The document discusses Kubler-Ross's five stages of grief (denial, anger, bargaining, depression, acceptance) and common fears of dying patients such as fear of loneliness, sorrow, the unknown, loss of control, and suffering/pain. It also addresses supporting grieving individuals and families, nursing care for the dying patient and after death, and how cultural backgrounds can impact beliefs about 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