1. Human Growth & Development – Death and Dying
K. McConnell RN
HSTE 1

2. Death is often referred to as the final stage of growth
When a patient is told that he/she has a TERMINAL ILLNESS, a disease that cannot be cured and will result in death, patients react in many different ways.
Dr. Elizabeth Kübler-Ross has researched the dying process and has identified 5 stages of grieving that dying patients and their families may experience in preparation for death.
Stages may not appear in order and some patients may be in several stages at the same time. Some patients die before progressing through all the stages

3. The 5 Stages of grieving
Denial – “No, not me!” Usually occurs first. The person cannot accept the reality of death. May refuse to discuss the situation or may request additional tests and second opinions.
Anger – Occurs after patient can no longer deny situation. “Why me?” questions are common. Patient may become hostile or bitter. May lash out at family, friends, or healthcare providers.
Bargaining – Patient accepts death but wants more time to live. Patient may turn to religion or other spiritual beliefs. The will to live is strong and the patient might fight hard to overcome the illness. Pts. Make promises to God to obtain more time (see their kids graduate, attend a wedding, etc)

4. 5 Stages continued…
Depression – occurs when patients realize that death will come soon and they will no longer be able to be with their families or reach their goals. May express regret, experience deep sadness or overwhelming despair. Allowing patient to cry or express grief is important during this stage.
Acceptance – The final stage. Pts. Understand and accept the fact that they are going to die. May complete unfinished business, write wills, give away belongings, write letters. Gradually separate themselves from the world and other people. At the end, they may be “at peace” or prepared to die with dignity. Patients need emotional support during this time as well.

5. Caring for the Dying patient
Can be very difficult, but rewarding for the caregiver. Healthcare workers must first understand their own personal feelings about death and come to terms with these feelings.
The Hospice – care is provided with the aim of allowing the patient to die with dignity and in the most comfortable situation as possible. Hospice care is not for those who will recover. It is end of life care. Can be in a home, hospital, medical center or special hospice facility. Care can be provided by home health aides or other HC professionals.
Support and understanding for the patient and families is of utmost importance in hospice care.

6. The right to die
Patients have the right to refuse life-saving measures and other care.
Patients who have a terminal illness often express the desire to be allowed to die with dignity without life-sustaining measures being applied.
Patients will use the living will to state their preferences.
Use of respirators, pacemakers, and other medical devices can be withheld as the patient has directed.