Unit 12Caring For Resident When Death Is Imminent and Following Death: Unit 12 Caring For Resident When Death Is Imminent and Following Death Nurse Aide I Course


Caring for Resident When Death Is Imminent and Following Death : 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.


Slide4: 12.0 Explore personal feelings concerning the concept of death.


Caring For Resident When Death Is Imminent and Following Death: 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 


Caring For Resident When Death Is Imminent and Following Death(continued): 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 


Caring For Resident When Death Is Imminent and Following Death(continued): Caring For Resident When Death Is Imminent and Following Death (continued) Factors influencing attitudes  Age Children view death as temporary


Caring For Resident When Death Is Imminent and Following Death(continued): 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


Slide10: 12.1 Identify the special needs of a dying resident.


Special Needs Of Dying Resident(continued): 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


Slide13: 12.2 Identify eight comfort measures that may be used with the dying resident.


Special Needs Of Dying Resident(continued): 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


Special Needs Of Dying Resident(continued): 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


Special Needs Of Dying Resident(continued): Special Needs Of Dying Resident (continued) Comfort Measures Head of bed elevated to facilitate breathing Modified diet


Slide18: 12.3 Describe the nurse aide’s role in relationship to the to the needs of the dying.


Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role: Caring For Resident When Death Is Imminent and Following Death Nurse Aide’s Role Source of strength and comfort Open and receptive Know own feelings about death and do not project those feelings onto resident.


Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role(continued): Caring For Resident When Death Is Imminent and Following Death Nurse Aide’s Role (continued) Empathetic Calm and efficient Normal tone of voice Good listening skills Non-judgmental


Slide22: 12.4 Review the various reactions residents may have as they face death.


Individual Resident’s Reaction To Death: 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


Slide25: 12.5 List and describe the five stages of grief, death and dying.


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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.”


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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?”


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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”


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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”


Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross: 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.”


Slide34: 12.6 Recognize the signs of approaching death.


Signs Of Approaching Death: 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


Signs Of Approaching Death: 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


Signs Of Approaching Death: 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)


Signs Of Approaching Death: Signs Of Approaching Death Changes in circulation and muscle tone (continued) Muscle tone body limp jaw may drop mouth may stay partly open


Signs Of Approaching Death: 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)


Signs Of Approaching Death: Signs Of Approaching Death Changes in Vital Signs (continued) Pulse rapid weak and irregular Blood pressure drops Temperature elevated subnormal


Signs Of Approaching Death: Signs Of Approaching Death Urinary and anal incontinence Decreased peristalsis, abdominal distention Release of flatus Decreased pain Loss of consciousness


Slide43: 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.


Nurse Aide’s Role In Spiritual Preparation For Death: 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


Nurse Aide’s Role In Spiritual Preparation For Death(continued): 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


Nurse Aide’s Role In Spiritual Preparation For Death(continued): 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


Slide48: 12.9 Identify the needs of the family as they encounter the dying process.


Nurse Aide’s Role In Meeting Family Needs: 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


Nurse Aide’s Role In Meeting Family Needs(continued): 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


Slide52: 12.10 Discuss the hospice philosophy.


Hospice Care: Hospice Care Health care service offered: in hospitals and extended care facilities by special facilities usually in the individual’s home Continuing care provided by team of health professionals Designed for residents with terminal illness


Hospice Care(continued): Hospice Care (continued) Acceptance of death as imminent (6 months or less) Assures that individual dies with dignity and comfort Not concerned with cure or life-saving procedures Emphasis on pain relief Trained volunteers and professionals make regular visits.


Hospice Care(continued): Hospice Care (continued) Provides counseling for individual and family: Emotional Psychological Spiritual Financial Bereavement Family included in all aspects of care as desired


Slide57: 12.11 Discuss the meaning of postmortem care.


Postmortem Care: Postmortem Care Care Of Body After (Post) Death (Mortem) Begin care when instructed by supervisor Treat body to privacy, respect and gentleness Give care before rigor mortis sets in


Slide59: 12.12 List five reasons for doing postmortem care.


Postmortem Care(continued): Postmortem Care (continued) Reasons for Postmortem Care Prevent discoloration and skin damage Maintain good appearance of body Identify body and prepare for transportation Position body in normal alignment Arrange time family to view the body


Slide62: 12.13 Demonstrate the procedure for postmortem care.