Unit 12 Caring For Resident When Death Is Imminent and Following Death

1. Unit 12Caring For Resident When Death Is Imminent and Following Death Nurse Aide I Course DHSR Approved Curriculum-Unit 12

2. Caring for Resident When Death Is Imminent and Following Death Introduction Death is defined as the final stage of life.  The nurse aide will need to develop a realistic attitude toward the topic of death to meet the physical and psychological needs of the resident and the family as they experience the dying process.  This unit also includes care of the body following death. DHSR Approved Curriculum-Unit 12

3. Factors Influencing Attitudes DHSR Approved Curriculum-Unit 12

4. Objective 12.0 Explore personal feelings concerning the concept of death. DHSR Approved Curriculum-Unit 12

5. Caring For Resident When Death Is Imminent and Following Death • Factors influencing attitudes  • Personal experiences  • Culture  • Some fear death  • Others look forward to and accept death  DHSR Approved Curriculum-Unit 12

6. Caring For Resident When Death Is Imminent and Following Death(continued) • Factors influencing attitudes  • Religion  • Belief in life after death  • Reunion with loved ones  • Reincarnation  • Punishment for sins  • No afterlife  DHSR Approved Curriculum-Unit 12

7. Caring For Resident When Death Is Imminent and Following Death(continued) • Factors influencing attitudes  • Age • Children view death as temporary DHSR Approved Curriculum-Unit 12

8. Caring For Resident When Death Is Imminent and Following Death(continued) • Factors influencing attitudes • Age  • Adults may develop fears of: • pain and suffering • dying alone • separation from loved ones • Elderly generally have fewer fears DHSR Approved Curriculum-Unit 12

9. Special Needs Of Dying Resident DHSR Approved Curriculum-Unit 12

10. Objective 12.1 Identify the special needs of a dying resident. DHSR Approved Curriculum-Unit 12

11. Special Needs Of Dying Resident • Visits with family/significant others • Features of resident’s room: • pleasant as possible • lighting that meets resident’s preferences • well ventilated • odor free DHSR Approved Curriculum-Unit 12

12. Special Needs Of Dying Resident(continued) • Features of resident’s room: • Contains personal items which provide comfort and reassurance • Pictures • Mementos • Cards • Flowers • Religious objects DHSR Approved Curriculum-Unit 12

13. Objective 12.2 Identify eight comfort measures that may be used with the dying resident. DHSR Approved Curriculum-Unit 12

14. Special Needs Of Dying Resident(continued) • Comfort Measures • Attention to skin care • Good personal hygiene • Oral hygiene - denture care • Bedding changed as needed • Back massages DHSR Approved Curriculum-Unit 12

15. Special Needs Of Dying Resident(continued) • Comfort Measures • Frequent position changes • every two hours • P.R.N. • Good body alignment • supportive devices • prevention of deformities and pressure ulcers DHSR Approved Curriculum-Unit 12

16. Special Needs Of Dying Resident(continued) • Comfort Measures • Head of bed elevated to facilitate breathing • Modified diet DHSR Approved Curriculum-Unit 12

17. Caring For Residents When Death Is Imminent And Following Death: Nurse Aide's Role DHSR Approved Curriculum-Unit 12

18. Objective 12.3 Describe the nurse aide’s role in relationship to the to the needs of the dying. DHSR Approved Curriculum-Unit 12

19. Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role • Source of strength and comfort • Open and receptive • Know own feelings about death and do not project those feelings onto resident. DHSR Approved Curriculum-Unit 12

20. Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role(continued) • Empathetic • Calm and efficient • Normal tone of voice • Good listening skills • Non-judgmental DHSR Approved Curriculum-Unit 12

21. Individual Resident's Reaction to Death DHSR Approved Curriculum-Unit 12

22. Objective 12.4 Review the various reactions residents may have as they face death. DHSR Approved Curriculum-Unit 12

23. Individual Resident’s Reaction To Death • Accept or be resigned to death • Open and receptive • Communicate about uncertainties • Fearful or angry • Despairing and anxious • Hostile • Thoughtful and meditative DHSR Approved Curriculum-Unit 12

24. Five Stages Of Grief, Death And Dying As Described By Dr. Elisabeth Kubler-Ross DHSR Approved Curriculum-Unit 12

25. Objective 12.5 List and describe the five stages of grief, death and dying. DHSR Approved Curriculum-Unit 12

26. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • DENIAL • Defense mechanism • Buffer against reality • Emotional escape hatch • Resident may request another opinion DHSR Approved Curriculum-Unit 12

27. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • DENIAL (continued) • Resident may avoid discussion of death • Feeling of, “This can’t be happening to me.” DHSR Approved Curriculum-Unit 12

28. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • ANGER • Bitterness and turmoil • Sense of unfairness • Blame of others such as health care workers • Feeling of, “Why me?” DHSR Approved Curriculum-Unit 12

29. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • BARGAINING • Turn to religious and spiritual beliefs • Promises to God and others • Comfort and hope when all seems lost DHSR Approved Curriculum-Unit 12

30. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • BARGAINING (continued) • Generally know this won’t work • Frustration and anger dissolve into depression • “If only...I will” DHSR Approved Curriculum-Unit 12

31. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • DEPRESSION • Belief that hope is lost • Overwhelming despair • Introverted and withdrawn • Reminiscing and reviewing life • Sleeplessness • “I always wanted to” DHSR Approved Curriculum-Unit 12

32. Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross • ACCEPTANCE • Calm and subdued interest in life • Strives to complete unfinished business • Helps loved ones accept death • Needs others to validate worth of life • “I’ve had a good life.” DHSR Approved Curriculum-Unit 12

33. Signs of Approaching Death DHSR Approved Curriculum-Unit 12

34. Objective 12.6 Recognize the signs of approaching death. DHSR Approved Curriculum-Unit 12

35. Signs Of Approaching Death • Changes in sensory functions and ability to speak • Vision • increased secretions in corner of eyes • blurred vision • failing vision • no eye movement/staring DHSR Approved Curriculum-Unit 12

36. Signs Of Approaching Death • Changes in sensory functions and ability to speak (continued) • Speech • becomes difficult • hard to understand • may be unable to speak • Hearing - last function to be lost DHSR Approved Curriculum-Unit 12

37. Signs Of Approaching Death • Changes in circulation and muscle tone • Circulation • fails • heat gradually lost from body • hands and feet cold to touch and mottled • face becomes pale or gray and mottled • perspiration may increase (diaphoresis) DHSR Approved Curriculum-Unit 12

38. Signs Of Approaching Death • Changes in circulation and muscle tone (continued) • Muscle tone • body limp • jaw may drop • mouth may stay partly open DHSR Approved Curriculum-Unit 12

39. Signs Of Approaching Death • Changes in Vital Signs • Respirations • slower • shallow • labored • may experience dyspnea, apnea, Cheyne-Stokes • mucous collects in the throat and bronchial tubes (death rattle) DHSR Approved Curriculum-Unit 12

40. Signs Of Approaching Death • Changes in Vital Signs (continued) • Pulse • rapid • weak and irregular • Blood pressure drops • Temperature • elevated • subnormal DHSR Approved Curriculum-Unit 12

41. Signs Of Approaching Death • Urinary and anal incontinence • Decreased peristalsis, abdominal distention • Release of flatus • Decreased pain • Loss of consciousness DHSR Approved Curriculum-Unit 12

42. Nurse Aide's Role In Spiritual Preparation For Death DHSR Approved Curriculum-Unit 12

43. Objectives 12.7 Define the role of the nurse aide in the spiritual preparation for death. 12.8 Contrast the spiritual preparation for death practiced by those of various religions. DHSR Approved Curriculum-Unit 12

44. Nurse Aide’s Role In Spiritual Preparation For Death • Priest, rabbi, minister or other clergy may be contacted at request of resident or family • Privacy to be provided when clergy with resident DHSR Approved Curriculum-Unit 12

45. Nurse Aide’s Role In Spiritual Preparation For Death(continued) • Support resident’s religious/spiritual practices even if different from that of nurse aide • Listen respectfully to religious/spiritual beliefs • Participate in religious practices if asked and acceptable DHSR Approved Curriculum-Unit 12

46. Nurse Aide’s Role In Spiritual Preparation For Death(continued) • Treat religious objects with care and respect: • medals • pictures • statues • bibles • Encourage family and friends to be included DHSR Approved Curriculum-Unit 12

47. Nurse Aide's Role In Meeting Family Needs DHSR Approved Curriculum-Unit 12

48. Objective 12.9 Identify the needs of the family as they encounter the dying process. DHSR Approved Curriculum-Unit 12

49. Nurse Aide’s Role In Meeting Family Needs • Available for support • Use touch as appropriate • Courteous and considerate • Respect right to privacy • Let family assist with care, if they desire, where appropriate DHSR Approved Curriculum-Unit 12

50. Nurse Aide’s Role In Meeting Family Needs(continued) • Use good communication skills • Listen and provide understanding throughout the grief/loss stages • Answer questions or refer to supervisor DHSR Approved Curriculum-Unit 12