1. DFS Approved Curriculum-Unit 121 Unit 12 Caring For Resident When Death Is Imminent and Following Death Nurse Aide I Course

2. DFS Approved Curriculum-Unit 122 Caring for Resident When Death Is Imminent and Following Death Introduction Death is defined as the final stage of life.  The nurse aide will need to develop a realistic attitude toward the topic of death to meet the physical and psychological needs of the resident and the family as they experience the dying process.  This unit also includes care of the body following death.

3. DFS Approved Curriculum-Unit 123

4. 4 12.0Explore personal feelings concerning the concept of death.

5. DFS Approved Curriculum-Unit 125 Caring For Resident When Death Is Imminent and Following Death Factors influencing attitudes –Personal experiences –Culture Some fear death Others look forward to and accept death

6. DFS Approved Curriculum-Unit 126 Caring For Resident When Death Is Imminent and Following Death (continued) Factors influencing attitudes –Religion Belief in life after death Reunion with loved ones Reincarnation Punishment for sins No afterlife

7. DFS Approved Curriculum-Unit 127 Caring For Resident When Death Is Imminent and Following Death (continued) Factors influencing attitudes –Age Children view death as temporary

8. DFS Approved Curriculum-Unit 128 Caring For Resident When Death Is Imminent and Following Death (continued) Factors influencing attitudes –Age Adults may develop fears of: –pain and suffering –dying alone –separation from loved ones Elderly generally have fewer fears

9. DFS Approved Curriculum-Unit 129

10. 10 12.1Identify the special needs of a dying resident.

11. DFS Approved Curriculum-Unit 1211 Special Needs Of Dying Resident Visits with family/significant others Features of resident’s room: –pleasant as possible –lighting that meets resident’s preferences –well ventilated –odor free

12. DFS Approved Curriculum-Unit 1212 Special Needs Of Dying Resident (continued) Features of resident’s room: –Contains personal items which provide comfort and reassurance Pictures Mementos Cards Flowers Religious objects

13. DFS Approved Curriculum-Unit 1213 12.2Identify eight comfort measures that may be used with the dying resident.

14. DFS Approved Curriculum-Unit 1214 Special Needs Of Dying Resident (continued) Comfort Measures –Attention to skin care –Good personal hygiene –Oral hygiene - denture care –Bedding changed as needed –Back massages

15. DFS Approved Curriculum-Unit 1215 Special Needs Of Dying Resident (continued) Comfort Measures –Frequent position changes every two hours P.R.N. –Good body alignment supportive devices prevention of deformities and pressure ulcers

16. DFS Approved Curriculum-Unit 1216 Special Needs Of Dying Resident (continued) Comfort Measures –Head of bed elevated to facilitate breathing Modified diet

17. DFS Approved Curriculum-Unit 1217

18. DFS Approved Curriculum-Unit 1218 12.3Describe the nurse aide’s role in relationship to the to the needs of the dying.

19. DFS Approved Curriculum-Unit 1219 Caring For Resident When Death Is Imminent and Following Death Nurse Aide’s Role Source of strength and comfort Open and receptive Know own feelings about death and do not project those feelings onto resident.

20. DFS Approved Curriculum-Unit 1220 Caring For Resident When Death Is Imminent and Following Death Nurse Aide’s Role (continued) Empathetic Calm and efficient Normal tone of voice Good listening skills Non-judgmental

21. DFS Approved Curriculum-Unit 1221

22. DFS Approved Curriculum-Unit 1222 12.4Review the various reactions residents may have as they face death.

23. DFS Approved Curriculum-Unit 1223 Individual Resident’s Reaction To Death Accept or be resigned to death Open and receptive Communicate about uncertainties Fearful or angry Despairing and anxious Hostile Thoughtful and meditative

24. DFS Approved Curriculum-Unit 1224

25. DFS Approved Curriculum-Unit 1225 12.5 List and describe the five stages of grief, death and dying.

26. DFS Approved Curriculum-Unit 1226 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross DENIAL –Defense mechanism –Buffer against reality –Emotional escape hatch –Resident may request another opinion

27. DFS Approved Curriculum-Unit 1227 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross DENIAL (continued) –Resident may avoid discussion of death –Feeling of, “This can’t be happening to me.”

28. DFS Approved Curriculum-Unit 1228 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross ANGER –Bitterness and turmoil –Sense of unfairness –Blame of others such as health care workers –Feeling of, “Why me?”

29. DFS Approved Curriculum-Unit 1229 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross BARGAINING –Turn to religious and spiritual beliefs –Promises to God and others –Comfort and hope when all seems lost

30. DFS Approved Curriculum-Unit 1230 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross BARGAINING (continued) –Generally know this won’t work –Frustration and anger dissolve into depression –“If only...I will”

31. DFS Approved Curriculum-Unit 1231 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross DEPRESSION –Belief that hope is lost –Overwhelming despair –Introverted and withdrawn –Reminiscing and reviewing life –Sleeplessness –“I always wanted to”

32. DFS Approved Curriculum-Unit 1232 Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross ACCEPTANCE –Calm and subdued interest in life –Strives to complete unfinished business –Helps loved ones accept death –Needs others to validate worth of life –“I’ve had a good life.”

33. DFS Approved Curriculum-Unit 1233

34. DFS Approved Curriculum-Unit 1234 12.6Recognize the signs of approaching death.

35. DFS Approved Curriculum-Unit 1235 Signs Of Approaching Death Changes in sensory functions and ability to speak –Vision increased secretions in corner of eyes blurred vision failing vision no eye movement/staring

36. DFS Approved Curriculum-Unit 1236 Signs Of Approaching Death Changes in sensory functions and ability to speak (continued) –Speech becomes difficult hard to understand may be unable to speak –Hearing - last function to be lost

37. DFS Approved Curriculum-Unit 1237 Signs Of Approaching Death Changes in circulation and muscle tone –Circulation fails heat gradually lost from body hands and feet cold to touch and mottled face becomes pale or gray and mottled perspiration may increase (diaphoresis)

38. DFS Approved Curriculum-Unit 1238 Signs Of Approaching Death Changes in circulation and muscle tone (continued) –Muscle tone body limp jaw may drop mouth may stay partly open

39. DFS Approved Curriculum-Unit 1239 Signs Of Approaching Death Changes in Vital Signs –Respirations slower shallow labored may experience dyspnea, apnea, Cheyne-Stokes mucous collects in the throat and bronchial tubes (death rattle)

40. DFS Approved Curriculum-Unit 1240 Signs Of Approaching Death Changes in Vital Signs (continued) –Pulse rapid weak and irregular –Blood pressure drops –Temperature elevated subnormal

41. DFS Approved Curriculum-Unit 1241 Signs Of Approaching Death Urinary and anal incontinence Decreased peristalsis, abdominal distention Release of flatus Decreased pain Loss of consciousness

42. DFS Approved Curriculum-Unit 1242

43. DFS Approved Curriculum-Unit 1243 12.7Define the role of the nurse aide in the spiritual preparation for death. 12.8Contrast the spiritual preparation for death practiced by those of various religions.

44. DFS Approved Curriculum-Unit 1244 Nurse Aide’s Role In Spiritual Preparation For Death Priest, rabbi, minister or other clergy may be contacted at request of resident or family Privacy to be provided when clergy with resident

45. DFS Approved Curriculum-Unit 1245 Nurse Aide’s Role In Spiritual Preparation For Death (continued) Support resident’s religious/spiritual practices even if different from that of nurse aide Listen respectfully to religious/spiritual beliefs Participate in religious practices if asked and acceptable

46. DFS Approved Curriculum-Unit 1246 Nurse Aide’s Role In Spiritual Preparation For Death (continued) Treat religious objects with care and respect: –medals –pictures –statues –bibles Encourage family and friends to be included

47. DFS Approved Curriculum-Unit 1247

48. DFS Approved Curriculum-Unit 1248 12.9Identify the needs of the family as they encounter the dying process.

49. DFS Approved Curriculum-Unit 1249 Nurse Aide’s Role In Meeting Family Needs Available for support Use touch as appropriate Courteous and considerate Respect right to privacy Let family assist with care, if they desire, where appropriate

50. DFS Approved Curriculum-Unit 1250 Nurse Aide’s Role In Meeting Family Needs (continued) Use good communication skills Listen and provide understanding throughout the grief/loss stages Answer questions or refer to supervisor

51. DFS Approved Curriculum-Unit 1251

52. DFS Approved Curriculum-Unit 1252 12.10Discuss the hospice philosophy.

53. DFS Approved Curriculum-Unit 1253 Hospice Care Health care service offered: –in hospitals and extended care facilities –by special facilities –usually in the individual’s home Continuing care provided by team of health professionals Designed for residents with terminal illness

54. DFS Approved Curriculum-Unit 1254 Hospice Care (continued) Acceptance of death as imminent (6 months or less) Assures that individual dies with dignity and comfort Not concerned with cure or life- saving procedures Emphasis on pain relief Trained volunteers and professionals make regular visits.

55. DFS Approved Curriculum-Unit 1255 Hospice Care (continued) Provides counseling for individual and family: –Emotional –Psychological –Spiritual –Financial –Bereavement Family included in all aspects of care as desired

56. DFS Approved Curriculum-Unit 1256

57. DFS Approved Curriculum-Unit 1257 12.11Discuss the meaning of postmortem care.

58. DFS Approved Curriculum-Unit 1258 Postmortem Care Care Of Body After (Post) Death (Mortem) –Begin care when instructed by supervisor –Treat body to privacy, respect and gentleness –Give care before rigor mortis sets in

59. DFS Approved Curriculum-Unit 1259 12.12List five reasons for doing postmortem care.

60. DFS Approved Curriculum-Unit 1260 Postmortem Care (continued) Reasons for Postmortem Care –Prevent discoloration and skin damage –Maintain good appearance of body –Identify body and prepare for transportation –Position body in normal alignment –Arrange time family to view the body

61. DFS Approved Curriculum-Unit 1261

62. DFS Approved Curriculum-Unit 1262 12.13Demonstrate the procedure for postmortem care.

63. DFS Approved Curriculum-Unit 1263