1. 23 Death and Dying Define the following term: Terminal illness a disease or condition that will eventually cause death.

2. 23 Death and Dying 1. Discuss the stages of grief REMEMBER: Not every resident goes through all of the stages of grief, nor do they necessarily go through them in this order.

3. 23 Death and Dying Transparency 23-1: Stages of Grief Denial: refusal to believe they are dying Anger: “Why me?” Bargaining: “Yes me, but…” Depression: need to mourn and review their lives Acceptance: preparing for death

4. 23 Death and Dying 2. Describe the grief process These are seven common reactions to the death of a loved one. Shock: especially at our own feelings Denial: usually lasts a short time Anger: at God, the doctors, even at the person who died Guilt: that we are still alive Regret: for what we did or did not do Sadness: depression, headaches, or insomnia Loneliness: missing the person and painful memories

5. 23 Death and Dying 3. Discuss how feelings and attitudes about death differ The following factors may influence feelings and attitudes about death: Experience with death Personality type Religious beliefs Cultural background

6. 23 Death and Dying 3. Discuss how feelings and attitudes about death differ Think about this question: How have your background and experiences affected your attitudes about death?

7. 23 Death and Dying 4. Discuss how to care for a dying resident Remember these guidelines when caring for a dying resident: Be aware of diminished senses and help keep resident comfortable Provide attentive care of mouth and nose Provide good skin care Physical comfort is very important - observe carefully for signs of pain Help make the environment soothing and pleasant Remember that emotional and spiritual support are essential at this time

8. 23 Death and Dying 4. Discuss how to care for a dying resident Think about these questions: How can you treat residents with dignity when they are approaching death? Which of the residents’ rights may apply when a resident is close to death?

9. 23 Death and Dying 4. Discuss how to care for a dying resident REMEMBER: Advance directives must be honored and the residents’ decisions regarding advance directives must be respected.

10. 23 Death and Dying 5. Describe ways to treat dying residents and their families with dignity and honor their rights REMEMBER: You can treat residents with dignity as they are approaching death by respecting their rights and their preferences (see Handout 23-1, “The Dying Person’s Bill of Rights”).

11. 23 Death and Dying Transparency 23-2: Rights to Remember When Caring for the Terminally Ill 1.The right to refuse treatment. 2.The right to have visitors. 3.The right to privacy.

12. 23 Death and Dying Transparency 23-3: Ways to Treat Dying People and their Families with Dignity Respect their wishes in all ways possible. Do not isolate or avoid a resident who is dying. Do not make promises that cannot or should not be kept. Continue to involve the dying person in facility activities. Listen if they want to talk. Do not babble, or be especially cheerful or sad. Keep the resident comfortable. Assure privacy when they want it. Respect the privacy of the family and other visitors. Help with the family’s physical comfort.

13. 23 Death and Dying Define the following term: Palliative care care that focuses on the comfort and dignity of the person rather than on curing him or her.

14. 23 Death and Dying 6. Define the goals of a hospice program Hospice care and palliative care have the following goals: Comfort of resident Dignity of resident

15. 23 Death and Dying 6. Define the goals of a hospice program Think about this question: Hospice works to meet the resident’s physical, emotional, social, and spiritual needs. Why is the focus not on wellness or recovery?

16. 23 Death and Dying 6. Define the goals of a hospice program The following skills and attitudes are useful in a hospice setting: Be a good listener. Respect privacy and independence. Be sensitive to individual needs. Be aware of your own feelings. Recognize the stress. Take good care of yourself. Take a break when you need to.

17. 23 Death and Dying 6. Define the goals of a hospice program Think about these questions: Are the skills and attitudes listed on the previous slide any different than those required when caring for other residents? How can NAs deal with their own feelings when doing hospice work? Would a hospice NA support group be a good idea?

18. 23 Death and Dying Define the following term: Cheyne-Stokes respirations slow, irregular respirations or rapid, shallow respirations.

19. 23 Death and Dying 7. Explain common signs of approaching death REMEMBER: Death can be sudden or gradual, but physical signs often occur that can indicate approaching death.

20. 23 Death and Dying Transparency 23-4: Signs of Approaching Death Blurred vision that gradually fails Unfocused eyes Impaired speech Diminished sense of touch Loss of movement, muscle tone, and feeling Rising body temperature or below normal temperature Decreasing blood pressure Weak pulse that is abnormally slow or rapid Slow, irregular respirations or rapid, shallow respirations “Rattling” or “gurgling” sound when breathing Cold, pale skin Mottling, spotting, or blotching of skin caused by poor circulation Perspiration Incontinence Disorientation or confusion

21. 23 Death and Dying Define the following term: Rigor mortis the Latin term for the temporary condition after death in which the muscles in the body become stiff and rigid.

22. 23 Death and Dying 8. List changes that may occur in the human body after death The following changes occur in the body after death: No heartbeat, pulse, respiration, or blood pressure Rigor mortis Eyelids partially open; eyes in fixed stare Mouth may remain open Incontinence

23. 23 Death and Dying 8. List changes that may occur in the human body after death REMEMBER: Although these changes are a normal part of death, it is also normal to find them frightening. Tell the nurse immediately to help confirm the death.

24. 23 Death and Dying Define the following term: Postmortem care care of the body after death.

25. 23 Death and Dying 9. Describe postmortem care Remember these postmortem care guidelines: Rigor mortis may make body difficult to move. Talk to the nurse if you need assistance. Bathe the body gently. Place drainage pads. Do not remove tubes or other equipment. Put in dentures if instructed by the nurse.

26. 23 Death and Dying 9. Describe postmortem care Postmortem care guidelines (cont’d.): Close eyes. Position body. Put a small pillow under head. Follow facility policy on personal items. Strip the bed after body is gone. Open windows to air the room. Straighten room. Respect wishes of family and friends. Document procedure.

27. 23 Death and Dying 9. Describe postmortem care REMEMBER: Facilities may have special policies on postmortem care. Know and follow your facility’s policy.

28. 23 Death and Dying 9. Describe postmortem care Think about these questions: How do you think you will feel about providing postmortem care? Do you think you find it difficult to touch a dead body? How can they show emotional support to the resident who is dying? To family members after the death?

29. 23 Death and Dying 9. Describe postmortem care REMEMBER: In home care it is important to ask the family members of a client who has died what you can to do help. You may answer the phone, make coffee or a meal, supervise children or keep family members company.