Stages of Dying and Related Nursing

Interventions
 DENIAL : on becoming aware of their
impending death, most individuals initially react
by denying the reality of the situation.
 ANGER : The stage of denial is gradually
replaced, and the “No, not me” reaction is
substituted for one of “Why me?”.
 BARGAINING : After recognizing that neither
denial not anger changes the reality of
impending death, dying persons may attempt to
negotiate a postponement of the inevitable.

DEPRESSION : When a patient is
hospitalized with increasing frequency
and experiences declining functional
capacity and more symptoms, the reality
of the dying process is emphasized.
 ACCEPTANCE : For many dying
persons, a time comes when struggling
ends and relief ensures.
Family members may experience feelings of
helplessness when faced with the dying
person’s depression.

Hope permeates all stages of the

dying process.
Physical Care Needs
PAIN : Concern regarding the degree of pain
that will be experienced and its management
may be considerable source of distress for
dying individuals; nurses can reduce distress for
patients by supplying them with realistic
information regarding pain.
RESPIRATORY DISTRESS : It is a common
problem in dying patients. In addition to the
physical discomfort resulting from dyspnea,
patients can experience tremendous
psychological distress associated with the fear,
anxiety, and helplessness that results from the
thought of suffocating.
CONSTIPATION : Reduced food and fluid
intake, inactivity, and the effects of medications
cause constipation to be a problem for most
dying patients – a problem that can add to the
discomfort these patients already are
experiencing.
 POOR NUTRITIONAL INTAKE : Many dying
patients experience anorexia, nausea, and
vomiting that can prevent the ingestion of even
the most basic nutrients.
SPITITUAL CARE NEEDS : Each religion has its
own practices related to death, and nursing
staff must respect these practices to promote
the fulfilment of patients’ spiritual needs.
Signs of Imminent Death
Decline in blood pressure
Rapid, weak pulse
Dyspnea and periods of apnea
Slower or no pupil response to
light
Profuse perspiration
Cold extremities
Bladder and bowel incontinence
Pallor and mottling of skin
Loss of hearing and vision
 An advance directive
protects the patient’s right
to make decisions about
terminal care and eases
some of the burden of
family members during this
difficult time.