understanding the dying process and needs of the resident nearing the end of life. nursing...

Understanding the Understanding the dying dying processprocess and and needsneeds of the of the resident nearing the end resident nearing the end of life. of life.

Nursing Fundamentals 7243 12.04

Unit A Nurse Aide Workplace FundamentalsEssential 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.

Nursing Fundamentals 7243 2

2.04 Introduction2.04 Introduction

Death is defined as the final stage of Death is defined as the final stage of life. life. The nurse aide will need to The nurse aide will need to develop a realistic attitude toward develop a realistic attitude toward the topic of death to meet the the topic of death to meet the physical and psychological needs of physical and psychological needs of the resident and the family as they the resident and the family as they experience the dying process. experience the dying process. This This indicator also includes care of the indicator also includes care of the body following death.body following death.2.04


The sun The sun settingsetting

is no less is no less beautiful beautiful

than the sun than the sun rising. rising.

Psychological changes of Psychological changes of the grieving residentthe grieving resident


Five stages of grieving have been identified by

Elizabeth Kubler-Ross

Elizabeth kubler-ross five stagesElizabeth kubler-ross five stages


Not all residents go through all the Not all residents go through all the stagesstages

Some residents may stay in one stage Some residents may stay in one stage until death occursuntil death occurs

Residents may move back and forth Residents may move back and forth between grieving stagesbetween grieving stages

Family and friends of the resident will Family and friends of the resident will experience the grief stagesexperience the grief stages



Understanding the Understanding the stages of griefstages of grief helps helps

the Nurse Aidethe Nurse Aide apply apply psychological psychological

support to resident, support to resident, family, and friendsfamily, and friends


Nursing Fundamentals 72437

2.04

DENIALDENIAL

• Defense mechanismDefense mechanism• Buffer against realityBuffer against reality• Emotional escape Emotional escape

hatchhatch• Resident may request Resident may request

another opinion another opinion



DENIAL (continued)

• Resident may Resident may avoid discussion avoid discussion of deathof death

• Feeling of, Feeling of, ““This This cancan’’t be t be happening to me.happening to me.””

Care PointCare Point


Nurse Aides must be Nurse Aides must be ready to listen if the ready to listen if the

resident expresses their resident expresses their feelingsfeelings



ANGER• Bitterness and turmoilBitterness and turmoil

• Sense of unfairnessSense of unfairness

• Blame of others such Blame of others such as health care workersas health care workers

• Feeling of, Feeling of, ““Why me?Why me?””



Nurse Aide must not take the Nurse Aide must not take the accusations personallyaccusations personally

Do not follow the urge to leave the Do not follow the urge to leave the angry residentangry resident

Listen empathetically Listen empathetically



BARGAINING• Turn to religious Turn to religious

and spiritual and spiritual beliefsbeliefs

• Promises to God Promises to God and othersand others

• Comfort and Comfort and hope when all hope when all seems lostseems lost



BARGAINING (continued)

• Generally know Generally know this wonthis won’’t workt work

• Frustration and Frustration and anger dissolve into anger dissolve into depressiondepression

• ““If only...I willIf only...I will””



Listen and reflect what is said, Listen and reflect what is said, express understandingexpress understanding

Be aware of when silence is Be aware of when silence is helpful and words are nothelpful and words are not



DEPRESSION Belief that hope is lostBelief that hope is lost Overwhelming despairOverwhelming despair Introverted and withdrawnIntroverted and withdrawn Reminiscing and reviewing Reminiscing and reviewing

lifelife SleeplessnessSleeplessness ““I always wanted toI always wanted to””



Your touch, Your touch, if acceptedif accepted, can be , can be very helpfulvery helpful

Understand the residentUnderstand the resident’’s feeling of s feeling of lossloss

Do not deny death is approachingDo not deny death is approaching



ACCEPTANCE• Calm and subdued interest Calm and subdued interest

in lifein life

• Strives to complete Strives to complete unfinished businessunfinished business

• Helps loved ones accept Helps loved ones accept deathdeath

• Needs others to validate Needs others to validate worth of lifeworth of life

• ““II’’ve had a good life.ve had a good life.””


Nursing Fundamentals 724318

2.04

Your presence lets them know Your presence lets them know you will not desert themyou will not desert them

Listen if they wish to discuss Listen if they wish to discuss their deaththeir death

FACTORS INFLUENCING RESIDENTS/FAMILY FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATHATTITUDES TOWARD DEATH


Personal experiencesPersonal experiences Culture; some fear Culture; some fear

death others look death others look forward to and accept forward to and accept death death

Factors influencing residents/family attitudes toward Factors influencing residents/family attitudes toward deathdeath


Religion Belief in life after death Belief in life after death Reunion with loved ones Reunion with loved ones ReincarnationReincarnation Punishment for sins Punishment for sins No afterlife No afterlife

FACTORS INFLUENCING RESIDENTS/FAMILY FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATHATTITUDES TOWARD DEATH


Age: ChildrenChildren view death at view death at temporarytemporaryAdultsAdults may develop fears of may develop fears of pain and suffering, dying alone, pain and suffering, dying alone, separation from loved onesseparation from loved onesElderlyElderly generally have fewer generally have fewer fearsfears

Individual resident’s reaction to death


Accept or be resigned to deathAccept or be resigned to death

Open and receptiveOpen and receptive

Communicate about uncertaintiesCommunicate about uncertainties

Fearful or angryFearful or angry

Despairing or anxiousDespairing or anxious

HostileHostile

Thoughtful and meditativeThoughtful and meditative

COMMONCOMMON PHYSICAL SIGNSPHYSICAL SIGNS OFOF IMPENDING DEATHIMPENDING DEATH


Changes in sensory functionsensory function and the ability to speak

VISION Blurred and failing vision

Increased secretions in corner of eye

No eye movement / staring / unfocused eye


Reduce glareReduce glare and keep keep room lightening lowroom lightening low

COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH



SPEECHSPEECH becomes difficultbecomes difficult hard to understandhard to understand may be unable to speakmay be unable to speak


Do not expect an answerDo not expect an answer Observe body language of Observe body language of

the residentthe resident Anticipate needsAnticipate needs

Changes in SENSORY FUNCTIONSENSORY FUNCTION and the ability to speak

HEARINGHEARING

last sensory last sensory function to be lost…function to be lost…




Be careful Be careful what you what you

say!say!


TOUCHTOUCH

SENSE OF TOUCH IS SENSE OF TOUCH IS

DEMINISHEDDEMINISHED




Resident can no longer Resident can no longer turn themselves, turn themselves,

SKIN CARE IS SKIN CARE IS PARAMOUNTPARAMOUNT



Changes in CIRCULATION AND MUSCLE TONECIRCULATION AND MUSCLE TONE and the ability to speak

LOSS OF MOVEMENT, LOSS OF MOVEMENT, MUSCLE TONE, AND FEELINGMUSCLE TONE, AND FEELING

Body is limpBody is limp Jaw may dropJaw may drop Mouth may stay partly Mouth may stay partly

openopen




CIRCULATION FAILSCIRCULATION FAILS Heat is lost from the bodyHeat is lost from the body’’ Mottling (bruised Mottling (bruised

appearance), spotting, or appearance), spotting, or blotching of skin caused by blotching of skin caused by poor circulationpoor circulation




CIRCULATION FAILSCIRCULATION FAILS Hands and feet cold to Hands and feet cold to

touchtouch Face becomes pale or gray Face becomes pale or gray

and mottledand mottled Perspiration may increase Perspiration may increase

(DIAPHORESIS)(DIAPHORESIS)



Changes in vital signsvital signs

Blood pressure Blood pressure decreasesdecreases



Changes in vital signsvital signs

Pulse:Pulse:Abnormally slow, Abnormally slow, rapid, or irregularrapid, or irregular

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