Unit 12-caring For Resident When Death Is Imminent

Unit 12

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

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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

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12.0 Explore personal feelings concerning the concept of death.

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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

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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

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

• Factors influencing attitudes – Age • Children view death as temporary

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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

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12.1 Identify the special needs of a dying resident.

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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

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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

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

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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

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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

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Special Needs Of Dying Resident (continued)

• Comfort Measures – Head of bed elevated to facilitate breathing • Modified diet

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

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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. DHSR Approved Curriculum-Unit 12

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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 DHSR Approved Curriculum-Unit 12

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

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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

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12.5 List and describe the five

stages of grief, death and dying.

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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

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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.”

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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

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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

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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

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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

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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

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12.6 Recognize the signs of approaching death.

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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

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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

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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

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

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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

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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

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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

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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

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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

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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

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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

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

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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

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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

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12.10 Discuss the hospice philosophy.

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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 DHSR Approved Curriculum-Unit 12

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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 lifesaving procedures • Emphasis on pain relief • Trained volunteers and professionals make regular visits. DHSR Approved Curriculum-Unit 12

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Hospice Care (continued)

• Provides counseling for individual and family: – Emotional – Psychological – Spiritual – Financial – Bereavement • Family included in all aspects of care as desired DHSR Approved Curriculum-Unit 12

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12.11 Discuss the meaning of postmortem care.

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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

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12.12 List five reasons for doing postmortem care.

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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 DHSR Approved Curriculum-Unit 12

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12.13 Demonstrate the procedure for postmortem care.

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