The document outlines a seminar on end-of-life care, focusing on the definition, types of grief, and the psychosocial and physical manifestations of approaching death. It emphasizes the importance of providing comprehensive support to both patients and their families during this critical period. Additionally, it provides guidelines for the care of the body after death, including procedural steps and documentation requirements.

1. KING GEORGE’S MEDICAL UNIVERSITY
KING GEORGE’S ,COLLEGE OF NURSING
SEMINAR ON
END OF LIFE CARE
SUBMITTED TO: SUBMITTED BY:
MRS. PRIYANKA SINGH DIVYA PAL
CLINICAL INSTRUCTOR M.SC. N. 1ST YEAR
K.G.M.U. COLLEGE OF NURSING K.G.M.U. COLLEGE OF NURSING
1

2. OUTLINES
• Introduction
• Definition of end of life care
• Terminologies
• Types of grief
• Theories of grief
• Indications of death
• Psychosocial manifestation of approaching death
• Physical manifestation of approaching death
• Care of the body after death
2

3. INTRODUCTION
End –of -life care includes physical, emotional, social and spiritual support for
patients and their families. The goal of end -of -life care is to control pain and other
symptoms so the patient can be as comfortable as possible.
3

4. DEFINITION
“End-of –life care refers to health care, not only of patients in the final hours or
days of their lives, but more broadly care of all those with a terminal illness or
terminal disease condition that has become advanced ,progressive and incurable.”
4

5. TERMINOLOGIES
Loss:- an aspect of self no longer available to a person.
Death:- cessation of life.
Grief:- pattern of physical and emotional responses to bereavement.
End of life:- final phase of a patient’s illness when death is imminent.
Death rattle:- a sound that is something heard coming from a dying person’s
throat or chest.
Palliative care:- making life as easy as possible for patients and families living
with serious illness.
5

6. Hospice care:- Hospice care is given when there is life expectancy of 6 months
or less.
6

7. DEFINITION OF GRIEF
Grief is a strong sometime overwhelming emotion for people, regardless of
whether their sadness stems from the loss of a loved one or from a terminal
diagnosis they or someone they love have received.
7

8. TYPES OF GRIEF
Normal grief:- Complex emotional, social, physical, behavioural and spiritual
responses to loss and death.
Anticipatory grief:- Associated with the normal grief response before the loss
actually occurs.
Delayed or inhibited grief:- Absence of evidence of grief when it ordinarily
would be expected.
Distorted grief:- Symptoms associated with normal grieving are exaggerated.
8

9. Chronic or prolonged grief:- Maintaining personal possessions aimed at keeping
a lost loved one alive.
Disenfranchised grief:- When relationship to the decreased person is not socially
sactioned.
9

10. Ambiguous loss:- The lost person is physically present but not psychologically
available.
Complicated grief:- Prolonged or significantly difficult time moving forward
after a loss.
Masked grief:- Disruptive behaviour due to loss and ineffective grief resolutions.
10

11. KUBLER-ROSS THEORY
5 STAGES OF GRIEVING(1969):- The five stages of grief model or the kubler ross
model is popularly known as a model that describes a series of emotions
experienced by people who are grieving:-
DENIAL
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE
11

12. 12

13. BOWLBY 4 PHASES OF MOURNING (1980)
Bowlby and markes (1980) identify four phases of mourning :-
 Numbing
 Yearning and searching
 Disorganization and despair
 Reorganization
NUMBING:- feeling “stunned” or “unreal” can be interrupted by periods of
intense emotion. 13

14. YEARNING AND SEARCHING:- Full effects of emotional outbursts and
uncontrollable crying.
DISORGANIZATION AND DESPAIR:- Evaluation of loss, may become angry at
perceived person at fault.
REORGANIZATION:- Person begins to move forward with life, roles , skills and
relationships.
14

15. WORDEN’S FOUR TASKS OF MOURNING
WORDEN’S FOUR TASKS OF MOURNING(1991):-
Task 1:- To accept the reality of the loss.
Task 2:- To work through the pain and grief.
Task 3:- To adjust to the environment in which the decreased is missing.
Task 4:- To emotionally relocate the decreased and move on with life.
15

16. 16

17. INDICATIONS OF DEATH
Relaxed muscles
No pulse
No breathing
Fixed eyes
Total lack of response to external stimuli.
No muscular movement , especially breathing.
No reflexes
A bowel or bladder release
No response
17

18. PSYCHOSOCIAL MANIFESTATIONS OF APPROACHING DEATH
Altered decision making
Anxiety
Helplessness
Life review
Peacefulness
Unfinished business
18

19. Restlessness
Saying goodbyes
Decreased socialization
Fear of loneliness
Fear of meaninglessness
Unusual communication of one’s life
Fear of pain
Vision like experience
19

20. PHYSICAL MANIFESTATION OF APPROACHING DEATH
Sensory:- decreased sensation , perception, blurring of vision, siking and glazing
of eyes, blink reflex absent, eyelids remain half open.
Integumentary:-mottling on hands ,feet, arms and legs , cold, clammy skin,
cyanosis on nose, nail beds, knees , wax like skin when very near to death.
Respiratory:- increased respiratory rate , chyne-stokes respiration , inability to
cough or clear respiration , secretions resulting in grunting , gurgling.
20

21. Urinary:- decreased urine output , urinary incontinence, unable to urinate.
Gastrointestinal :-accumulation of gas, distension, nausea , loss of sphincter
control.
Musculoskeletal :- inability to move, sagging of jaw , difficulty in swallowing ,
difficulty in maintaining posture and alignment , loss of gag reflex, jerking.
Cardiovascular:- increased heart rate, slower and weakening pulse, irregular
rhythm . decreased in blood pressure , delayed absorption of drugs.
21

22. CARE OF BODY AFTER DEATH
PROCEDURAL GUIDELINES:-
EQUIPMENTS:- Bath towels, wash clothes, wash basin, scissors, shroud kit with
name tags, bed linen , room deodorizer, documentation forms.
22

23. NURSES:-
 Make arrangements for staff, spiritual advisor or other to stay with the family
while the body is prepared for viewing.
Prepare the death care tray.
23

24. Cleanse body thoroughly, apply clean sheets.
Brush and comb clients hair.
Encourage family to say good bye through both touch and talk.
24

25. Do not rush good bye process.
Remove all equipments and ornaments.
Clarify the personal belongingness to handover the personal objects and body.
Do not discard items found after the family is gone, tell them what is found. 25

26. Apply name tags.
Cover the body while shifting on the death trolly.
Complete documentation
Follow all protocols and policies to meet all legal requirements in caring for the body.
26

27. APPROPRIATE DOCUMENTATION
Time of death and actions taken to prevent or cardiac arrest record if applicable.
Name of the person that pronounced the client’s death.
Make special preparation and type of donation , including time, staff, company.
27

28. The name of the family member or friend who was called and who came to the
hospital- donor organization, morgue, funeral home, chaplain.
Time of discharge and destination of the body , location of the name tags on the
body, special requests .
 Made by the family ,any other statements that might be needed to clarify the
situation.
28

29. 29