Ch17

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 17
Dying and Death:
The Last Developmental Stage

DeathDeath
 Defined by The Uniform Determination of
Death Act
– Irreversible cessation of circulatory and
respiratory functions
– Irreversible cessation of all functions of the
brain, including the brain stem

EuthanasiaEuthanasia
 Legally defined as act or practice of
painlessly putting to death persons from
incurable or distressing diseases
 Illegal throughout the world
 Many do not support active euthanasia
 Some may support passive euthanasia

Euthanasia cont.Euthanasia cont.
 Physiologic, economic, and sociologic
aspects are not considered when
prolonging life
 Based on two fundamental principles
– Right to privacy
– Right to refuse treatment when informed

Right-to-Die MovementRight-to-Die Movement
 Insists people should have the last word
about their own lives, either to maintain or
to discontinue treatment when ill or dying
 Living Will laws
 Brain-death laws
 Durable power of attorney

Patient Self-Determination ActPatient Self-Determination Act
 Written information about rights in order
for person in order for person to make
medical decisions
 Institutions must recognize Living Will and
Durable Power of Attorney for Health Care
 Agencies must educate staff, maintain
written policies, and document person’s
status on medical record

Types of Advanced DirectivesTypes of Advanced Directives
 Living Will
 Durable Medical Power of Attorney for
Health Care
 Advanced Medical Directive
 Declaration of Desire for a Natural Death

Assisted SuicideAssisted Suicide
 American Nurses Association has issued
a statement against it
 Certain measures fall within ethical
principles
– Double effect
– Patient autonomy
– Practicing futile interventions

Role of NurseRole of Nurse
 Review guidelines that help to determine
client’s desire to die and how to respond
 Determine own beliefs about life, death,
and practices
 Listen carefully to clients and families
 Act on values about the sanctity of life and
health
 Let live and let die

Child’s Concept of DeathChild’s Concept of Death
 Death is reversible (0-5)
 Death is personified (5-9)
 Death is final (9 and above)
 Ideas and anxiety about separation and
death and ability to handle loss are
influenced by many factors

Child’s Concept of Death cont.Child’s Concept of Death cont.
 Perceptions
– Parent’s death deliberate
– Death is catching
– Associate death with sleep
– Blame on the living parent
– Use of magical thinking
 Children often know more about death
than parents realize

Adolescent’s Concept of DeathAdolescent’s Concept of Death
 Concerned about the body and personal
future
 Low tolerance for accepting death
 Perceives self as invincible
 Death means a lack of fulfillment
 May not cry at death of loved one
 May hide mourning

Adult’s Concept of DeathAdult’s Concept of Death
 Influenced by experiential, cultural, and
religious backgrounds
 Past experiences and whether death is
sudden or anticipated also affects concept
 Four responses to viewing death
– Positivist
– Negativist
– Activist
– Passivist

Near-Death ExperiencesNear-Death Experiences
 People describe similar experiences
 People awake with sense of peace,
comfort, and bliss
 Case studies verify near-death
experiences
 Respect that some view as a religious
experience and others not

Near-Death AwarenessNear-Death Awareness
 Extraordinary awareness of how death will
unfold and what the person will need to
die well
 Pay attention to everything dying person
says
 Watch for signs in the client’s behavior
that indicate near-death awareness
 Respond positively to client

Stages of AwarenessStages of Awareness
 Closed awareness
– Client does not know about impending death
 Suspicious awareness
– Client suspects death
 Mutual pretense
– Client knows that he or she is dying
 Open awareness
– Client knows that he or she is dying and
others acknowledge

Premonition of DeathPremonition of Death
 Refers to those people who lack any sign
of death yet correctly anticipate their own
deaths
– Feel no depression or anxiety toward death
– May make less contact with others during
terminal period
 Death perceived as release from
continuing in world where there is no
reason to remain

Postponement of DeathPostponement of Death
 Refers to person who makes overt or
covert decision about the choice of date or
event of time for death
 Death may seem inevitable but person
holds on unexpectedly
 Some live beyond time of expected death

Grief ReactionsGrief Reactions
 Denial and isolation
 Anger
 Depression
 Preparatory Depression
 Acceptance or resolution

Anniversary ReactionAnniversary Reaction
 Refers to feelings of grief and sadness or
reliving of mourning process a year after
death of loved one
 Grief may be more intense at other times
– Person’s birth date
– One of several major holiday throughout the
year

Preparation for DeathPreparation for Death
 Establish Living Will
 Keep folder with important information
– Contacts for attorneys, banker, life insurance
– Birth certificates
– Copies of will
– Financial records
– Social security statements
– Personal requests

Organ DonationOrgan Donation
 Continue to administer care to dying client
 Identify the potential donor and refer to
procurement agency
 Family members must understand person
is dead before they are informed of legal
right of donating
 Allow family to talk to procurement
coordinator

PitfallsPitfalls
 Withdrawal from the client
 Isolation of emotions
 Failure to perceive own feelings or
feelings of client and family
 Displacing own feelings onto other team
members
 Burning out
 Fearing illness and death

Personal AssessmentPersonal Assessment
 Be aware of and cope with personal
feelings about death
 Recognize when you need support or time
off
 Establish a support system at work and
outside of work
 Use specialist to talk through feelings
 Establish healthy balance between work
and outside life

Client and Family AssessmentClient and Family Assessment
 Total person is assessed
 Learn what the client and family know
about the client’s condition
 Recognize people handle dying and death
differently
 Get clues from client and family about
what is important to them
 Observe family members for pathological
responses

Examples of Nursing DiagnosesExamples of Nursing Diagnoses
 Death anxiety
 Risk for aspiration
 Decreased cardiac
output
 Chronic pain
 Powerlessness
 Impaired social
interaction
 Impaired
swallowing
 Impaired skin
integrity
 Impaired bed
mobility

Last StageLast Stage
 Create a gestalt of life lived
 Find meaning in accomplishments
 Identify the legacy left behind
 Three tasks
– Recontextualizing
– Resurrecting the unlived life
– Forgiveness

Psychospiritual NeedsPsychospiritual Needs
 Ask questions
– What the client need to get done
– Whom the client needs to contact to resolve
feelings or unfinished business
 Offer to help clients contact clergyman,
relatives, friend, or attorney
 Help patient transform despair into search
for personal meaning

Physical NeedsPhysical Needs
 Nutrition
 Hygiene
 Rest
 Elimination
 Relief of pain
 Care of mouth,
nose, eyes, skin,
and peripheral
circulation
 Positioning
 Environmental
considerations

Caring for the ClientCaring for the Client
 Use principles of effective communication
 Avoid too strict a routine in care
 Encourage communication among doctor,
client, and family
 Explore with family ways to communicate
with client
 Be attentive listener
 Look and speak directly to client

Spiritual and Social NeedsSpiritual and Social Needs
 Needs
– Meaning
– Forgiveness
– Love
– Hope
 Assist with spiritual needs or contact
someone who can
 If possible, help client dress and groom to
receive visitors

Family CareFamily Care
 Family will be comforted by
compassionate care
 Attitude is important
– Convey interest and availability

Family Care cont.Family Care cont.
 Allow family to assist in nontechnical
aspects of care
 Allow family rituals and patterns unless
harmful to client
 Encourage family to take time to rest and
meet needs
 Show acceptance of grief
 Prepare the family for changes in client’s
condition

Crisis of DeathCrisis of Death
 May cause life crises for surviving family
members
 Help family cope and make referrals
 Help family understand the process of the
dying loved one disengaging from life and
from them
 Listen and mediate as family insists on
life-saving and heroic measures

News of DeathNews of Death
 Best communicated to family unit or group
 Done in privacy
 Accommodate requests to see the dead
person
 Use well-timed honesty with survivors of
an accident who inquire about others
 Refer to grief or spiritual counselor

Death of ChildrenDeath of Children
 Encourage parents to share feelings
 Complement parents’ need to care for
child
 Death may cause shock, confusion,
helplessness, emptiness, and intense
sadness
 Long-term therapy is often needed

Assessing GriefAssessing Grief
 Absent or delayed grief
 Complicated grief
 Pathologic grief
 Neurotic grief
 Dysfunctional grief
 Clinical depression

Home CareHome Care
 Visiting nurse helps and teaches family
 Allows family members to gain satisfaction
from administering care
 Client feels dignity, identity, and sense of
control
 Some may feel like this type of care is
“giving up”

Hospice CareHospice Care
 Gives person homelike care with
interdisciplinary team
 Helps the client accept and cope with
dying process
 Fosters communication between client
and family
 Enhances client’s autonomy and relieves
symptoms
 Works with psychological aspect of illness

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