Death and Dying Self-Study Slides
Source: raw/nsg210_wk09_DEATHDYING.pptx. “Death and Dying Communication Workshop, NSG210,” Nancy Saliba, MA, RN, BC, CNE. 39 slides.
Slide 8 is an image only, and slide 22 (“Table 11-1, Questions and Critical Thinking in Preparation to Care for Dying Patients”) shows only its title in the file, so the table content is not captured here.
Introduction
Death is universal but only recently studied by developmental psychologists. Questions being explored: what death means at different life stages, how people face their own death, how survivors react, and how people prepare and cope.
Death Across the Lifespan
| Stage | Understanding and reactions | Common causes |
|---|---|---|
| Childhood | No concept of death until about age 5; around 5, begins to grasp finality and irreversibility; by about 9, accepts universality and finality; by middle school, understands customs (funerals, cremation, ceremonies) | |
| Adolescence | Unrealistic views of death; sense of invincibility; with terminal illness, denial and depression | |
| Young adulthood | Prime of life, so death seems unthinkable; anger and impatience; concerns about intimate relationships, sexuality, and future plans | |
| Middle adulthood | Fear of death often greatest | Heart attack, stroke |
| Late adulthood | Realizes death is near; faces more deaths of peers; less anxious about dying; a marked drop in memory and reading ability can foreshadow death within a few years (“terminal decline”) | Cancer, stroke, heart disease |
Mourning and Funerals
- Average funeral and burial cost about $7,000
- Survivors are vulnerable to pressure to “provide the best”
- Shaped by social norms and customs
Differing Concepts of Death
- Shaped by cultural and subcultural values
- Death may be seen as punishment, as a judgment of one’s contributions, or as the start of redemption or eternal life
- Cultural differences in grieving: body preparation, religious rites, military customs, family or personal wishes
Choosing the Nature of Death
DNR issues:
- Separating “extreme” or “extraordinary” measures from routine care
- Whether an intervention will improve or worsen the person’s current quality of life
- Who the decision-maker is
Why DNR wishes are not always followed:
- Staff are reluctant to stop aggressive treatment
- Physicians often say they did not know the patient’s wishes
- Providers are trained to save patients and worry about legal liability
Tools for control over one’s death: living will, health care proxy, durable power of attorney.
Palliative Care and Hospice
- Palliative care settings: hospitals, outpatient clinics, long-term care, home
- Hospice: multidisciplinary team (physician, pharmacist, social workers, others) for the last phase (6 months) of incurable disease; goal is to live as fully and comfortably as possible
Death Education
- Thanatologists (people who study death) recommend death education for everyone, since Western society hides death
- Types: crisis intervention (emergency counseling, for example after the Oklahoma City bombing), routine death education in schools and colleges, and education for helping professions (most effective when it explores feelings, not just facts)
Nurses Who Care for the Dying
- Are well educated, have clinical support, and partner closely with hospice and palliative services
- Are confident in clinical skills and aware of ethical, spiritual, and legal issues
- Need to know their own feelings about death, which clarifies their values and helps meet holistic needs
- Are uniquely qualified: holistic, comprehensive, effective, compassionate, cost effective
- Spend more time with dying patients and families than any other team member; educate, support, guide, and advocate; attend to physical, emotional, psychosocial, and spiritual needs
Benefits of Good End-of-Life Nursing Care
- Pain and symptom control
- Relief of psychosocial distress
- Coordinated care across settings with good communication
- Preparing patient and family for death
- Clarifying goals of treatment and values
- Support and education on benefits and burdens of treatment
Family Support During Grief and Bereavement
- Before death: ease fears and anxieties; maintain hope
- After death: relief statements, rationalizations, education about mourning and bereavement
Caring for the Caregiver
Ask yourself: What have I done to meet my own needs today? Have I laughed? Did I eat, rest, exercise, and play? How have I felt today? Do I have something to look forward to?
Barriers to Quality End-of-Life Care
- Not acknowledging the limits of medical technology
- Poor communication among decision-makers
- Disagreement about goals of care
- No timely advance care plan
- Lack of training in pain and symptom control
- Unwillingness to be honest about a poor prognosis; discomfort telling bad news
- Not understanding what hospice or palliative referral can offer
Core Principles of End-of-Life Care
- Respect the dignity of patients, families, and caregivers
- Be sensitive to and respect patient and family wishes
- Use interventions that meet the patient’s goals
- Relieve pain and symptoms
- Assess, manage, and refer psychological, social, and spiritual problems
- Provide continuity and collaboration
- Provide access to palliative and hospice care
- Respect the right to refuse treatment
- Support evidence-based practice and research
Pronouncement of Death
- No carotid pulse
- Pupils fixed and dilated
- No heart sounds
- No breath sounds
Postmortem Care
Done promptly, quietly, efficiently, and with dignity.
Before death if possible: straighten limbs, place head on pillow.
After pronouncement:
- Put on gloves
- Remove tubes, replace soiled dressings, pad the anal area
- Gently wash the body if needed
- Place body on back with head and shoulders elevated
- Close eyes by gently pulling the lids down by the lashes
- Insert dentures
- Clean gown, cover with a clean sheet
Follow institutional policy:
- Note and chart time of death
- Notify the attending physician and family
- Chart any special directions
- Allow family time with the person
- Gather glasses and belongings
- Prepare paperwork for body removal; call the funeral home or other transport
- Chart what personal items and belongings went with the body, and who received them
- Tag or identify the body per policy
Videos
- Bereavement Issues (4:33): https://youtu.be/KIv1-ti6m_I
- Delivering Bad News: What Not To Do (4:24): https://youtu.be/HWAZnhCuAeE
- Delivering Bad News: An Excellent Encounter (7:56): https://youtu.be/_uOS7hfKkVI