1. Human Growth and Development Death and Dying

2. Basic Definitions Death=final stage of growth Terminal illness=disease that cannot be cured and will result in death Hospice care=program designed to provide care for the terminally ill while allowing them to die with dignity. It provides palliative care Palliative care=measures taken to treat symptoms and/or pain even though it will not cure a disease; comfort measures

3. Stages of Death and Dying Dr. Elizabeth Kubler-Ross identified 5 stages of grieving that dying patients & their families/friends may experience in preparation of death: denial, anger, bargaining, depression, & acceptance The stages may not occur in order, & they may overlap or be repeated several times Patients may not progress through all of the stages before death occur Patients may be in several stages at the same time

4. Denial “No, not me!” stage Usually happens when first told of terminal illness Occurs when the person cannot accept the reality of death or when the person feels loved ones cannot accept the truth Pts may say “The doctor doesn’t know what he is talking about” or “The tests must be wrong”

5. Denial Pts may get 2 nd opinion, request more tests Pts may refuse or avoid discussion about their situation It is important that pts discuss these feelings & HCW listen to pt & try to provide support without confirming or denying: “It must be hard for you.” “You feel additional tests will help?”

6. Anger Occurs when pt is no longer able to deny death Pts may say “Why me?” or “It’s your fault.” Pts may strike out at others, become hostile & bitter Pts may blame themselves, their loved ones, or health care workers

7. Anger HCW must understand that this anger is not a personal attack, the anger is caused by the situation HCW should provide understanding & support, respond to pt’s demands quickly & with kindness

8. Bargaining Occurs when pts accept death but want more time to live Pts may turn to religion and spiritual beliegs At this point, the will to live is strong, & pts fight hard to achieve goals Pts may make promises to God to obtain more time HCW must be supportive & good listeners & help pts meet their goals when possible

9. Depression Occurs when pts realize that death will come soon & they will no longer be with their families or be able to complete their goals Pts may express regrets, withdraw, become quiet Pts may experience great sadness & overwhelming despair HCW should let pts know that it is Ok to be depressed, provide quiet understanding, support, a simple touch, & allow pts to cry or express grief

10. Acceptance Final stage when pts accept fact they are going to die Pts may complete unfinished business & try to help those around them deal with the oncoming death Pts gradually separate themselves from the world & others At the end, they are at peace & can die with dignity Pts still need emotional support, even just the touch of a hand