it is an inevitable, unequivocal, and universal experience, common to all.

Death is difficult for many individuals to face-perhaps the most difficult and painful reality to all.

Gerontological nurses commonly face the reality of death because more than 80% of all who die are elderly. It is not only the event of death that gerontological nurses must learn to deal with but also the entire dying process-the complexity of experiences that dying individuals, their family, their friends, and all others involved with them go through.

D-o not go gentle into that night, old age should burn and rave at close of day Rage, rage against the dying of the light.

-Dylan Thomas

E-ach person is born to one possession which outvalues all the others-his last breath.

-Mark Twain

D-eath is fortunate for the child, bitter to the youth, too late to the old.

-Publilius Syrus

 A- man can die but once: We owe God a death.

-Shakespeare,

Henry IV

At one time, most births and deaths occurred in the home. In multigenerational family living, older persons were part of the household and could be naturally observed as they grow old and died. Personal involvement with births and dying process was common. Perhaps the family felt a certain comfort and closeness by being with and doing for the person whose life was about to begin or end.

A high mortality rate also made experiences with the dying process more common in the past. Not only were living conditions poor, health care facilities inadequate, disease control techniques limited, and technologies to fight and control natures elements unheard of, but also there were fewer numbers of hospitals and other institutions in which people could die.

The declining mortality rate is one of several factors that have limited our experience with the dying process. Another factor is that our more mobile nuclear families are frequently composed of young members, with older parents and grandparents living in different households, often in different parts of the country. With a majority of deaths occurring in an institutional or hospital setting, rarely do family and friends remain with the individuals or witness the dying process.

Nurses were more prepared to deal with the care of a dead body than with the dynamics involved with the dying process. Not only was open discussion of an individuals impending death rare, but also it was typical for the dying person to be moved to a separate and often isolated location during the last few hours of life.

Nursing now offers a more humanistic approach to caring for the dying patient. Emphasis on meeting the total needs of the patient in a holistic manner has stimulated greater concern for the psychosocial/spiritual care of the dying. In addition, there is now recognition that family and significant others play a vital role in the dying process and must be considered by the nurse.

DENIAL - initial response to protect the self from anxiety - No not me, Its not true, Its not impossible - may continue to make impractical/unrealistic plans - may comment that a mistake has been made about the diagnosis of terminal illness - Adaptive response: crying, verbal, denial - Maladaptive response: absence or reaction such a crying.

ANGER

- individual feel that they are victims of incompetence or a vengeful God(they did something wrong so they are being punished), fate (karma), circumstances (wrong place and wrong time) - why me, what did I do to reserve this? - they seek for reasons, answers and explanations - may express anger overtly being irritable, impatient, critical verbally abusive - Adaptive response: verbal expression - Maladaptive: persistent guilt or low self-esteem, aggression, self-destructive ideation or behavior

BARGAINING - the person try to inhibit good behavior, make up for perceived wrong doings or other engage in behaviors that would please GOD so he will be given more time-an extension of life or granted recovery - Yes, me but - If I live until Christmas or until my childs graduation(so many ifs), I will do this... - Adaptive response: bargains for treatment control, express wish to be alive for specific events in the near future - Maladaptive response: bargains for unrealistic activities or events in the distant future

DEPRESSION

- occurs when the reality of loss or impending loss cannot be ignored anymore and the person grieves for himself and those he will leave behind, for the things that he can no longer accomplish or experience - Yes, Im dying - withdrawn, has no energy and interest to interact - Adaptive response: crying, withdrawing from interaction - Maladaptive response: self-destructive actions, despair

ACCEPTANCE
- Occurrs when the person has come to peace with himself and others - Yes, I am ready - Stage of affective void-not happy nor sad