Professional Documents
Culture Documents
THE DYING
PERSON
INTRODUCTION
† Some deaths are sudden, others expected
† Accepting one’s own mortality is a
developmental stage of life
† Your feelings about death
affect the care you give
† Must understand the dying
process to meet dying
person’s physical,
psychological, social,
& spiritual needs
TERMINAL ILLNESS
† Illness or injury for which no
reasonable expectation of recovery
exists
† Doctors can’t predict time of death
† Hope and the will to live strongly
influence living
and dying
ATTITUDES ABOUT
DEATH
† Experiences, culture, religion, and age
influence attitudes
† Attitudes change as age &
circumstances change
† Dying people often need hospital,
nursing center, hospice, or home care
† Family often involved in process
ATTITUDES ABOUT
DEATH
† When death occurs funeral director
called to take body
† Many adults & children have never had
contact with dying person or at time of
death
† Practices & attitudes
differ among cultures
† Attitudes influenced
greatly by religion
RELIGION’S AFFECT ON DYING
† Beliefs about life after death influence
attitude toward death (ex: reincarnation
is belief that spirit or soul is reborn into
another human body or into another
form of life)
† Rites & rituals during
dying process or at
death influenced by
religion
† Religion offers comfort to some people
as they or loved one are dying
AGE’S AFFECT ON DYING
† Adults:
† Fear pain & suffering, dying alone, invasion
of privacy, loneliness, and separation from
loved ones
† Worry about loved ones left behind
† Resent death ability to keep from dreams
† Age 3-5 think death is temporary
† Blame themselves
† See death as punishment
for being bad
AGE’S AFFECT ON DYING
† Age 5-7
† Know death is final
† Think death only happens to others
† Relate death to punishment & body
mutilation (ideas from TV, cartoons, video
games, movies, fairy tales)
† Older persons
† Fewer fears than younger persons, but may
fear dying alone
† Know it will come, may welcome it (free of
pain & suffering) or think of as reunion with
loved one
STAGES OF DEATH & DYING
DESCRIBED BY ELISABETH
KUBLER-ROSS
Denial: “No, not me!”
Anger: “Why me?” May be
outraged & jealous of healthy
Bargaining: make promises to bargain for more
time – may be on spiritual level
Depression: mourn things lost & that will be lost
Acceptance: calm & at peace
NOTE: may not go through stages in order, may
go back & forth, may never get to last stage
PSYCHOLOGICAL, SOCIAL,
AND SPIRITUAL NEEDS
Dying person may want:
Family & friend’s present
To talk about fears & anxieties
To be alone
Listen and let them express feeling in own
way
Use touch to show caring
(along with silence)
May want to see spiritual leader
Provide privacy
Be courteous to leader
Handle spiritual objects with respect
PHYSICAL NEEDS
Dying may take minutes, hours, weeks:
Body processes slow
Person is weak
LOC change
Keep comfortable and maintain dignity
Vision blurs:
Explain what doing
May turn toward light, avoid bright lights
Dark room may frighten
Eyes may be ½ open with secretions in
corners – good eye care essential
PHYSICAL NEEDS
Hearing one of last functions lost
Assume they can hear you – provide
reassurance & explanations
Speak in normal voice
Speech become difficult
Anticipate needs
Don’t ask questions that require long
answers
Continue to talk to person
PHYSICAL
Mouth
NEEDS
Oral hygiene promotes comfort
As death nears & unable to take frequent
oral fluids, frequent oral care important
(esp. if can’t swallow)
Carefully clean nose
(crusting) & apply lubricant prn
Circulation fails & body temp rises as death
nears:
Skin cool & mottled
Diaphoretic – have increased need for skin
care & changing gown/ linens, use light
covers
PHYSICAL NEEDS
• Appetite slowly decreases to point
of no intake
– Meat, first to avoid, followed by
breads/fruits/vegetables; then sweets
only then liquids onto sips
water only
– Assist family to accept this
loss of appetite
PHYSICAL NEEDS
Elimination
Incontinence may occur – pericare needed
Constipation & urinary retention may
necessitate enemas & catheters
Comfort and positioning
Good alignment & changing positions
Analgesics prn
May need Semi-Fowlers
position to make
breathing easier
PHYSICAL NEEDS
Person’s room should be comfortable &
pleasant:
Well lit & ventilated
Remove unnecessary equipment
Keep upsetting equipment out of site
Arrange mementos, religious items,
flowers, or significant items in view
Family members may
be present all the time
Room may be near
nurses’ station
FAMILY
† Hard time for family – show
feelings by being available & courteous
† Stay as long as they wish - respect the
right to privacy, but don’t ignore care of
patient
† Family members need support,
understanding, courtesy, and respect –
go thru same stages as patient
† Family may desire spiritual leader also
HOSPICE CARE
† Focuses on the physical, emotional,
social, and spiritual needs of dying
† May be part of hospital or nursing center
or separate agency – many offer home
care
† Not concerned with cure or life-saving
measures, but comfort &
preserving quality of life
† Provides follow-up care
and support groups
for survivors
LEGAL ISSUES
† Much attention given to right to die
† Consent is needed for any treatment.
† The Patient Self-Determination Act and
OBRA (right to accept or refuse medical
treatments) – Advance Directives:
† Living wills: document with wishes
† Durable power of attorney
† “Do not resuscitate” orders written by
MD after consulting with patient & family
QUALITY OF LIFE
† Person has right to die in peace & with dignity
† Dying person’s bill of rights (see p. 810)
† Right to privacy before & after death – drape &
screen
† Right to visit with others in privacy – family able to
come & go freely, private room if possible
† Right to confidentiality (diagnosis & condition)
† Free from mistreatment or restraints
† Right to safe & home-like setting –
protect property, keep odor-free,
neat & clean
† Right to personal choice – advance
directives – staff must respect choices
SIGNS OF DEATH
† Signs may occur rapidly or slowly:
† Movement, muscle tone,
sensation lost – mouth may stay open
† Peristalsis slows – distention, fecal incontinence or
impaction common
† Body temperature rises – feels cold, looks pale, &
perspires heavily
† Circulation fails – pulse fast, weak, irregular & BP
falls
† Respiratory system fails – Cheyne-Stokes or slow
respirations & mucous collects (death rattle)
† Pain decreases as loses consciousness
† At time of death: no pulse, respirations, or blood
pressure & pupils are fixed and dilated
† Doctor must pronounce dead (coroner or medical
examiner may pronounce or be notified)
CARE OF THE BODY AFTER
DEATH – POSTMORTEM
CARE
The right to privacy and the right to be
treated with dignity and respect apply after
death (close drapes, curtains, doors)
Care begins after pronounced dead
Goal is to maintain good appearance of
body - discoloration & skin damage
prevented, handle gently
Valuables gathered
to give to family
Other patients may need support
CARE OF THE BODY AFTER
DEATH – POSTMORTEM
CARE
Rigor mortis (rigidity of skeletal muscles)
develops 2-4 hours after death
Body positioned in normal body alignment
before rigor mortis sets in
Body should appear in comfortable
position for viewing by family
Moving body may cause expulsion of
air from lungs or intestines,
normal sounds produced
Standard Precautions
CARE OF THE BODY AFTER
DEATH – POSTMORTEM
CARE
Raise bed to comfortable level
Place pillow under head & shoulders
Close eyelids gently by pulling lashes down
Close mouth using rolled washcloth under
chin to support closed position prn
Follow facility policy for dentures (in mouth
or in cup to be sent to mortuary)
Remove tubes, replace
dressings, inventory
valuables
CARE OF THE BODY AFTER
DEATH – POSTMORTEM
CARE
Bathe soiled areas & comb hair
If family coming to view:
Apply clean gown & bed linen
Cover body to shoulders
Arrange room neatly
Provide for privacy
Identify & assemble belongings - place in
labeled bags for family – document
After body is removed, strip unit
Follow instructions per charge nurse
CARE OF THE BODY AFTER
DEATH – POSTMORTEM
CARE
Observe & report:
What was done with belongings
Unusual occurrences related to care
Unusual responses of family or
residents
Any other significant
observations
Remove & discard
gloves, wash hands