Pall 9016: Understanding death

Approaching Death
Approaching Death

“When you were born, you cried and the world

rejoiced.
Live your life in a manner so that when you die
the world cries and you rejoice”

Indian proverb
Reflection

 What do you want your end of life to look

like?

 What is a “good death” in your estimation?

 How do you think your experiences have

shaped this?
A Good Death:
What the literature says

 Free from avoidable stress

 In general accord with patient’s and family

wishes

 Reasonably consistent with clinical, cultural,

and ethical standards
Stages of Impending death

There are a number of predictable signs that

death will occur in the near future:
Signs that death is coming

• Progressive weakness
• Bedbound state
• Sleeping much of the time
• Decreased intake food and fluid
• Darkened and/or decreased urine output
• Difficulty swallowing (dysphagia)
Signs that death is coming
Signs that death is coming

 http://ltctoolkit.rnao.ca/sites/default/files/res
ources/AppF_ESAS_EndofLifeBPG2011_pg10
6to107.pdf
Signs and Symptoms Con’t

• Delirium not related to reversible causes

• Decreased level of consciousness not related
to other causes
• Noisy respiration/excessive respiratory tract
secretion
• Change in breathing pattern (Cheyne-Stokes
respiration periods of apnea)
• Mottling and cooling of the extremities
CHCA Domains of Care

Canadian Hospice Care Association (CHCA)Domains

of Care, include the following:
1. Disease management
2. Physical
3. Psychological
4. Spiritual
5. Social
6. Practical
7. End-of-life care/death management
8. Loss and Grief
CHCA Domains of Care
Approaching Death

How do nurses support a good death?

Supporting a Good Death

Nurses use effective communication to facilitate end of life

decisions related to:
 Cultural and spiritual values, beliefs, and practices
 Emotions and fears
 Past experiences with death and loss
 Clarifying goals of care
 Family preferences related to direct care involvement
 Practical needs
 Informational need;
 Supportive care needs;
 Loss and grief; and
 Bereavement planning
Five Domains of Quality End of Life Care

1. Receiving adequate pain and symptom

management
2. Avoiding inappropriate prolongation of dying
3. Achieving a sense of control
4. Relieving burden
5. Strengthening of relationships with loved
ones