Death & Dying

Elizabeth Kubler-Ross describes a five part pattern that is experienced by the anticipated dying person and by those close to him.

Stages of Death & Dying Not everyone progress smoothly through all five stages in order Some people skip; some regress to a stage they have already been through. Some get stuck in a particular stage (such as anger or depression)

Denial The news of dying is too overwhelming to accept at once The fact can be ignored or one may ask for a second opinion or verification of the medical reports Denial allows one to go on with the business of living from day to day

Anger Once the inevitability of death is accepted, the difficult emotion surfaces Whatever those who are trying to help are doing is wrong The person is reacting with anger that his life is being cut short and he is about to enter an unknown situation

Bargaining Once anger subsides, the person enters a most frantic stage of bargaining Trying for an extension of life or a higher quality of life Most of the bargains are secret and made with God i.e. “live long enough to see grandchild” or “daughter’s wedding”

Depression Characterized by inherent sadness The person accepts the fact that death is imminent and prepares to say goodbye to everyone This is a very difficult stage

Acceptance The person quietly accepts the imminent death, He has done everything he can to prepare to die The person seems calm Most important wish is not to die alone

Sudden Death Survivors Reactions include: Hostility Guilt and self-blame Preoccupation with dead person Disbelief Physical distress Sudden death includes: accidents, homicide, suicide or unexpected illness

Survivors who have lost a spouse from sudden death need to/for See the person after he is admitted to the emergency dept Make sure that prompt physical attention is given, even if the person is already dead Immediately be told of the severity of the situation Express anxieties about impending death Comfort and support from family members and health professionals

Wrong things to Say: I know how your feeling How are you? It will be OK You will get over this.

Right Things to Do: Simple clear instructions Acceptance, nodding, nonverbal Simple choices Non-judgmental Arrange support through a friend or religion Remember: Honesty, Listening and Privacy

Interventions Be respectful to the dying person and the family members Do not interrupt a dying person who is telling their story unless it is necessary for their care. Do not take away all hope. Touch of the person may be important if their senses are failing Give factual information

Interventions Fulfill requests as best as possible Provide appropriate reassurance and support to survivors Depending on the circumstances, referrals to community agencies may be helpful Become aware of your own fears and thoughts regarding death

Interventions Do not avoid the dying person or their family. They need your contact and they need to talk to you. Dying people usually wish to discuss their situation but often fear rejection Ask them how you might best help them Let them guide you to make them feel somewhat more comfortable.

Interventions Do not push them to talk. At times silence may be preferred. Do not lie. Genuine warmth, understanding and compassion will do more than anything else to assist a dying person.

Grief Our normal response to life’s losses as well as part of the cycle of change. Never the same for two people in time or intensity

Factors Which Effect Coping: Previous loss history Support systems Spiritual resources Coping abilities Cultural and Gender expectations Personality Age Cultural and religious beliefs How the death occurred: natural, accidental, suicide, homicide

Grief: Normal Responses Shock: “I just don’t believe it” Anger: “Why couldn’t they fix him?” “Why me?” Emotional Release: “I can’t stop crying” Sadness/guilt: “It’s wrong to laugh” “I wish I was there” Loneliness: “Without her, I can’t go on”

Grief: Normal Responses Preoccupation: “I can’t get him out of my mind” Depression: Life is not worth living” Lost: “We had plans together” Confusion: “I can’t seem to concentrate on a thing” Isolation: “Who cares?” “Why bother?” Relief: “He would have wanted it this way”

Signs & Symptoms Exhaustion Headaches Palpitations, breathlessness Change in appetite Sleeping problems Lack of strength, energy Change in self care Spiritual confusion Disorientation to time, place Apathy Impaired self esteem Difficulty concentrating Feelings: emptiness, despair, hopelessness, helplessness, bitterness, euphoria

Needs of Family Members Experiencing Anticipatory Grief: Need to/for Be with dying person Helpful to dying person Assurance of client’s comfort Be informed of client’s condition Be informed of impending death Ventilate emotions Comfort and support from other family members Have opportunity to complete cultural rituals Acceptance, support and comfort from health professionals.

Appropriate Approaches to Remorse, Grief and Reconciliation Phases: Careful, active listening Avoid judgmental statements Allowing the person to express themselves Assuring the person that it is ok to feel bad. Avoid sedation unless it is absolutely necessary and ordered by a doctor Being caring and supportive