Death

1. Roark, 2004
Grief Process, Death and
Dying

2. Roark, 2004
LOSS
 Actual
 Perceived
 External Objects
 Known Environment
 Significant Other
 Aspect of Self
 Life

3. Roark, 2004
Kubler-Ross Stages of Grief
 Denial
 Anger
 Bargaining
 Depression
 Acceptance

4. Roark, 2004
Death and Dying
 Assisting the patient
to “Live well” and “Die
well”
What does this mean to
you?

5. Roark, 2004
Common fears of the dying patient
 Fear of Loneliness
 Distancing by support people and caregivers
can occur
 Debilitation, pain, and incapacitation
 Hospital, a place that can be very lonely
 Fear of dying alone

6. Roark, 2004
Fears of the dying client
 Fear of Sorrow
 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

7. Roark, 2004
Fears of the dying client
 Fear of the unknown:
 Death is an unknown state
 What will happen after death?
 What will happen to loved ones, those left
behind

8. Roark, 2004
Fears of the dying client
 Loss of self concept and body integrity
 Mutilation via therapy
 Body image changes
 Loss of role or status
 Loss of standard of living

9. Roark, 2004
Fears of the dying client
 Fear of Regression
 Ego is threatened
 Physical deterioration may occur
 Mental deterioration may occur
 Unable to care for self
 Become dependent on others for care

10. Roark, 2004
Fears of the dying client
 Fear of Loss of Self Control
 Loose ability to control life decisions
 Loose ability to control ADL’s
 Loss of control of body functions
 Loss of control of emotions
 Loss of independence

11. Roark, 2004
Fears of the dying client
 Fear of Suffering and Pain
 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

12. Roark, 2004
Child’s Response to Illness and
Death
 Infant
 Toddler
 Preschool
 School Aged
 Adolescent

13. Roark, 2004
Cultural Backgrounds Affect Beliefs
Concerning Death
 Beliefs, attitudes, and values that stem from the
patient’s cultural background will strongly
influence their reaction to loss, grief, and death
 Expressions of grief are governed by what is
acceptable by the family and within the cultural
context
 Comfort may be found through spiritual beliefs,
and finding comfort in specific rites, rituals, and
practices

14. Roark, 2004
Cultural Backgrounds Affect Beliefs
Concerning Death
 Organized religious practices
 Nurses need to be in tune with patients’
spiritual needs
 Becoming familiar with cultural views will
help…
 Can you name some cultural practices
associated with loss, grief, and death?

15. Roark, 2004
Support the client
 Nurses can help to identify coping mechanisms,
and encourage effective coping mechanisms
 Allow client/family to visit the chapel if desired
 Allow family members around
 Client may have problems with conflicting
feelings that do not align with culture or
religious practices-nurse can evaluate coping
and guide the client to appropriate interventions

16. Roark, 2004
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

17. Roark, 2004
Nurses response to the dying
patient
 Nurses grieve also
 Nurses need to come to terms with personal
meanings of life and death
 Best prepared to work with terminal clients
when the nurse has been given the time to
come to terms with own mortality
 Common feelings
 Develop personal/professional support systems

18. Roark, 2004
Rationale for Communicating
Truthfully about Terminal Illness
 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

19. Roark, 2004
Communicating Terminal Illness,
continued
 The nurse:
 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

20. Roark, 2004
List nursing strategies appropriate
for grieving persons
 Open ended statements
 Patient sets the pace
 Accept any grief reaction
 Be aware—nurse may be target of anger
 Remove barriers
 Avoid giving advice
 Allow patient to talk
 Allow patient to express signs of hope
 Support hope by helping focus

21. Roark, 2004
Assist Family to Grieve
 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

22. Roark, 2004
Choices of Care Setting
 Families have choices of where to care for
the dying loved one
 Ask the patient and family preferences
 Support whatever the choice
 Hospital, Home/Hospice

23. Roark, 2004
Elements of Hospice Care
 Home care coordinated with hospital
 Control of symptoms holistically
 Physician directed care
 Utilization of variety of health care
professionals
 Bereavement follow up care
 Acceptance based on need, not $

24. Roark, 2004
Nursing strategies to meet physical
and psychosocial needs of the
dying patient
 Thorough pain control
 Maintain
independence
 Prevent isolation
 Spiritual comfort
 Support the family

25. Roark, 2004
Signs/Symptoms of Approaching
Death
 Motion and sensation is gradually lost
 Increase in temperature
 Skin changes-cold, clammy
 Pulse-irregular, and rapid
 Respirations-strenuous, irregular, Cheyne stokes
 “Death rattle”
 Decrease Blood Pressure
 Jaw and Facial muscles relax
 MOST POSITIVE SIGN OF DEATH=Absence of brain
waves (Need two MDs to sign off)

26. Roark, 2004
Nursing care after death
 Autopsy: examination performed after a
person’s death to confirm or determine
cause of death
 For tissue and organ removal:
 Keep CV system going
 Call donor bank representative
 Must be agreed on by all family members
 Or, patient decision before death

27. Roark, 2004
Nursing care after death
Legally, a person is considered dead when there is
a lack of brain waves even though other body
organs continue to function
This definition allows for harvesting of organs and
tissue for donation
Vital organs are: heart, liver, kidney, lung,
pancreas
Non-vital organs are: eye corneas, long bones,
middle ear bones, and skin

28. Roark, 2004
Deceased patient, before viewing
the body
 Check orders for special requests
 Remove equipment
 Remove supplies
 Change soiled linens and cleanse patient
 Use room deodorizer
 Place patient in supine position, with small pillow
under head
 Insert dentures

29. Roark, 2004
Deceased patient, before viewing
the body continued
 Remove valuables and give to family
 Stay with family, if requested
After the family leaves:
 Tag patient according to hospital/agency policy
 Wrap body in shroud
 Put ID tag on shroud
 Transfer to morgue
 Document

30. Roark, 2004
Describe response of family to
dying process
 Related to cultural background
 Unresolved grief issues
 Emotions
 Requests
 Physical symptoms may occur
 Reorganization
 Individualized grief patterns

31. Roark, 2004
Behavioral responses that obstruct
the expression of grief
 Sudden, unexpected death
 Lengthy illness resulting in death
 Loss of a child
 Perception that the death was preventable
 Unsteady relationship with deceased
 Mental illness of survivor
 Lack of social support

32. Roark, 2004
Thanatology
 Thanatology= study of death
 The description of study of the
phenomena of death, and of psychological
mechanisms for coping with death