1. DEATH AND DYING

2. INTRODUCTION It is important for CNAs to understand the stages and signs of dying as well as the grieving process so that they may help provide support to the resident and the family.

3. Stages of Grief Dr. Kubler-Ross’s discusses the five stages of dying. Denial: refusal to believe they are dying Anger: “Why me?” Bargaining: “Yes me, but…” Depression: need to mourn and review their lives Acceptance: preparing for death Emphasize that not every resident goes through all these stages or in this order.

4. The Death of a Loved One There are 7 stages a person may go through when they have someone close to them who dies. Shock: especially at our own feelings Denial: usually lasts a short time Anger: at God, the doctors, even at the person who died Guilt: that we are still alive Regret: for what we did or did not do Sadness: depression, headaches, or insomnia Loneliness: missing the person and painful memories

5. Advance Directives Definition: legal documents that allow you to convey your decisions about end of life care ahead of time (living will). They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on.

6. Caring for a Dying Resident Diminished senses Care of mouth and nose Skin care Comfort Environment Emotional and spiritual support

7. How can you treat residents with dignity when they are approaching death?

8. Treating the Resident and Their Family With Dignity Respect their wishes in all ways possible. Do not isolate or avoid a resident who is dying. Do not make promises that cannot or should not be kept. Continue to involve the dying person in facility activities. Listen if they want to talk. Do not babble, or be especially cheerful or sad. Keep the resident comfortable. Assure privacy when they want it. Respect the privacy of the family and other visitors. Help with the family’s physical comfort.

9. Resident Rights to Remember The right to refuse treatment The right to have visitors The right to privacy

10. Common Signs of Approaching Death Blurred vision that gradually fails; Unfocused eyes Impaired speech Diminished sense of touch Loss of movement, muscle tone, and feeling Rising body temperature or below normal temperature Decreasing blood pressure Weak pulse that is abnormally slow or rapid

11. Common Signs of Approaching Death Slow, irregular respirations or rapid, shallow respirations “Rattling” or “gurgling” sound when breathing Cold, pale skin Mottling, spotting, or blotching of skin caused by poor circulation Incontinence Disorientation or confusion

12. Changes That Occur After Death No heartbeat, pulse, respiration, or blood pressure Rigor mortis (death stiffness) Eyelids partially open; eyes in fixed stare Mouth may remain open Incontinence

13. Postmortem Care Definition: Care provided for a person immediately after death Rigor mortis may make body difficult to move. Bathe the body gently. Place drainage pads. Do not remove tubes or other equipment. Put in dentures if instructed by the nurse. Close eyes.

14. Postmortem Care Position body. Put a small pillow under head. Follow facility policy on personal items. Strip the bed after body is gone. Open windows to air the room. Straighten room. Respect wishes of family and friends. Document procedure.