DFS Approved Curriculum-Unit 12 1

Unit 12Caring For Resident When

Death Is Imminent and Following Death

Nurse Aide I Course

DFS Approved Curriculum-Unit 12 2

Caring for Resident When Death Is Imminent and Following Death

IntroductionDeath is defined as the final stage of life. The nurse aide will need to develop a realistic attitude toward the topic of death to meet the physical and psychological needs of the resident and the family as they experience the dying process. This unit also includes care of the body following death.

DFS Approved Curriculum-Unit 12 3

DFS Approved Curriculum-Unit 12 4

12.0 Explore personal feelings concerning the concept of death.

DFS Approved Curriculum-Unit 12 5

Caring For Resident When Death Is Imminent and Following Death

• Factors influencing attitudes –Personal experiences –Culture 

• Some fear death • Others look forward to and accept death 

DFS Approved Curriculum-Unit 12 6

Caring For Resident When Death Is Imminent and Following Death

(continued)• Factors influencing attitudes 

–Religion • Belief in life after death • Reunion with loved ones • Reincarnation • Punishment for sins • No afterlife 

DFS Approved Curriculum-Unit 12 7

Caring For Resident When Death Is Imminent and Following Death

(continued)

• Factors influencing attitudes –Age

• Children view death as temporary

DFS Approved Curriculum-Unit 12 8

Caring For Resident When Death Is Imminent and Following Death

(continued)• Factors influencing attitudes

–Age • Adults may develop fears of:

–pain and suffering–dying alone–separation from loved ones

• Elderly generally have fewer fears

DFS Approved Curriculum-Unit 12 9

DFS Approved Curriculum-Unit 12 10

12.1 Identify the special needs of a dying resident.

DFS Approved Curriculum-Unit 12 11

Special Needs Of Dying Resident

• Visits with family/significant others • Features of resident’s room:

–pleasant as possible–lighting that meets resident’s

preferences–well ventilated–odor free

DFS Approved Curriculum-Unit 12 12

Special Needs Of Dying Resident(continued)

• Features of resident’s room:–Contains personal items which

provide comfort and reassurance• Pictures• Mementos• Cards• Flowers• Religious objects

DFS Approved Curriculum-Unit 12 13

12.2 Identify eight comfort measures that may be used with the dying resident.

DFS Approved Curriculum-Unit 12 14

Special Needs Of Dying Resident(continued)

• Comfort Measures–Attention to skin care–Good personal hygiene–Oral hygiene - denture

care–Bedding changed as

needed–Back massages

DFS Approved Curriculum-Unit 12 15

Special Needs Of Dying Resident(continued)

• Comfort Measures–Frequent position changes

• every two hours• P.R.N.

–Good body alignment• supportive devices• prevention of deformities and pressure ulcers

DFS Approved Curriculum-Unit 12 16

Special Needs Of Dying Resident(continued)

• Comfort Measures–Head of bed elevated to facilitate

breathing• Modified diet

DFS Approved Curriculum-Unit 12 17

DFS Approved Curriculum-Unit 12 18

12.3 Describe the nurse aide’s role in relationship to the to the needs of the dying.

DFS Approved Curriculum-Unit 12 19

Caring For Resident When Death Is Imminent and Following Death

Nurse Aide’s Role• Source of strength and

comfort• Open and receptive• Know own feelings about

death and do not project those feelings onto resident.

DFS Approved Curriculum-Unit 12 20

Caring For Resident When Death Is Imminent and Following Death

Nurse Aide’s Role(continued)

• Empathetic• Calm and efficient • Normal tone of voice• Good listening skills• Non-judgmental

DFS Approved Curriculum-Unit 12 21

DFS Approved Curriculum-Unit 12 22

12.4 Review the various reactions residents may have as they face death.

DFS Approved Curriculum-Unit 12 23

Individual Resident’s Reaction To Death

• Accept or be resigned to death• Open and receptive• Communicate about

uncertainties• Fearful or angry• Despairing and anxious• Hostile• Thoughtful and meditative

DFS Approved Curriculum-Unit 12 24

DFS Approved Curriculum-Unit 12 25

12.5 List and describe the five stages of grief, death and dying.

DFS Approved Curriculum-Unit 12 26

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross

• DENIAL–Defense mechanism–Buffer against reality–Emotional escape hatch–Resident may request

another opinion

DFS Approved Curriculum-Unit 12 27

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross

• DENIAL (continued)–Resident may avoid

discussion of death–Feeling of, “This can’t

be happening to me.”

DFS Approved Curriculum-Unit 12 28

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross

• ANGER–Bitterness and turmoil–Sense of unfairness–Blame of others such

as health care workers–Feeling of, “Why me?”

DFS Approved Curriculum-Unit 12 29

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross

• BARGAINING–Turn to religious and

spiritual beliefs–Promises to God and

others–Comfort and hope

when all seems lost

DFS Approved Curriculum-Unit 12 30

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross

• BARGAINING (continued)–Generally know this

won’t work–Frustration and anger

dissolve into depression

–“If only...I will”

DFS Approved Curriculum-Unit 12 31

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross• DEPRESSION

–Belief that hope is lost–Overwhelming despair–Introverted and withdrawn–Reminiscing and reviewing life–Sleeplessness–“I always wanted to”

DFS Approved Curriculum-Unit 12 32

Five Stages of Grief, Death and Dying as Described

by Dr. Elizabeth Kubler-Ross• ACCEPTANCE

–Calm and subdued interest in life–Strives to complete unfinished

business–Helps loved ones accept death–Needs others to validate worth of life–“I’ve had a good life.”

DFS Approved Curriculum-Unit 12 33

DFS Approved Curriculum-Unit 12 34

12.6 Recognize the signs of approaching death.

DFS Approved Curriculum-Unit 12 35

Signs Of Approaching Death• Changes in sensory functions and

ability to speak–Vision

• increased secretions in corner of eyes

• blurred vision• failing vision• no eye movement/staring

DFS Approved Curriculum-Unit 12 36

Signs Of Approaching Death

• Changes in sensory functions and ability to speak (continued)–Speech

• becomes difficult• hard to understand• may be unable to speak

–Hearing - last function to be lost

DFS Approved Curriculum-Unit 12 37

Signs Of Approaching Death• Changes in circulation and muscle tone

–Circulation• fails• heat gradually lost from body• hands and feet cold to touch and mottled

• face becomes pale or gray and mottled• perspiration may increase (diaphoresis)

DFS Approved Curriculum-Unit 12 38

Signs Of Approaching Death• Changes in circulation and muscle

tone (continued)–Muscle tone

• body limp• jaw may drop• mouth may stay partly open

DFS Approved Curriculum-Unit 12 39

Signs Of Approaching Death• Changes in Vital Signs

–Respirations• slower• shallow• labored• may experience dyspnea, apnea, Cheyne-Stokes

• mucous collects in the throat and bronchial tubes (death rattle)

DFS Approved Curriculum-Unit 12 40

Signs Of Approaching Death

• Changes in Vital Signs (continued)–Pulse

• rapid• weak and irregular

–Blood pressure drops–Temperature

• elevated• subnormal

DFS Approved Curriculum-Unit 12 41

Signs Of Approaching Death

• Urinary and anal incontinence

• Decreased peristalsis, abdominal distention

• Release of flatus

• Decreased pain

• Loss of consciousness

DFS Approved Curriculum-Unit 12 42

DFS Approved Curriculum-Unit 12 43

12.7 Define the role of the nurse aide in the spiritual preparation for death.

12.8 Contrast the spiritual preparation for death practiced by those of various religions.

DFS Approved Curriculum-Unit 12 44

Nurse Aide’s Role In Spiritual Preparation For Death

• Priest, rabbi, minister or other clergy may be contacted at request of resident or family

• Privacy to be provided when clergy with resident

DFS Approved Curriculum-Unit 12 45

Nurse Aide’s Role In Spiritual Preparation For Death

(continued)• Support resident’s religious/spiritual

practices even if different from that of nurse aide

• Listen respectfully to religious/spiritual beliefs

• Participate in religious practices if asked and acceptable

DFS Approved Curriculum-Unit 12 46

Nurse Aide’s Role In Spiritual Preparation For Death

(continued)• Treat religious objects

with care and respect:–medals–pictures–statues–bibles

• Encourage family and friends to be included

DFS Approved Curriculum-Unit 12 47

DFS Approved Curriculum-Unit 12 48

12.9 Identify the needs of the family as they encounter the dying process.

DFS Approved Curriculum-Unit 12 49

Nurse Aide’s Role In Meeting Family Needs

• Available for support• Use touch as appropriate• Courteous and considerate• Respect right to privacy• Let family assist with care,

if they desire, where appropriate

DFS Approved Curriculum-Unit 12 50

Nurse Aide’s Role In Meeting Family Needs

(continued)• Use good communication

skills• Listen and provide

understanding throughout the grief/loss stages

• Answer questions or refer to supervisor

DFS Approved Curriculum-Unit 12 51

DFS Approved Curriculum-Unit 12 52

12.10 Discuss the hospice philosophy.

DFS Approved Curriculum-Unit 12 53

Hospice Care• Health care service offered:

–in hospitals and extended care facilities–by special facilities–usually in the individual’s home

• Continuing care provided by team of health professionals

• Designed for residents with terminal illness

DFS Approved Curriculum-Unit 12 54

Hospice Care(continued)

• Acceptance of death as imminent (6 months or less)

• Assures that individual dies with dignity and comfort

• Not concerned with cure or life-saving procedures

• Emphasis on pain relief• Trained volunteers and professionals

make regular visits.

DFS Approved Curriculum-Unit 12 55

Hospice Care(continued)

• Provides counseling for individual and family:–Emotional–Psychological–Spiritual–Financial–Bereavement

• Family included in all aspects of care as desired

DFS Approved Curriculum-Unit 12 56

DFS Approved Curriculum-Unit 12 57

12.11 Discuss the meaning of postmortem care.

DFS Approved Curriculum-Unit 12 58

Postmortem Care

• Care Of Body After (Post) Death (Mortem) –Begin care when instructed by

supervisor–Treat body to privacy, respect and

gentleness–Give care before rigor mortis sets in

DFS Approved Curriculum-Unit 12 59

12.12 List five reasons for doing postmortem care.

DFS Approved Curriculum-Unit 12 60

Postmortem Care(continued)

• Reasons for Postmortem Care–Prevent discoloration and skin

damage–Maintain good appearance of body–Identify body and prepare for

transportation–Position body in normal alignment–Arrange time family to view the body

DFS Approved Curriculum-Unit 12 61

DFS Approved Curriculum-Unit 12 62

12.13 Demonstrate the procedure for postmortem care.

DFS Approved Curriculum-Unit 12 63