Death and Dying

Overview of Death and Dying

 One of the most difficult issues in nursing practice

 Often difficult for nurses to maintain objectivity because of

identification and response to death based on own value system and
personal experiences

 Nurses need to take time to analyze their own feelings about death
before they can effectively help others with terminal illness

ASSESSMENT
 A. Physical discomfort

 B. Emotional reaction (withdrawal, anger, acceptance) and stage of

dying

 C. Desire to discuss impending death, value of own life

 D. Level of consciousness

 E. Family needs

F. Stages of dying (Kuber-Ross)

Stages of Grieving/Dying (Kubbler-Ross)

 1. Denial- refuses to believe that the loss has occurred

 2. Anger- the individual resists the loss and may “act out” feelings.

 3. Bargaining- the individual attempts to make a deal in an attempt

to postpone the reality of loss.

 4. Depression- feeling of loneliness and withdrawal from others

 5. Acceptance- the individual comes to terms with loss, or

impending loss, psychological reactions to loss to the loss cease,
and the interaction to other people resumed

Pneumonics: (dabda)
Stages Behaviors

DENIAL Refuses to believe that loss is happening

ANGER Retaliation/Hostility

BARGAININ Feelings of guilt, fear of punishment for sins

G

DEPRESSIO Laments over what has happened , withdrawn behavior

N

ACCEPTAN Begins to plan like wills, prosthesis, comes to terms with loss
CE

STAGES OF BELIEFS IN DEATH

Infancy NO clear concept of Death

to 5 It is Reversible. Temporary sleep
years old
Immobility and Inactivity

5 to 9 Understands DEATH is FINAL but can be AVOIDED

years

9-12 Death is INEVITABLE

years Understands own mortality
Fears death

12-18 Fears a lingering Death

years Fantasizes avoidance of death

18-45 Attitude is influenced by religion

Increased attitude and awareness

45-65 Experiences peak of death anxiety

years Accepts mortality

65 and Death as multiple meanings, encounters and fears

above
ANALYSIS
NURSING DIAGNOSES FOR THE DYING CLIENT MAY INCLUDE:

 A. Anxiety F. Impaired mobility

 B. Pain G. Powerlessness

 C. Ineffective coping H. Self-care

 D. Fear I. Social isolation

 E. Anticipatory grieving J. Hopelessness

PLANNING
GOALS:

A. Client will
1. Will be maintained in optimum physical comfort

2. Maintain sense of security

3. Have opportunity to discuss what death means and to progress

through stages of dying

4. Help client accept losses

5. Provide relief from loneliness, fear and depression

B. Family will have opportunity to be with client as much as they

desire

C. The major goals for the dying clients are:

1. To maintain PHYSIOLOGIC and PSYCHOLOGIC support

2. To achieve a dignified and peaceful death

3. To maintain personal control

INTERVENTIONS
1. Recognize clients/families have own way of dealing with death and
dying

2. Support clients/families as they work through dying process

3. Accept negative responses from clients/families

4. Encourage clients/families to discuss feelings related to death and
dying

5. Support staff and seek support for self when dealing with dying client
and grieving family

 D – SUPPORTIVE

 A- PROVIDE STRUCTURE AND CONTINUITY

 B – LISTEN AND ENCOURAGE

 D- ALLOW EXPRESSION AND PROVIDE FOR SAFETY

 A- ENCOURAGE PARTICIPATION

EVALUATION
A. Client has
1. Taken opportunity to discuss feelings about impending death and
eventually acknowledges inevitable outcome

2. Been comfortable and participated in self-care for as long as possible

B. Family discussed feelings about loss of loved one

GRIEF AND LOSS

 Grief is a form of sorrow involving feelings, thoughts, and behaviors
caused by bereavement

 Loss is a universal experience that occurs throughout life span

  Responses to loss are strongly influenced by one’s cultural
background

 The grief process involves a sequence of affective, cognitive, and

psychological states as a person responds to, and finally accepts a
loss

Definitions:
 LOSS= something valuable is gone

 GRIEF= total response to emotional experience related to loss

 BEREAVEMENT= Subjective response by loved-ones

 MOURNING= behavioral response

OVERVIEW OF GRIEF & LOSS

A . Response to loss (person, body part, role)

B. Biologic, psychologic, social implications

C. Family system effects

D Mourning is process to resolve grief

E. Despair, depression

F. Detachment from loss

G. Renewed interest, investment in others / interests

H. Mourning is process to resolve grief

1. Shock, disbelief are short term

2. Resentment, anger

3. Possible auditory, visual hallucinations

4. Possible guilt

5. Possible fear of becoming mentally ill

ASSESSMENT
 A. Weight loss
  B. Sleep disturbances

 C. Thoughts centered on loss

 D. Dependency, withdrawal, anger, guilt

 E. Suicide potential

ANALYSIS
 A. Ineffective coping

 B. Hopelessness

 C. Sleep pattern disturbances

 D. Disturbed thought process

 E. Risk for violence, self-directed

PLANNING
Goals: Client/Family will

 1. Discuss responses to loss

 2. Resume normal sleeping/eating patterns

 3. Resume ADL as they accept loss

IMPLEMENTATION
 A. Encourage client/family to express feelings

 B. Accept negative feelings/defenses

 C. Employ emphatic listening

 D. Explain mourning process and relate to client/ family responses

 E. Refer client/ family to support groups

EVALUATION
Client/ Family has:
 1. Expressed feelings

 2. Progressed through mourning process

 3. Seeked necessary support groups