Death and Dying

A Look At Aspects of Death,

Palliative Care and Grief
Changes in Leading Causes of
Death in the U. S.
 Life expectancy has been increased by
25 years
 In 1900, infectious diseases killed most
 In 2000, chronic diseases (heart
disease, cancer, stroke) are major
killers
Most Common Causes of
Death in U. S.
 Heart disease
 Malignant neoplasms
 Cerebrovascular disease
 Chronic lower respiratory disease
 Accidents
 Diabetes Mellitus
 Alzheimer’s Disease
 Influenza and Pneumonia
Deadliest Diseases Worldwide
 Low-income countries
 Middle-income countries
 High-income countries

(WHO, 2004)
Biological Aspects of Death
 Physiological death-when vital organs
cease to function
 Body shuts down
 Increase sleep
 Eat less
 Blood pools
 Breathing sporadic
 Clinical death-when brain ceases to
function
Aspects of Death
 Social
 When people stop calling or visiting
 Even health care professionals do this
(‘circling the drain’)
 What to do for those who are dying?
Aspects of Death
 Psychological
 When person accepts his or her death and
begins to withdraw
 Can occur much sooner than biological
death
Kubler-Ross: Five Stages of
Dying
 Denial
 Anger
 Bargaining
 Depression
 Acceptance
What is hospice?

Hospitality, place for travelers,

home for the sick
Origins of modern hospice
 London
 Dame Cicely
Saunders
 Autonomy of choice
 To live always
 Die peacefully
Saunders’ 7 Pains
 Physical  Interpersonal
 Spiritual  Financial
 Intellectual  Bureaucratic
 Emotional
Palliative Care
 Care for the dying
 Focus on comfort and pain relief
 Nausea, shortness of breath
 Bed sores, pain
 Double-effect of pain medication
administration
 Focus on dying with dignity
Hospice Team
 RN-total care
 MSW family/legal
 Chaplain
 CNA-bathing, grooming
 Physician
 Volunteers
 (see audio clips at the end of your lesson)
Grief and Loss
 Grief
 Anticipatory grief
 Grief and mixed emotions
 What to do for those in grief
 Disenfranchised grief