1. Death and Dying Objectives will appear in RED. Pre-Test!

2. “Quotes About Death” “I’m not afraid of death; I just don’t want to be there when it happens.” – Woody Allen “The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time.” – Mark Twain “Death ends a life, not a relationship.” – Mitch Albom, Tuesdays with Morrie “What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.” – Albert Pike

3. Introduction to Death and Dying What is it like to lose something or someone we care for? Where does our understanding of death come from? Why do most people dislike talking and thinking about death? Death is a natural part of life!

4. What is Death? Let’s Brainstorm. Try to define Death.

5. Identify the Stages of Death. Clinical Death -W-When the heart and lungs cease to function. -N-No Breathing, Circulation, the brain is in the first stages of shutting down Brain Death -L-Lack of oxygen to brain cells. -T-The brain is deprived of oxygen, but the organs and tissues are not totally depleted yet, with life support, they are viable Biological/Cellular Death -W-When oxygen in the tissues and organs is depleted and all functions slowly cease. -T-The process of dying is over.

6. Explain why there is a possibility for disagreement of whether a person is dead or not. Medical technology

7. Explain how a person’s understanding of death is influenced by age. From ages 2 to 5, children recognize death but do not recognize it as permanent. From 5 to 9, children know death is permanent, but do not realize it could happen to them. From age 10, people recognize death as permanent and inevitable Elderly accept death as inevitable and final

8. Explain Death and Dying Vocabulary: Autopsy examination to determine the cause of death. Bereaved one who has suffered loss of another through death. Condolence expression of sympathy for another in grief. Coroner an official responsible for investigating deaths, particularly those happening under unusual circumstances, and determining the cause of death. Deceased one who has died. Epitaph a short composition in prose or verse, written as a tribute to a dead person Eulogy speech or writing in praise of dead person.

9. Vocabulary Continued: Interment burial underground Living Will legal statement of person ’ s wishes concerning his treatment before death. Morgue a place where the bodies of accident victims and unknown persons found dead are kept prior to identification and disposal. Mortuary a place where dead bodies are prepared or kept prior to burial or cremation. Mourning act of expressing grief. Obituary news of death in publication. Wake a watch over the body of a dead person all night, just before burial. Will legal statement of person ’ s wishes concerning disposal of his or her property after death

10. Explain Grief. The pain, discomfort, and mental and physical feelings that most people feel following the death of a loved one. People suffer grief at the loss of anything. It doesn ’ t just have to be death. GRIEF is the emotion we feel when we suffer a great loss. We can grieve over the loss of a love relationship, a divorce, or other painful losses It is a “ process ” and is a healthy release

11. Explain The Grieving Process. Grief Activity: Place the stages of grief in order according to the Kubler-Ross model of grief or adjusting to death. Acceptance Bargaining Denial Anger Depression

12. Denial A conscious or unconscious refusal to accept. Natural defense mechanism. Usually temporary shock and disbelief before reality sets in. One can even make believe to an extent by reenacting rituals that they used to go through with their loved one. We set an extra plate at the table. We expect them to be there when we get home. We flash back to memories and conversations. These are all part of this stage.

13. Anger A person gets angry. The anger can manifest itself in many ways. Manifests as anger at self, others (including medical staff). Important for medical staff and family to understand and be non-judgmental. One will blame others for the loss. Become easily agitated having emotional outbursts. Can even become angry at ourselves. Care must be taken here not to turn the anger inwards. Release of this anger is essential.

14. Bargaining Bargaining can be with ourselves or if a person is religious, with their god. Often a person will offer something to try to take away the reality of what really happened. They may try to make a deal, to have their loved one back as they were before the tragic event occurred. It is only human to want things back as they were before.

15. Depression Feelings of loneliness and hopelessness; difficulty in performing daily activities This is the most difficult of the stages to deal with. Outbursts of tears may occur. A person may feel like there is no purpose to life anymore. A person may feel like they are being punished. Pleasure and joy may be difficult to express. There may even be thoughts of suicide. If at any time in this stage, a person feels like doing harm to themselves, professional counseling should be sought.

16. Acceptance This the final stage of grief. Adjusting to the finality of death and going on with life. A person can accept the loss and now be able to regain their energy and goals for the future. It may take some time, maybe years to get to this stage…but it will happen!

17. Stages in Adjustment to Death Stage of Grief and Stages in Adjustment to Death are one and the same. An individual dealing with the reality of terminal illness or the loss of a loved one will move through some or all of Elisabeth Kubler- Ross’s Stages. This model is not set in stone. Different people experience grief and death acceptance in different ways. This is a general model of observations.

18. Coping with Crisis Other emotions we may deal with when in mourning? Shock Guilt Any others? Intense Feeling of Pain/Loss Usually occurs two to three months after the loss. The bereaved person may withdraw from the world. Identify Reactions to Loss

19. Shock Occurs between the time of death and time of the final arrangements During “ shock ” one may even deny that the death has occurred.

20. Physical Reactions Numbness Disinterest Tightness in Throat Pain Tired Insomnia Unfeeling

21. Emotional Reactions Sense of Unfairness Anxiety Feeling of Relief Stabbing Pain Hostility Guilt Sudden Anger Gladness Fear Anger

22. Explain how to cope with grief. Attend support groups in your area Therapy with a psychologist or other qualified mental health professional Eat well Exercise Get enough rest

23. o Read and learn about death-related grief responses o For some, seeking solace in the faith community o Seek comforting rituals o Allow emotions -Tears can be healing. o Avoid major changes in residence, jobs, or marital status, etc.

24. Identify What Dying People Need. Most people are aware of their final moments in life and have very specific emotional needs. They want to express their needs and final wishes. They want to be surrounded by loved ones. They want a “death with dignity.”

25. Needs of the Terminally Ill People who are aware their death may be near also need: An opportunity to talk about their feelings Time alone

26. Explain The Role of Hospice Hospice is an organization that assists terminally ill people and their families. They also offer grief counseling services. They differ from a “hospital” in that they are not trying to prolong life, but ease the dying persons transition into death. (no life sustaining machines) They provide a “homelike” atmosphere where the dying and their families can be together.

27. Decisions that Must be Made Funeral or Memorial Service? Wills: a legal document that deals with a persons “possessions,” children, assets such as $$, houses, etc. Living Will: A document that specifies what a person would want for emergency treatment in the event they could not speak for themselves. Advance Directives Power of Attorney

28. http://www.youtube.com/watch?v=VWL6t7- 6VHA Short video on Advanced Directives

29. Death and Mourning Traditions Around the World worksheet Complete the worksheet. Be prepared to discuss the reasoning behind your choice.

30. Funeral Vs. Memorial Service When a person dies, the person is usually buried or cremated. Funeral: If the person has not been cremated, normally the body is present depending on the family ’ s wishes or the religious practice of the deceased. Memorial Service: The body is not present as a rule. If cremated, the ashes of the person may be there. Memorial Services often take place after the body has been buried or cremated.

31. How are Funerals Helpful? They help grieving people bring closure to the death They help people adjust to the loss. They assist people in observing the death in a spiritual way. They help family and friends find needed support during their loss