DFS Approved Curriculum-Unit 121 Unit 12 Caring For Resident When Death Is Imminent and Following...

DFS Approved Curriculum-Unit 12 1

Unit 12Caring For Resident When

Death Is Imminent and Following Death

Nurse Aide I Course


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.


12.0 Explore personal feelings concerning the concept of death.


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



(continued)

• Factors influencing attitudes –Religion

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



(continued)

• Factors influencing attitudes –Age

• Children view death as temporary



(continued)

• Factors influencing attitudes–Age

• Adults may develop fears of:–pain and suffering–dying alone–separation from loved ones

• Elderly generally have fewer fears


12.1 Identify the special needs of a dying resident.


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


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


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



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

care–Bedding changed as

needed–Back massages



• Comfort Measures–Frequent position changes

• every two hours• P.R.N.

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



• Comfort Measures

–Head of bed elevated to facilitate breathing

• Modified diet


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



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.



Nurse Aide’s Role(continued)

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


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


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


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


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




• DENIAL (continued)

–Resident may avoid discussion of death

–Feeling of, “This can’t be happening to me.”




• ANGER

–Bitterness and turmoil

–Sense of unfairness

–Blame of others such as health care workers

–Feeling of, “Why me?”




• BARGAINING–Turn to religious and

spiritual beliefs–Promises to God and

others–Comfort and hope

when all seems lost




• BARGAINING (continued)–Generally know this

won’t work–Frustration and anger

dissolve into depression

–“If only...I will”




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




• 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.”


12.6 Recognize the signs of approaching death.


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



• 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



• 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)



• Changes in circulation and muscle tone (continued)–Muscle tone

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



• Changes in Vital Signs–Respirations

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

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



• Changes in Vital Signs (continued)–Pulse

• rapid• weak and irregular

–Blood pressure drops–Temperature

• elevated• subnormal



• Urinary and anal incontinence

• Decreased peristalsis, abdominal distention

• Release of flatus

• Decreased pain

• Loss of consciousness


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.


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



(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



(continued)• Treat religious objects

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

• Encourage family and friends to be included


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


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


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


12.10 Discuss the hospice philosophy.


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


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.


Hospice Care(continued)

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

• Family included in all aspects of care as desired


12.11 Discuss the meaning of postmortem care.


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


12.12 List five reasons for doing postmortem care.


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


12.13 Demonstrate the procedure for postmortem care.

DFS Approved Curriculum-Unit 121 Unit 12 Caring For Resident When Death Is Imminent and Following...

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