Dying, Death, and Hospice Chapter 23

Learning Objectives Discuss the stages of grief, the grief process, and how feelings and attitudes about death differ Discuss how to care for a dying resident Describe ways to treat dying residents and their families with dignity and how to honor their rights Define the goals of a hospice program Explain common signs of approaching death List changes that may occur in the human body after death Describe postmortem care and different postmortem practices

Terminal illness Denial Anger Bargaining Depression Acceptance Stages of Grief People may refuse to believe they are dying Denial People may become angry that they are dying Anger People may make promises to God or somehow try to bargain for their recovery Bargaining People may become deeply sad or depressed Depression People who are dying accept death and prepare for it Acceptance

Grieving & Death Feelings and Attitudes about Death Prior experience with death Personality types Religious believes Culture Grieving Shock Denial Anger Guilt Regret Sadness Loneliness

Caring for a Dying Resident Ways to treat the dying with dignity and respect: Right to refuse treatment Right to visitors Promote privacy Respect their wishes Do NOT isolate or avoid them Help with family’s physical comfort The Dying Person’s Bill of Rights Right to: Be treated as a human Be free from pain Have their questions answered honestly Die in peace and with dignity Participate in care decisions Caring for a Dying Resident Diminished senses Frequent oral and skin care Promote comfort Comfortable environment Provide emotional and spiritual support Listen and be present ADVANCE DIRECTIVES

Hospice Care Hospice Care Holistic, compassionate care given to dying people and their families Focus is on dignity and comfort of a dying person Palliative Care Care that focuses on the comfort and dignity of a person who is very sick and/or dying, rather than curing them Typically involves pain relief and comfort Working with Hospice Be sensitive to individual needs Be a good listener Respect privacy Be aware of your own feelings Recognize the stress Take good care of yourself Take a break when you need to

The Dying Process Approaching Death Death Postmortem care Visual changes Diminished sense of touch, movement, muscle tone Altered Vital Signs Cheyne-Stokes respirations or gurgling sound when breathing Skin changes Incontinence Disorientation or confusion Approaching Death No heartbeat, pulse, respiration, or blood pressure Muscles become stiff and rigid Eyelids may be partially open or in a fixed stare Mouth may remain open Body may be incontinent of urine and stool Death Care of the body after death You may be tasked with: Bathing gently and placing drainage pads where needed Closing the eyes Position the body Strip the bed when the body is gone Open windows to freshen the air and tidy up Respect family wishes Do NOT remove tubes or equipment Postmortem care

Wake Viewing Open casket funeral Closed casket funeral Cremation Postmortem Practices Wake Viewing Open casket funeral Closed casket funeral Cremation

Review Stages of grief The grief process Caring for dying residents Treating dying residents with dignity Hospice Approaching death Postmortem care and practices