Unit A Nurse Aide Workplace Fundamentals Essential Standard NA2.00 Apply communication and interpersonal skills and physical care that promote mental health and meet the social and special needs of residents in long-term care. Indicator 2.04 Understand the Dying Process and Needs of the Resident Nearing the End of Life. Nursing Fundamentals 7243 Understanding the dying process and needs of the resident nearing the end of life. 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

2.04 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 indicator also includes care of the body following death. 2.04 Nursing Fundamentals 7243

is no less beautiful than the sun rising. Nursing Fundamentals 7243 The sun setting is no less beautiful than the sun rising. 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Psychological changes of the grieving resident Nursing Fundamentals 7243 Five stages of grieving have been identified by Elizabeth Kubler-Ross 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 Not all residents go through all the stages Some residents may stay in one stage until death occurs Residents may move back and forth between grieving stages Family and friends of the resident will experience the grief stages Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 Understanding the stages of grief helps the Nurse Aide apply psychological support to resident, family, and friends 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 DENIAL Defense mechanism Buffer against reality Emotional escape hatch Resident may request another opinion Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 DENIAL (continued) Resident may avoid discussion of death Feeling of, “This can’t be happening to me.” Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Nursing Fundamentals 7243 Care Point Nurse Aides must be ready to listen if the resident expresses their feelings Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 ANGER Bitterness and turmoil Sense of unfairness Blame of others such as health care workers Feeling of, “Why me?” 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Care Point Nurse Aide must not take the accusations personally Nursing Fundamentals 7243 Care Point Nurse Aide must not take the accusations personally Do not follow the urge to leave the angry resident Listen empathetically Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 BARGAINING Turn to religious and spiritual beliefs Promises to God and others Comfort and hope when all seems lost 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 BARGAINING (continued) Generally know this won’t work Frustration and anger dissolve into depression “If only...I will” Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Care Point Listen and reflect what is said, express understanding Nursing Fundamentals 7243 Care Point Listen and reflect what is said, express understanding Be aware of when silence is helpful and words are not 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 DEPRESSION Belief that hope is lost Overwhelming despair Introverted and withdrawn Reminiscing and reviewing life Sleeplessness “I always wanted to” Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Care Point Your touch, if accepted, can be very helpful Nursing Fundamentals 7243 Care Point Your touch, if accepted, can be very helpful Understand the resident’s feeling of loss Do not deny death is approaching Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Elizabeth kubler-ross five stages Nursing Fundamentals 7243 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.” 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Care Point Your presence lets them know you will not desert them Nursing Fundamentals 7243 Care Point Your presence lets them know you will not desert them Listen if they wish to discuss their death 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH Nursing Fundamentals 7243 Personal experiences  Culture; some fear death others look forward to and accept death  2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Factors influencing residents/family attitudes toward death Nursing Fundamentals 7243 Religion  Belief in life after death  Reunion with loved ones  Reincarnation  Punishment for sins  No afterlife  Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH Nursing Fundamentals 7243 Age:  Children view death at temporary Adults may develop fears of pain and suffering, dying alone, separation from loved ones Elderly generally have fewer fears 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Individual resident’s reaction to death Nursing Fundamentals 7243 Individual resident’s reaction to death Accept or be resigned to death Open and receptive Communicate about uncertainties Fearful or angry Despairing or anxious Hostile Thoughtful and meditative Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 Changes in sensory function and the ability to speak VISION Blurred and failing vision Increased secretions in corner of eye No eye movement / staring / unfocused eye 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

Reduce glare and keep room lightening low Nursing Fundamentals 7243 Reduce glare and keep room lightening low 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in sensory function and the ability to speak SPEECH becomes difficult hard to understand may be unable to speak Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Observe body language of the resident Anticipate needs Nursing Fundamentals 7243 Do not expect an answer Observe body language of the resident Anticipate needs Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in SENSORY FUNCTION and the ability to speak HEARING last sensory function to be lost… Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

Be careful what you say! Nursing Fundamentals 7243 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in sensory function and the ability to speak TOUCH SENSE OF TOUCH IS DEMINISHED Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

SKIN CARE IS PARAMOUNT Resident can no longer turn themselves, Nursing Fundamentals 7243 Resident can no longer turn themselves, SKIN CARE IS PARAMOUNT 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in CIRCULATION AND MUSCLE TONE and the ability to speak LOSS OF MOVEMENT, MUSCLE TONE, AND FEELING Body is limp Jaw may drop Mouth may stay partly open Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in CIRCULATION AND MUSCLE TONE and the ability to speak CIRCULATION FAILS Heat is lost from the body’ Mottling (bruised appearance), spotting, or blotching of skin caused by poor circulation Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in CIRCULATION AND MUSCLE TONE and the ability to speak CIRCULATION FAILS Hands and feet cold to touch Face becomes pale or gray and mottled Perspiration may increase (DIAPHORESIS) Nursing Fundamentals 7243 2.04 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Blood pressure decreases 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.

COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in vital signs Pulse: Abnormally slow, rapid, or irregular 2.04 Nursing Fundamentals 7243 2.04 Understand the dying process and needs of the resident nearing the end of life.