Understanding the dying process and needs of the resident nearing the end of life.

1. Unit A Nurse Aide Workplace Fundamentals Essential Standard NA2.00 Apply communication and interpersonal skills and physical care that promote mental health and meet the social and special needs of residents in long-term care. Indicator 2.04 Understand the Dying Process and Needs of the Resident Nearing the End of Life. Understanding the dying process and needs of the resident nearing the end of life. Nursing Fundamentals 7243

2. 2.04 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 indicator also includes care of the body following death. Nursing Fundamentals 7243

3. The sun setting is no less beautiful than the sun rising. Nursing Fundamentals 7243

4. Psychological changes of the grieving resident Five stages of grieving have been identified by Elizabeth Kubler-Ross Nursing Fundamentals 7243

5. Elizabeth kubler-ross five stages • Not all residents go through all the stages • Some residents may stay in one stage until death occurs • Residents may move back and forth between grieving stages • Family and friends of the resident will experience the grief stages Nursing Fundamentals 7243

6. Elizabeth kubler-ross five stages Understanding the stages of griefhelps the Nurse Aideapply psychological support to resident, family, and friends Nursing Fundamentals 7243

7. Elizabeth kubler-ross five stages • DENIAL • Defense mechanism • Buffer against reality • Emotional escape hatch • Resident may request another opinion Nursing Fundamentals 7243

8. Elizabeth kubler-ross five stages • DENIAL (continued) • Resident may avoid discussion of death • Feeling of, “This can’t be happening to me.” Nursing Fundamentals 7243

9. Care Point Nurse Aides must be ready to listen if the resident expresses their feelings Nursing Fundamentals 7243

10. Elizabeth kubler-ross five stages • ANGER • Bitterness and turmoil • Sense of unfairness • Blame of others such as health care workers • Feeling of, “Why me?” Nursing Fundamentals 7243

11. Care Point • Nurse Aide must not take the accusations personally • Do not follow the urge to leave the angry resident • Listen empathetically Nursing Fundamentals 7243

12. Elizabeth kubler-ross five stages • BARGAINING • Turn to religious and spiritual beliefs • Promises to God and others • Comfort and hope when all seems lost Nursing Fundamentals 7243

13. Elizabeth kubler-ross five stages • BARGAINING(continued) • Generally know this won’t work • Frustration and anger dissolve into depression • “If only...I will” Nursing Fundamentals 7243

14. Care Point • Listen and reflect what is said, express understanding • Be aware of when silence is helpful and words are not Nursing Fundamentals 7243

15. Elizabeth kubler-ross five stages • DEPRESSION • Belief that hope is lost • Overwhelming despair • Introverted and withdrawn • Reminiscing and reviewing life • Sleeplessness • “I always wanted to” Nursing Fundamentals 7243

16. Care Point • Your touch, if accepted, can be very helpful • Understand the resident’s feeling of loss • Do not deny death is approaching Nursing Fundamentals 7243

17. Elizabeth kubler-ross five stages • 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.” Nursing Fundamentals 7243

18. Care Point • Your presence lets them know you will not desert them • Listen if they wish to discuss their death Nursing Fundamentals 7243

19. Unit A / Essential Standard NA2.00 / Indicator 2.01 / Letter B BRAIN STORM Think Recall the conversation of a friend who had a family member to die. Did you hear any of Kubler-Ross stages of death (grieving)? Act Raise your hand and share your thoughts. Nursing Fundamentals 7243

20. Kubler-Ross – Five stages of griefHave we got it?Let’s check and see Student Name A Student Name B Stick diagnostics Nursing Fundamentals 7243

21. FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH • Personal experiences • Culture; some fear death others look forward to and accept death  Nursing Fundamentals 7243

22. Factors influencing residents/family attitudes toward death • Religion • Belief in life after death  • Reunion with loved ones  • Reincarnation • Punishment for sins  • No afterlife  Nursing Fundamentals 7243

23. FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH • Age: • Children view death at temporary • Adults may develop fears of pain and suffering, dying alone, separation from loved ones • Elderly generally have fewer fears Nursing Fundamentals 7243

24. Individual resident’s reaction to death • Accept or be resigned to death • Open and receptive • Communicate about uncertainties • Fearful or angry • Despairing or anxious • Hostile • Thoughtful and meditative Nursing Fundamentals 7243

25. COMMONPHYSICAL SIGNSOFIMPENDING DEATH • Changes in sensory function and the ability to speak • VISION • Blurred and failing vision • Increased secretions in corner of eye • No eye movement / staring / unfocused eye Nursing Fundamentals 7243

26. Reduce glare and keep room lightening low Nursing Fundamentals 7243

27. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in sensory function and the ability to speak • SPEECH • becomes difficult • hard to understand • may be unable to speak Nursing Fundamentals 7243

28. Do not expect an answer • Observe body language of the resident • Anticipate needs Nursing Fundamentals 7243

29. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in SENSORY FUNCTION and the ability to speak • HEARING • last sensory function to be lost… Nursing Fundamentals 7243

30. Be careful what you say! Nursing Fundamentals 7243

31. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in sensory function and the ability to speak • TOUCH • SENSE OF TOUCH IS DEMINISHED Nursing Fundamentals 7243

32. Resident can no longer turn themselves, SKIN CARE IS PARAMOUNT Nursing Fundamentals 7243

33. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in CIRCULATION AND MUSCLE TONE and the ability to speak • LOSS OF MOVEMENT, MUSCLE TONE, AND FEELING • Body is limp • Jaw may drop • Mouth may stay partly open Nursing Fundamentals 7243

34. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in CIRCULATION AND MUSCLE TONE and the ability to speak • CIRCULATION FAILS • Heat is lost from the body’ • Mottling (bruised appearance), spotting, or blotching of skin caused by poor circulation Nursing Fundamentals 7243

35. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in CIRCULATION AND MUSCLE TONE and the ability to speak • CIRCULATION FAILS • Hands and feet cold to touch • Face becomes pale or gray and mottled • Perspiration may increase (DIAPHORESIS) Nursing Fundamentals 7243

36. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Blood pressure decreases Nursing Fundamentals 7243

37. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Pulse: Abnormally slow, rapid, or irregular Nursing Fundamentals 7243

38. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Temperature: Rising or below-normal Nursing Fundamentals 7243

39. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Respirations: Slow, irregular alternating with rapid, shallow akaCheyne-Stokes Nursing Fundamentals 7243

40. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in VITAL SIGNS RESPIRATIONS: “fish out of water breathing”aka Agonal Breathing Nursing Fundamentals 7243

41. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Respirations: Rattling or gurgling sound referred to as Death Rattle Nursing Fundamentals 7243

42. Elevate HOB to facilitate breathing Nursing Fundamentals 7243

43. Unit A / Essential Standard NA2.00 / Indicator 2.01 / Letter B BRAIN STORM Think Why do you think the vital signs change as they do when a resident is dying? Act Raise your hand and share your thoughts. Nursing Fundamentals 7243

44. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in bowel and bladder elimination Urinaryandanalincontinence Nursing Fundamentals 7243

45. COMMON PHYSICAL SIGNS OF IMPENDING DEATH • Changes in bowel and bladder elimination • Decreased peristalsis • abdominal distention • release of flatus Nursing Fundamentals 7243

46. BRAIN STORM Think Why do you think the changes in bowel and bladder elimination occur? Act Raise your hand and share your thoughts. Nursing Fundamentals 7243

47. COMMON PHYSICAL SIGNS OF IMPENDING DEATH DECREASED PAIN Nursing Fundamentals 7243

48. COMMON PHYSICAL SIGNS OF IMPENDING DEATH DECREASED INTAKE OF FOOD AND FLUID Nursing Fundamentals 7243

49. Modify diet. • Do not force feed. • Fluids most important. Nursing Fundamentals 7243

50. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Disorientation and confusion, loss of consciousness Nursing Fundamentals 7243