & mourning , death &
dying
Explain death & dying theory of Kubler Ross
Describe additional theoretical models
Enlist physical signs of dying
Enumerate physical signs of death

Objectives
Enlist fear of dying person
Describe care of dying person
Elaborate changes in body after death
Explain last office
DEATH & DYING THEORY 3/7/2017 5

Introduction
Death remains a great mystery, one of the central issues with
which religion, philosophy and science have wrestled since the
beginning of human history. we tend to view death as a feared
enemy that can and should be defeated by modern medicine and
machines. Only knowing & accepting the death can reduce the
fear

Loss & Grief
Loss
The experience of parting (seperating) with an object, person, or
relationship that one values
(Craven & Hirnle, 2009)
Grief
Psychological and physiologic responses a person experiences
after the loss of a signiﬁcant person, object, or relationship.

Bereavement & Mourning
Bereavement
It is a state of desolation (unhappiness) that occurs as the result
of a loss. Bereavement is the subjective response
Mourning
Mourning encompasses the socially prescribed behaviors after
the death of a signiﬁcant other. Mourning behaviors are socially
conventional (based on) bereavement behaviors.

Death & Dying
Death
Irreversible cessation of all functions of the entire brain,
including the brain stem
Dying
A process that from a medical point of view begins when a
person has a disorder that is untreatable inevitably ends in
death or the final stages of a fatal disease

Development of Concept Of Death
Age Beliefs / Attitudes
Infants to 5 years Do not understand death, belief that it is reversible
& temporary
5 to 9 years Death is final , can be avoided wishes & unrelated
actions are responsible
9 to 12 years Understand own mortality interest in after life &
fear of death
12 to 18 years Fears and fantasizes avoidance
18 to 45 years Increased attitude towards death
45 to 65 years Accepts mortality
65 + years Multiple meanings; encounters and fears

Elisabeth
Kubler-Ross
July 8, 1926 –
August 24, 2004

Biographic Sketch of Kubler_Ross
Swiss-American psychiatric
1963 accepted a position at the University of Colorado School
of Medicine
Completed her training in psychiatry in 1963
Pioneer in near death studies and the author of the
groundbreaking book On Death and Dying (1969)
1977 in Escondido, California, near San Diego, she founded
"Shanti Nilaya" (Home of Peace)

Stages of Grief
Acronym 'DABDA'.
Denial
Anger
Bargaining
Depression
Acceptance

Stages of Grief Contd…
Denial
A healthy response to a stressful situation, and it act as a
temporary buffer to help protect individual.
“This can’t be happening to me”
Anger
A person become angry, resentful, and hostile. Anger may
be directed to love ones and expressed through shouting,
complaining, and bitterness.
“Why is this happening to me”

Bargaining
Typically occurs throughout the dying process. Before a
loss, it seems like you will do anything if only your loved
one would be spared, you bargain to prolong life.
Depression
Feels as though it will last forever but It is the an
appropriate response of great loss not a mental
illness

Acceptance
Reality that our loved one is physically
gone and recognizing that this new
reality is the permanent reality

Criticisms Of Kubler-ross Theory
There exists no real evidence that stages are present in coping
with death
No evidence that people coping with their impending death
move through all of stages one through five
The limitations on the method of research employed by Kubler-
Ross have not been adequately considered
Stage Theory tends to prescribe rather than describe

Criticisms Of Kubler-ross Theory Contd…
Environmental factors
 A person's whole life may be over-looked in favor of the stages
they are supposed to be going through

Additional
Theoretical
Models

Charles A Corr
A social psychologist and recent researcher who wants to
help caregivers, researchers, and educators move beyond
limitations of the stage theory
Individual coping strategies
Patient empowerment
Practical guidelines for the dying patient

Debbie Messer Zlatin
She took focus away from how the observer deals with dying
process and tried to learn how the dying person interprets his/her
own reality
Exploratory study
Life themes
Importance of integration of themes

William McDougall
A researcher, founder of field of social psychology. He kept a
journal of his own terminal illness, and provided an intellectual
approach
Need to avoid increasing pain & to remain alert and mentally fit
His intellect was the most inspired when his pain was most
intense. Therefore, he did not feel like he was defeated
He did not concentrate on emotions, nor did he attempt to
create a list of developmental tasks
stresses personal uniqueness because it is individual-centered.

Physical
Signs Of
Dying
Confusion
& Drowsines
Skin is
cold to
touch
Breathing
problems
Loss of
bowel or
bladder
control
Withdrawal
Decreased
appetite

Pronouncement Of Death
Absence of carotid pulses
Pupils are fixed and dilated
Absent heart sounds
Absent breath sounds

Fears of Dying Person
Fear of loneliness
Fear of sorrow
Fear of the unknown
Loss of self concept & body integrity
Fear of regression
Fear of suffering & pain

Taking Care Of Dying Person
Deal with mental anguish and fear of death
Listen carefully
Accept their own counter transferences, as doubts, guilt and
damage to their narcissism are encountered
Developing a sense of control and efficacy
Encouraging peer groups for families coping with
bereavement.

Taking Care Of Dying Person Contd…
Developing increased resourcefulness in dealing with death
related situations
Recognize level of death anxiety
Understanding of pain and suffering
Effective communication and interactions

Changes In Body After Death
Rigor Mortis
Body becomes stiff within 4 hours after death as a result of
decreased ATP production. ATP keeps muscles soft and
supple.
Algor Mortis
Temperature decreases by a few degrees each hour. The
skin loses its elasticity and will tear easily.

Rigor Mortis Algor Mortis

Changes In Body After Death Contd…
Livor Mortis
Dependent parts of body become discolored. The patient
will likely be lying on their back, their backside being the
'dependent' body part. The discoloration is a result of blood
pooling, as the hemoglobin breaks down.

Last Offices
“Procedures performed,
usually by a nurse ,to the
body of a dead person
shortly after death has been
confirmed They can vary
between hospitals and
between cultures”

Last Offices Contd…
Aims
To prepare the deceased for the mortuary (a funeral home or
morgue), respecting their cultural beliefs
Comply with legislation, in particular where the death of a
patient requires the involvement of a Procurator Fiscal aka.
Coroner
To minimize any risk of cross-infection to relative, health care
worker or persons who may need to handle the deceased

Procedure
Straighten the body
See that dentures are placed in the mouth if patient has any
Remove all appliances
Close the eyes and mouth when open
Bring the jaws together by placing a rolled towel under the chin
Bathe the body using the Lysol solution to rinse

Procedure contd…
Pack anus & Vagina (if female). If there is any discharge from
the nose and mouth, pack them too
Pad wrists with cotton and the tie the 2 wrists together
Pad the ankles and tie them together.
Wrap body with a sheet well & attach tag
Cover the prepared body with a sheet and notify the head
nurse or call for the messenger to take the body to the morgue

Conclusion
Terminally ill patients constitute a vulnerable group that
deserves specialized and sensitive care that addresses their
physical, psychosocial, and spiritual needs. This
comprehensive approach to care at the end of life requires
better understanding of the religious background of patients.
Improvement in the awareness of healthcare professionals
about Islamic teachings is likely to promote sensitive caring
for their Muslim patients.

References
Retrieve from https://en.wikipedia.org/wiki/Elisabeth_K%C3%BCbler-Ross on 9th Feb
2017
https://nurseslabs.com/nursing-care-of-the-dead/ on 17th Feb , 2017
Retrieved from http://medical-dictionary.thefreedictionary.com/dying on 22nd Feb ,
2017

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