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Death and dying-1

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Death and dying-1

  1. 1. Death and Dying Nur 448
  2. 2. Definitions <ul><li>Terminally ill </li></ul><ul><li>Imminently dying </li></ul>
  3. 3. … in Modern Society <ul><li>The Death-Dying Relationship </li></ul><ul><li>Dying: Denial and Beyond Denial </li></ul>
  4. 4. … Fears of the Patient <ul><li>Fear of Isolation </li></ul><ul><li>Fear of Pain </li></ul><ul><li>Fear of Dependence </li></ul><ul><li>Fear of Death Itself </li></ul><ul><ul><li>Death and Immortality </li></ul></ul><ul><ul><li>Death as the End </li></ul></ul>
  5. 5. Stages of Dying <ul><li>Denial and isolation </li></ul><ul><li>Anger </li></ul><ul><li>Bargaining </li></ul><ul><li>Depression </li></ul><ul><li>Acceptance </li></ul>
  6. 6. Setting Treatment Priorities <ul><li>Information sharing </li></ul><ul><li>Responsivity and responsibility </li></ul><ul><li>How much and what kind? </li></ul><ul><li>Treating losses and fears </li></ul><ul><li>Maintaining hope </li></ul>
  7. 7. When Death Is Imminent <ul><li>Maximizing comfort </li></ul><ul><li>Saying good-bye </li></ul><ul><li>Accepting rejection </li></ul>
  8. 8. When You Don ’t Know What To Say <ul><li>Avoid rote responses – each person is unique. </li></ul><ul><li>Avoid common greetings (e.g. “ Hi! How are you?). </li></ul><ul><li>Be sincere, genuine and honest. Admit you don ’ t know what to say. </li></ul><ul><li>Don ’ t be afraid to discuss death. </li></ul>
  9. 9. When You Don ’t Know What To Say <ul><li>Don ’ t lecture or preach. </li></ul><ul><li>Let the person talk. </li></ul><ul><li>Ask what you can do and do it. Keep your promises. </li></ul><ul><li>Watch your tone of voice. Avoid “ cutesy ” baby talk and condescension. </li></ul><ul><li>Don ’ t abandon the patient. </li></ul>
  10. 10. Responses of the Patient ’s Family <ul><li>Anticipatory grief </li></ul><ul><li>Phases of grief </li></ul><ul><ul><li>Shock and numbness </li></ul></ul><ul><ul><li>Yearning and searching </li></ul></ul><ul><ul><li>Disorganization and despair </li></ul></ul><ul><ul><li>Reorganization </li></ul></ul>
  11. 11. What to Say to the Family <ul><li>How are you doing with all of this? </li></ul><ul><li>What can I do for you? </li></ul><ul><li>You must really be hurting </li></ul><ul><li>You must feel angry </li></ul><ul><li>This must be hard for you </li></ul><ul><li>Take all the time you need </li></ul><ul><li>Thank you for sharing your feelings </li></ul>
  12. 12. What NOT to Say <ul><li>I understand how you feel </li></ul><ul><li>Death was a blessing </li></ul><ul><li>It was God ’ s will </li></ul><ul><li>It all happened for the best </li></ul><ul><li>You ’ re still young </li></ul><ul><li>Be strong! </li></ul><ul><li>You have your whole life ahead of you </li></ul><ul><li>You ’ ll feel worse before you feel better </li></ul><ul><li>You can have other children </li></ul><ul><li>You can always remarry </li></ul><ul><li>Call me when I can help </li></ul><ul><li>Something good will come out of this </li></ul><ul><li>At least you have another child </li></ul><ul><li>He/she led a full life </li></ul><ul><li>It ’ s time to put it behind you now </li></ul>
  13. 13. Hospice <ul><li>Cares for people approaching death </li></ul><ul><li>Respects and values the dignity and worth of each person </li></ul><ul><li>Philosophy is to cherish and emphasize life </li></ul>
  14. 14. Hospice Services <ul><li>Interdisciplinary approach </li></ul><ul><li>Palliative care </li></ul><ul><li>Pain management </li></ul><ul><li>Support for family (respite care) </li></ul><ul><li>Death with dignity </li></ul><ul><li>Grief and bereavement </li></ul><ul><li>Funeral and memorial planning </li></ul>
  15. 15. Hospice Personnel <ul><li>Case manager </li></ul><ul><li>Nurses </li></ul><ul><li>Home health aides and homemaker services </li></ul><ul><li>Social workers </li></ul><ul><li>Spiritual counselors </li></ul><ul><li>Volunteers </li></ul><ul><li>Medical director and attending physician </li></ul><ul><li>Dietitians </li></ul><ul><li>PT, OT, ST </li></ul>
  16. 16. Preparing for Death – Advanced Directives <ul><li>Health Care Surrogate </li></ul><ul><li>Living Will </li></ul><ul><li>Legal Proxy </li></ul>
  17. 17. Everyone should have a living will Preparing a Living Will

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