LOSS, GRIEVING and DEATH&DYING

LOSS
• LOSS IS AN ACTUAL OR POTENTIAL SITUATION IN WHICH SOMETHING THAT IS VALUED IS CHANGED OR NO LONGER AVAILABLE.

General Types of LOSS
1. ACTUAL LOSS-Can be recognized by others.
1. PERCEIVED LOSSexperienced by one person but cannot be verified by others.

a person displays loss and grief behaviors for a loss that has yet to take place. national disaster. death. . 5. Ex.unpredictable event. Maturational loss. Serious and life threatening illness in a family member. disease. traumatic injury.3. First child with new sibling 4. Ex.result of natural developmental process. Situational loss. Anticipatory loss.

loss of one’s job. the death of a child. . retirement from a career.g. death of aged parents.g. departure of grown children from the home. loss of functional ability because off illness or injury • DEVELOPMENTAL LOSSES-e.Loss can be viewed as • SITUATIONAL LOSSES-e.

loss of limb. loss of adequate functioning of the pancreas.Types of Losses • According to: Maslow’s hierarchy • Physiologic losses: Loss of adequate air exchange. and other somatic related symptoms. or conditions represent physiologic losses .

divorce.• SAFETYY LOSSES: Loss of a safe environment. may be the starting point of a long journey of grief • LOSS OF SECURITY Sense of belonging-loss occurs when relationships change through birth. marriage. . illness and death. such as in domestic and public violence.

• LOSS OF SELF ESTEEM: Self-esteem needs are threatened or perceived as losses whenever there is a change in how a person is valued at work and in relationships. One’s sense of selfworth maybe challenged and experienced as a loss when perceptions of oneself change.

• LOSS related to self- actualization: Personal goals and individual potential may be threatened or lost when some external or internal crisis blocks or inhibits the striving toward fulfillment.

SOURCES OF LOSS
• 1. Loss of an aspect of oneself-the loss of an aspect of self changes a person’s body image, even though the loss may not be obvious. e.g. a face scarred from a burn(obvious to people) loss of part of stomach(not obvious)

Separation from an accustomed environment 4. loss of money LOSS OF ANIMATE e.2.g. pets 3.g. Loss of an object external to oneselfincludes LOSS OF INAMINATE OBJECTS that have importance to the person.LOSS OF A LOVEDOR VALUED PERSON . e.

.GRIEF Is the total response to the emotional experience related to loss.

job. . A loss cause by separation or death. pet.emotional reaction to loss. house. Ex. loss of body part.Grieving/Grief. Divorce.

TYPES OF GRIEF RESPONCES • A normal grief reaction may be ABBREVIATED GRIEF OR ANTICIPATORY.is brief but genuinely felt • “ANTICIPATORY GRIEF”. • “ABBREVIATED GRIEF”.Is experienced in advanced of the event. .

pathologic or complicated griefexist when the strategies to cope with the loss are maladaptive.UNHEALTHY GRIEF • That is. .

Dysfunctional grief.Agitation.Over activity without a sense of loss . Must have a support system. suicidal tendencies .Hostility in a person . Behavioral signs: . withdrawal from usual tasks or activities that previously gave pleasure. insomnia.prolonged emotional instability.Diminished participation in a religious group .Unable to discuss a loss without crying .Altered relationship with family and friends .

• DISENFRANCHISED GRIEF.OCCURS WHEN A PERSON IS UNABLE TO ACKNOWLEDGE THE LOSS TO OTHER PERSON .

Client is not acknowledged for the loss and does not gain support from others. Ex. .Disenfranchised grief.societal norms do not define the loss as a loss. interest. loss of child due to abortion. broken relationship. Children behavior at school. grades. death.

reinvesting emotional energy into new relationship .Coping mechanism to grief and loss T.experiencing the pain of loss A.to accept the reality of loss E. object or aspect of self R.adjustment to an environment that no longer includes the lost person.

.BEREAVEMENT • Is the subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship.

state of grieving where a person goes through grief reaction.. BEREAVEMENT.IS THE STATE BEING SUFFERED A LOSS Bereavement.( neglecting their health ) .

spiritual belief.MOURNING Is the behavioral process through which grief is eventually resolved or altered. and custom. . it is influenced by culture.

Mourning.period of acceptance of loss and grief during which the person learns to deal with the loss. ( return to more normal living habits ) .

STAGES OF GRIEVING Kubler-Ross’s(1969) DENIAL-”NO. • Is unready to deal with practical problems. . NOT ME • (Client behavioral responses) • Refuses to believe that loss is happening. such as prosthesis after the loss of a leg • May assume artificial cheerfulness to prolong denial. .

• . . Nursing Implications)  Verbally support client but do not reinforce denial.  Examine your own behavior to ensure that you do not share in client’s denial.

•Client or family may not believe the diagnosis. •Client may sleep more or be overly talkative or cheerful. •Client of family may be seeking second and third opinions.Denial •Client or family may refuse to accept the situation. . •Client or family may claim that the tests were wrong. •Client or family may claim that the tests were mixed up with those of someone else.

(Nursing Implications) Help client understand that anger is a normal response to feelings of loss and powerlessness. . Provide structure and continuity to promote feelings of security. do not take anger personally.ANGER ” WHY ME”(Client behavioral responses)  Client or family may direct anger at nurse or staff about matters that normally would not bother them. Deal with the needs underlying any angry reaction. Avoid withdrawal or retaliation.

• (Nursing Implications) • Listen attentively. real or managed.BARGAINING • “YES ME BUT”• (Client Behavioral Responses) • Seeks to bargain to avoid loss. and encourage client to talk to relieve guilt and irrational fear . May express feelings of guilt or fear of punishment for past sins.

•Because many with the bargains may be with a divine power. •Offer visits from clergy or other supports.Bargaining •You should: •Offer frequent chances for the client or family to talk. . the period may pass unnoticed.

• May talk freely(e. reviewing past losses such as money or job). ME”• (Client Behavioral Responses) • Grieves over what has happened and what cannot be.g.or may withdraw. • (Nursing Implication) • Allow patient to express sadness.DEPRESSION • “YES. • Communicate nonverbally by sitting quietly without expecting conversation • Convey caring by touch .

•You should: •Not force cheerful or important conversation. •Allow the client or religious supports.Depression •Some clients or families may not have a good outlet for their depression. .

May wish to begin making plans. (Nursing Implications) Encourage client to participate as much as possible in the treatment program.ACCEPTANCE-” I AM READY” (Client Behavioral Responses) Comes to terms with loss. May have decreased interest in surroundings and support people. .

•Offer visits from clergy.Acceptance •Client may want to be alone and families may feel rejected. . •Offer cultural or religious support. •You should: •Encourage family to come often but for brief visits.

Shock and disbelief. but denies it emotionally.ENGEL’S STAGES OF GRIEVING(1964) • 1. .Refuses to accept loss • Has stunned feelings • Accepts the situation intellectually.

funeral) .Conducts rituals of mourning (e.• 2. DEVELOPING AWARENESS.RESTITUTION.g. nurses.. • 3. or others.Reality of loss begins to penetrate consciousness • Anger may be directed at agency.

Represses all negative and hostile feelings toward lost object. • Still unable to accept new love object to replace lost person or object 5.• 4. RESOLVING THE LOSS. IDEALIZATION-Produces image of lost object that is most always devoid of undesirable features.Attempts to deal with painful void. .

 May feel guilty and remorseful about past inconsiderate or unkind acts to lost person  Unconsciously internalizes admired qualities of lost object  Reminders of lost object evoke fewer feelings of sadness  Reinvest feelings to others .

number and nature of other relationships.• 6. and number and nature of previous grief experiences . degree of dependence on relationship.OUTCOME. importance of lost object as source of support.Behavior influenced by several factors. degree of ambivalence toward lost object.

insomnia. 2nd.individual denies reality of loss: reactions are fainting. experience desperation. guilt.awareness develops. depression. diarrhea.reality of loss is acknowledged. Crying is the initial reaction. anger. .begins to feel the loss. one can deal with future loss.• Engel’s Theory. frustration. fatigue – all related to a fight – or – flight response produced by increased epinephrine when one is under stress. 3rd. After experiencing reactions from this loses.3 phases: Theories of grieving process 1st. New self . nausea. rapid heart rate.

and disbelief of the loss occur.There is shock.AVOIDANCE. CONFRONTATION-The grief is most intense and felt most acutely 3. . ACCOMODATION.There is gradual actions of acute grief to the beginning of an emotional and social reentry into the everyday world. denial.RANDO’S(1991) • 1. 2.

DEATH AND DYING .

BOTH FOR DYING PERSON AND FOR THOSE WHO SURVIVE .DEATH • Is AFUNDAMENTAL LOSS.

helping us savor life and giving us a sense of real existence .Death Affects our perceptions of life in beneficial ways such as giving an appreciation for living.

• Death. including the brain stem . Irreversible cessation of circulatory and respiratory functions 2. Irreversible cessation of all functions of the entire brain.present when an individual sustained either: 1.

Signs of impending death • • • • • • • • • Inability to swallow Pitting edema Decreased GI and GUT activity Bowel and bladder incontinence Loss of motion. sensation. but cold or clammy skin. cyanosis Lowered BP Noisy or irregular respiration Cheyne – Stokes respiration ( with periods of apnea ) . and reflexes Elevated temperature.

cellular Death-When different cells of the body die at different times. reflexes & flat encephalogram.3 PHASES OF DEATH • 1. .When insufficient oxygen reaches the brain • Lack of receptivity& responsiveness. When the heart ceases to beat and respiration cease • 2. Brain Death. movement or breathing. • 3.

It is natural and predictable as being born. Death is an issue to be avoided . Death is dreaded while birth is of welcome and celebrated.Dying Is an integral part of life.

occur as a sudden result of an accident. or pathologic crisis.DYING • Dying. etc. or it may occur after a prolonged experience of debilitating disease. such as heart attack. . injury. AIDS. such as cancer.

and genocide • • • • • • • .Common causes of Death Diseases Accidents Wars Homicides& suicides Sacrificial deaths Legal execution and symbolic death owing to banishment and incarceration • Abortion. infanticide.

Nursing Process and Grief • Assessment Factors in assessing: 1. socioeconomic status Ex. Personal Characteristics.age. What is the child response to the loss? Does the age of the dying make a difference? How does the gender of the client affect the response to death as described by the society? What resources do clients have to cope with a loss? ( insurance. education. costs for schooling ) . sex. role.

availability of health care workers.2. Nature of relationships. society Ex. Social support system. timing. family needs Ex.functions of the family. How long have you known the dying client? What role did the dying client play in your family? What contribution have been made by the client? 3. community. Who is present? Absent? Supportive? Nonsupportive? Are they always actually available or they just say “ Call me if you need me “? Do they use a listening ear approach rather than a judgmental approach? Is the client’s self – esteem build up and supported? .

How does the client or significant other perceive physical death? Meaning of life? How should the body be treated when removed? Can religious practices interfere with medical treatment? . community. attitudes. spiritualists Ex.death issues: personal. actual versus perceived Ex. Nature of loss. private or group. What is your belief about death? What passed experiences have you had? Outcomes? What has helped you cope in the past? Can you identify coping behaviors? 5. Cultural and spiritual beliefs.values.4. practices. family.

goals.? How do you feel about yourself? Tell me what you will do now that…? 8.6. Contrast the stage of the client to the stage of the significant other Validation of feelings expressed in emotion ( allow the client to talk and express his concerns ) .actual or perceived individual loses affecting future decisions and options Ex. worth. Hope. How have things change since an accident ( automobile causing permanent paralysis )? What planning has occurred for your own life? 7. Loss of personal life goals. What do you expect now that….relate to theorists Ex. adaptations to future changes Ex. Phases of grief.

role perceived by nurse. Lack of social support. by client and family. therapeutic communication Ex. What stage of grief am I in? Am I blaming myself? What could I have done differently? .9. mental health problems. Risks factors in survivors.high risks. guilty feelings.relationship. Family’s grief for dying client. 11. involvement with the dying process Ex. loss of a child Ex. Nursing role in grief. and any interventions done to solve the problem. sudden death.stage of nurse grief. Observation What has helped you deal with problems in the past? What has not helped? 10. violent death.

Gaining relief from loneliness and isolation • Implementation 1. . Achieving spiritual comfort 5. Maintaining hope 4. Includes adaptation to a loss. Health promotion. coping strategies and available community resources.through increasing family awareness that unspoken needs are not bad. Gaining and maintaining comfort 2. Maintaining independence in daily activities 3.• Planning Goals for the dying client: 1. Stressors commonly felt can be understood when others share the same feelings. stress management activities.

Health restoration. . Most of all to their limitations as a nurse.open – ended questions and reflective statements to validate observations. It also allows client to speak about their concerns. Health rehabilitation.to maximized the client remaining strength Sensitivity to the client is important if the nurse is to function effectively. social class of the client and family. Sensitive to culture. Therapeutic communication. lifestyle.focus on long-term goals 3. Ethnicity.2.

Miller. his brother recovered from a heart attack!” . He had no previous cardiac episodes but does have a family history of severe cardiovascular disease. a 40 year old man from the emergency department to the ICU with a massive MI after he collapsed at a tennis match. As the nurse continues to give updates on his condition to the wife. the wife asks. “ Will he be OK? I am sure that he will be better. The terminal prognosis has been explained by the physician.Sample Nursing Care Plan • The nurse admits Mr.

“ He will be fine. The wife calls her husband’s office and reassures them that he will be back in a few weeks.• She does not exhibit any understanding of the seriousness of his condition and the futility of recovery from this extensive damage of the heart. but she keeps saying. that’s not important right now!” . The staff have explained organ donation and have tried to encourage her to make a decision about such. She also continues to make calls to plan a business party later in the week.

NURSING DIAGNOSIS Dysfunctional grieving related to husband’s sudden illness and absence of expected anticipatory grief. .

• Planning Goals Expected outcomes Client’s wife will accept impending Wife will verbalize within the next 6 death of client within 48 hours. Client’s wife will demonstrate Wife will demonstrate feelings of effective grieving characteristics. Wife will make decision about organ donation within the next 12 hours. Wife will demonstrate characteristics of grieving as related to theory such as Kubler-Ross’s ( DABDA ) . Wife will not deny reality of loss while waiting. sadness and exhibit anticipatory loss within the next 24 hours. hours that death is actually impending. Wife will state several immediate lifestyle changes that will occur as a result of client’s hospitalization and death.

Offer privacy and security. and cultural expectations. spiritual. direction for planning unique interventions based on theory.• Interventions Interventions Rationale Display interest in wife’s situation Recognizing denial gives the staff and accept her behaviors of denial. Establish trust and a positive regard by creating an atmosphere of sharing. . Offer encouragement to explore Encouragement refocuses on and verbalize feelings of grief. Mutual trust. Privacy offers a place of security to exhibit personal needs and to work through feelings. Loss is directed by psychosocial. current needs and minimizes dysfunctional adaptation behaviors by facilitating resolution of grief by increasing problem-solving skills.

Professionals can use their expertise clergy. Encourage wife to become involve and talk with the spouse even if she Involvement gives the family to gets no response. family. allows better-informed choices. evaluate strategies are the first to be used effectiveness and offer as needed. . Discouraging maladaptive behaviors will minimize dysfunctional grieving. or other health care workers. Trust and relationships already formed will speed the therapeutic communication process. Hearing considers the last sense to leave before death. give wife minimized feelings of hopelessness permission to grieve. or helplessness. Answer’s wife support questions in a non-threatening and unbiased Exploration of potential reality manner. when one is under stress. and skills to direct the grieving process.Interventions Rationale Identify personal coping strategies Previously successful coping used in the past. Include resources of community support: significant others.

.Plan a conversation for wife to discuss her feelings about what has happened to her husband. .Give wife the opportunity during a conversation to openly grieve. .Ask if wife is ready to explore funeral arrangements with clergy and staff.Within several hours explore with wife her interest in organ donation.• Evaluation . .

or sleep Emphasizes immobility and inactivity as attributes of death Understands that death is final Believes own death can be avoided Associates death with aggression or violence Believes wishes or unrelated actions can be responsible for death 5 to 9 years .Development of the Concept of Death AGE INFANCY TO 5 YEARS BELIEFS/ ATTITUDES Does not understand concept of death. a temporary departure. Infant’s sense of separation forms basis for later understanding of loss and death Believes death is reversible.

substance abuse) .g.Understands death as the inevitable end of life • 12-18 years.• 9 to 12 years.Fears a lingering death • May fantasize that death can be defined.. acting out defiance through reckless behaviors(e. dangerous driving.

but views it in religious and philosophic terms.• Seldom thinks about death. • May seem to reach “adult” perception of death but be emotionally unable to accept it. • May still hold concepts from previous developmental stages .

Has attitude toward death influenced by religious and cultural beliefs • • • • 45-65 years.Accepts own mortality Encounters death of parents and some peers Experiences peaks of death anxiety Death anxiety diminishes with emotional well-being .• 18.45 years.

.• 65+ years.g. reunion of already deceased family members.. freedom from pain.Fears prolonged illness • Encounters death of family members and peers • Sees death as having multiple meanings (e.

Competencies Necessary for Nurses to Provide High-Quality Care to Patients and Families During the Transition at the End of Life .

family and health care team members about end-of-life issues. Communicate effectively and compassionately with the patient. 2. Promote comfort care to the dying client.1. 3. Recognized dynamic changes in health care and service delivery that improves professional preparation for end-of-life care. .

. values and expectations about individuals death. Demonstrate respect for the patient’s view and wishes during end-of-life care.Recognized one’s own attitude. any existing cultural and spiritual belief. feelings. 4. 5.

Use scientifically based tools to assess symptoms ( pain. 7. Collaborate with interdisciplinary team members while implementing nursing roles.6. . altered cognition ) experienced by client. DOB.

Evaluate the impact of traditional. family. 10. Apply legal and ethical principles in the analysis of complex issues in the end-of-life care. grief.8. Assist the patient. complementary therapies on patient centered outcome. . 9. loss and bereavement. colleagues and self to cope with suffering.

Nursing Interventions with Impending Death .

. • Artificial tears. and good lip care. massage. if eyes are open. massage.Personal care • Good mouth care: keep mouth moist • Skin care: use lotions. positioning. • Adequate pain control with medications.

• Clean and straighten linens often. • Provide adequate hydration.• Suctioning if there are increased secretions. • Change position of client as needed to promote comfort. . to ease breathing.

• Allow for religious music. and other supports. Holy Communion. holy books. .• Recognize Special Needs • Encourage visits by clergy. • Assess for the need for Last Rites.

.  Encourage cultural or religious rituals or practices.•Allow time for the family or friends to pray.

• Preparing the Family • Describe the physical changes that may be taking place as death approaches. • Offer the family opportunities for cultural or religious rituals. • Allow the family as much time as possible with the dying client. . • Keep the family updated as to the time of approaching death.

• • • • Allow for sleep and hygiene needs of the family or friends. Allow family or friends time to voice fears and concerns Allow the family time for questions. .• . Allow the family time for tears.

Legal Considerations .

•.•Coroner’s Case. suicides and suspicious or accidental deaths. . Those deaths in which the county coroner must be made aware: deaths such as homicides.

should be noted in the client’s chart. The date and time of death. along with the health care workers’ final activities. and cause(s) of death. •Documentation. The legal document that identifies the date. time. .•Death Certificate.

•Do not Resuscitate. Because these words may have different meanings for different people, it should be clearly documented what the meaning is for each client. Health care facilities will want to make sure that the wishes of the person and family are being carried out completely

•Establishing the time of death. Absence of response to external stimuli, heart rate, respiration and papillary reflexes. •Final disposition. Final destination for the body. The hospital or county morgue or funeral home is generally the final disposition of the body.

•Life Sustaining procedure. Any medical procedure that in the judgment of the physician would only prolong the dying process. •Living will. A document that informs the physician that in the event of a terminal illness or injury the person wishes to have life sustaining procedures stopped and withheld.

•Persistent Vegetative state. The law requires all hospitals that receive Medicare Dollars to ask for organ donations on death.•Organ Donations. . This condition must be documented by the physicians. A condition of irreversible cessation of all functions of the cerebral cortex that results in complete chronic and irreversible cessation of all cognitive functions.

A legal document in which a person specifies other person to make his or her medical decisions in the event the person cannot. In most states. •Postmortem / Autopsy. only a physician is responsible for this procedure . Certification as to the time of death. An examination conducted to determine the exact cause of death.•Power of Attorney for Health Care. •Pronouncement.

The Dying Person’s Bill of Right .

• I have the right to be free from pain. . participate in decisions • I have the right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals.• I have the right to concerning my care. • I have the right not to die alone.

• I have the right to be cared for by those who can maintain a sense of hopefulness.• I have the right to be treated as a living human being until I die. • I have the right to maintain a sense of hopefulness however changing its focus may be. • I have to express my feelings and emotions about my approaching death in my own way. . however changing this might be.

• I have the right not to be deceived.• I have the right to have my questions answered honestly. which may be contrary to beliefs of others. • I have the right to retain my individuality and not be judged for my decisions. . • I have the right to have help from and for my family in accepting my death. • I have the right to die in peace and dignity.

. sensitive. whatever these may mean to others.• I have the right to discuss and enlarge my religious and/or spiritual experiences. • I have the right to be cared for by caring. knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death. • I have the right to expect that sanctity of human body will be reported after death.

Signs and Symptoms of approaching death .

These symptoms are the result of the blood circulation slowing down. • The patient may lose bladder or bowel control.• The arms and legs may become cool to the touch and the underside of the body may become darker in color. resulting in incontinence. This results from slowing of the body’s metabolism. . • The patient will spend more and more time sleeping during the day and at times will be difficult to arouse.

• Signs of death include no breathing. and jaws relaxed and mouth slightly open. . no response to shaking or shouting.• The patient will have a decreased need for food and drink. eyelids slightly open with eyes fixed on one spot. • The patient’s breathing pattern will change during sleep to an irregular pace with 10-30 seconds periods of no breathing. loss of bladder and bowel control. no heartbeat.

Care After Death .

therapy used.time pronounced.personal. religious and cultural needs should be included during this process .Physicians must certify the death.Trained staff member provides an option for donations of organs or tissue.• 1. actions taken. • 3. Physicians may request an autopsy. especially for unusual circumstances. • 2.

g. minister. Check orders for any specimens or special orders needed by the physician. or others to stay with the family while preparing the body for viewing.• 4. • B.). shaving. rosary at the bedside . Make arrangements for staff. ask for special request for viewing(e.Nurse provide dignity and sensitivity to the client and the family • A. a special gown. Bible in hand.

• D. supplies. The family may want the client left in the current unshaven state if it was his custom to wear beard.• C. Shaving of male clients must be done before removal of the beard. tubes. and dirty linens according to protocol (unless organ donation is to take place. Remove all equipment. in that case leave support systems in place .

and remove all trash from the room. Cleanse the body thoroughly. apply clean sheets. but no make up is required. dentures should be in the mouth to maintain facial alignment. Position according to protocol.• E. • F. Hairpieces may be in place. .the eyes should be closed by gently holding them down a few minutes. packing should not be visible during viewing.

Give the family the option to view or not to view and go with them. • I . Lower the lighting and spray a deodorizer if possible to remove unpleasant odors. • H. Cover with a clean sheet up to the chin with arms outside covers if possible.• G. .

ask if they they would like to be left alone. Encourage the family to say goodbye through both touch and talk. Remind them that they can call you if needed . Once the family is more comfortable. Do not rush this process. Clarify that either option is acceptable • K. • L.• J.

• M. documentation will require both a descriptor of the objects and the name of who received it. . clarify personal belongings that are to stay with the body or who has taken personal items. with the time and date.

. are found after the family is gone.call the family and tell them what was found and ask who might pick it up.• N. Discard nothing if items.describing the articles will be helpful in the decisionmaking process for the client’s family.

PHASES OF DEATH .

immobilization.• Acute Crisis Phase . feelings of inadequacy and various defenses . conscious state changes.Characterized by such experiences as high anxiety.

Characterized by fear of the unknown. fear of suffering and pain. fear of loneliness. fear of sorrows. fear of loss control.• Chronic Living Dying Phase . . fear of loss of body. fear of loss of identity and fear of regression. fear of losing family and friends.

Terminal Phase . during this phase the four types of death are accomplished.Characterized by withdrawal into one’s self. .

POST MORTEM CARE .

. Intervention. close eyelids and mouth and insert dentures in mouth. It results from a lack of adenosine triphosphate which causes the muscles to contract and in turn immobilizes the joint.• Rigor Mortis: .The stiffening of the body that occurs about 2 to 4 hours after death.Position body in normal anatomical alignment.

• Algor mortis: .The gradual decrease of the body’s temperature after death. . When the blood circulation terminates and the hypothalamus ceases to function. Intervention.Remove tape and dressings gently to avoid tissue breakdown. Avoid pulling on skin or body parts. body temperature falls about 1 C per hour until it reaches room temperature.

After the blood circulation has ceased. releasing hemoglobin which discolors the surrounding tissues. the RBC breakdown. Intervention. .Elevate head to prevent facial discoloration.• Livor Mortis: .

.• Softening and liquefying of body tissues by bacterial fermentation.Store body in cool place in hospital morgue or other designated area. Intervention.

R E L I G I O D E A T H U S R I T U A L S .

.E A S R T U T s t E S H R n e R S O N I A D s u A N O m d N D O R L a b e X u s t i t e d c o th c t e t i e n w h i l e p a t is s t i l l c o n s c i o u s .

t h e h o l y b o o k .H b e to e a r t h IN m D a y U w is h to P a t i e n t b e in p l a c e d o n th e to fl o o r th e i l y c l o s e r d e a t h . . F a m is w a s h e n c o u r a g e d a n d p r e p a r e T h e to th e b o d y . B h a g a v a d g i t a . i s a n d r e a d .

. and the holy book.HINDU Patient may wish to be placed on the floor to be closer to the earth in death. is read. and 25. The Bhagavadgita. 8. Family is encouraged to wash and prepare the body. chapters 2.

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JUDAISM
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The body is washed by the burial society and wrapped in white linen. No embalming or flowers are used. A cantor will assist the rabbi in the funeral. Burial should be done within 24 hours and should not be done on the Sabbath.

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CONFUCIANISM Belief in reincarnation. burning incense and flowers are laid at the bedside to assist the spirit on its journey .

. R i t e s a t th e a n d L a s t c h a n t i n g a r e b e d s i d e e n c o u r a g e d .B U D D M H I S B e l i e f in re i n c a r n a t i o n .

.BUDDHISM Belief in reincarnation. Last Rites and chanting at the bedside are encouraged.

.L U T H M a y E R A t N a c c e p m H o l y C o m u n i o n . a n d L a s t R i t e s a r e o p t i o n a l .

LUTHERAN May accept Holy Communion. and Last Rites are optional. .

M A M E D T H B O A D P to I S T in T T N I S a y w i o i s h u s v i t e y to r e l i g c l e r g b e n e a r o f a t th e . ti m e d e a t h .

METHODIST AND BAPTIST D aaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaaaaaaaaaMay wish to invite religious clergy to be near at the time of death. .

M is re a d i l y is w i l l b o fa m U to w i l l to g o S 3 6 o f e n d in th e L I M th e Q u r a g e ” i l y th it in e ’ r a n T h e th e p a t i e n t . w r a p p i n g i t e . t C h a p t e r p a t i e n t n o b e f o r e d y re c i t e . c o u b u g . T h e “ T h e r e fa m g A l l a h d y i n a n d w h a s s i s t th e w a s h i n c l o t h .

.MUSLIM Chapter 36 of the Qur'an is read to the patient. The family will encourage the patient to recite. The family will assist in washing the body and wrapping it in the white cloth. “There is no god but Allah” before dying.

.S H A l l I N je w o T e l r y O is a n d to b e r e m v e d th w e b o d y a n a is d w h i t e a s h e d in d r e s s e d k i m o n o .

.SHINTO All jewelry is to be removed and the body is washed and dressed in a white kimono.

T w A T h i s O e h I S m i l y h a a t th v th e e M m a e ti m e fa to s e t a y p r i e b e d s i d a t o f d e a t h . .

.TAOISM The family may wish to have a priest at the bedside at the time of death.

n e r a l o f t e n . th A o is ro I C s i c k a n d H o e n l y c o C o u m n i o n A e r a g e d s a r y s e r v i c e e v e n fu i n g u s b e f o r e th e d o n e .R C A n O T i n t i n M H g o f A O th e N L m u .

A rosary service the evening before the funeral us often done. .ROMAN CATHOLIC Anointing of the sick and Holy Communion is encouraged.

Burning of incense.Specific Rituals • • • • • • • African Americans Cremation is not permitted the deceased is wrapped with special cloths before burial. also called “root medicine. For a year later a bowls of foodmay be placed on table for the spirit. reading of scriptures. Chinese Americans Have strict norms for announcing death. arranging the funeral and burial and mourning after burial.practice of calling on a group of spirits with one periodically makes peace during specific events in life. . Haitian Americans Practice vodun (vodoo). preparing the body.CULTURAL CONSIDERATION • Culture.”.

The deceased is bathed and dressed so that he or she can buy a drink as the spirit moves on afterlife. • Vietnamese Americans • Buddist . • Hispanic Americans • • • • • Native Americans .Japanese Americans Filipino Americans Wearing black clothes Announcements to be placed in local newspapers asking for prayers and blessings on the soul of the deceased.

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