Unit 7 Ch 39
Stages of the Dying Process and Nursing Interventions— 5th
Acceptance: fifth stage Struggling ends and relief ensues Possibility of this being a final rest to gain strength for the long journey Come to terms with death and gain a sense of peace
Stages of the Dying Process and Nursing Interventions— 2nd
Anger: second stage Feeling that nothing is right Difficult for individuals around the dying person Unfilled desires and unfinished business Family may feel guilt, embarrassment, grief, or anger in response to the dying person's anger
Physical Care Challenges: Poor Nutritional Intake
Anorexia, nausea, and vomiting prevent adequate nutritional intake Fatigue and weakness Nursing care and interventions: Stimulation of appetite Nausea and vomiting Other basic nursing measures
Stages of the Dying Process and Nursing Interventions— 3rd
Bargaining: third stage Postponement of the inevitable Promises in return for an extension of life Most bargains are made with God and usually kept as secret
Helping Family and Friends After a Death
Be available to provide support Variety of responses related to body viewing Encourage open expression of grief/feelings Guidance with funeral/burial arrangements Identify an advocate for help with planning Support through grieving/bereavement "Postventive" work of Edwin Schneidman
Signs of Imminent Death
Bodily functions slow down Signs and symptoms Nurses need to identify and recognize approach of death symptoms to keep family informed Determine if clergy is desired by the patient and/or family Care of the dying individual and family
Physical Care Challenges: Constipation
Common Causes A source of additional discomfort to dying individuals Prevention as a goal for care Nursing care and interventions
Physical Care Challenges: Respiratory Distress
Common problem in dying patients Physical discomfort of dyspnea Psychological distress Causes Nursing care and interventions
Is the following statement True or False? It is not appropriate for nurses to pray with dying patients and their families.
False If nursing staff feel comfortable with religious and spiritual practices of the patient, they can offer to pray with patients or read to them from religious texts. Nurses should ensure that prayers offered are consistent with the patient's belief system.
Supporting Through the Stages of the Dying Process
Family and friends may also pass through the stages of the dying process before they accept the impending death of a loved one Responses common to the stages of dying demonstrated by family and friends Nursing support and interventions depend on what stage the family member or friend is at the time of encounter
Supporting Family and Friends
Family and friends need to be considered May have needs requiring therapeutic interventions Interventions for family and friends going through the process -Offering appropriate support -May provide immense comfort
Physical Care Challenges: Pain
Fear is common Can be managed effectively Patients perceive and express pain differently based on many factors Indicators of pain Regularly assess pain Prevention is the goal Pain management interventions
Definitions of Death
Final termination of life Cessation of all vital functions Act or fact of dying United Nations Vital Statistics Division Brain death: determined by EEG Somatic death: determined by the absence of cardiac and pulmonary functions Molecular death: determined by cessation of cellular function
Elisabeth Kubler-Ross's (1969) conceptual framework
Five stages of coping mechanisms with dying The nurse needs to understand which interventions are most appropriate during each stage Not all dying persons progress through the stages in an orderly sequence or experience all of the stages
Family Experience with the Dying Process: past
Higher mortality rates Death in the home viewed as natural process Fewer hospitals and other institutions
Stages of the Dying Process and Nursing Interventions— hope
Hope Commonly permeates all stages Used as temporary form of denial Rationalization for unpleasant therapies Source of motivation A realistic confrontation of impending death does not negate the presence of hope
Advance Directives
Legal document that allows patients to express their desires regarding terminal care and life-sustaining measures Patient Self-Determination Act (PSDA) Nurses need to determine if patients have advance directives, review the patients wishes, and place the document in the medical record
Family Experience with the Dying Process: present
Limited experience with death Change in the site and circumstance of death
Family Experience with the Dying Process
Most people have minimal direct involvement with dying individuals Death has become more impersonal and unusual event Difficulty accepting one's own mortality Understanding one's own mortality can be therapeutic to the nurse personally, as well as helpful in the care of dying individuals Previous experiences with death Religious, spiritual, and cultural beliefs Philosophy of life Age Health status
Spiritual Care Needs
Nurses need knowledge of different religious views related to death and dying Assessment of religion and spirituality including individual practices Religion and spirituality are not synonymous Inclusion of clergy and members of the individual's own faith-based group Role of the nurse
Supporting the Dying Individual
Nurses were prepared to deal with care of a dead body—they now need to be more involved in the dying process Humanistic approach to caring for dying patients and their families Hospice care Need for individualized nursing interventions Nursing diagnoses
Supporting Nursing Staff
Staff caring for the dying have their own feelings regarding the death/dying experience Difficulty realizing one's own mortality Experience with death may be limited Death may be viewed as a dissatisfying failure Nurses may also experience the stages of the dying process Staff working with dying patients need support Nurses need to explore their own reactions to death experiences Acknowledgment of feelings Resource people available to assist nurses through providing support
Is the following statement True or False? Nurses who understand their own mortality are more comfortable helping individuals through the dying process.
True Understanding one's own mortality can be therapeutic to the nurse personally, as well as helpful in the care of dying patients.
Stages of the Dying Process and Related Nursing Interventions: 1st stage
Denial: first stage -Initial awareness of impending death -Deny the reality of the situation -Serves several useful purposes -May occur at various times throughout an illness; fluctuation Nursing care and interventions during this stage
Stages of the Dying Process and Nursing Interventions— 4th
Depression: fourth stage Reality of the dying process is emphasized Many losses can lead to depression Usually a silent depression Interest in prayer and desire for clergy
death
Difficult for many individuals to face Reluctance to accept mortality Gerontological nurses often face death and must learn to deal with the entire dying process Role of the nurse during this difficult time
Which of the following nursing interventions is appropriate for the dying person who is in the stage of denial? a. Focus on the conflicting messages that dying people often demonstrate b. Acceptance of the dying individual's reaction c. Suggest that the patient aggressively seeks a second opinion d. Assist in the denial of the reality of impending death
b. Acceptance of the dying individual's reaction Perhaps the most important nursing action during the stage of denial is to accept the individual's reactions and to provide an open door for honest dialogue.
Which of the following interventions is most appropriate when caring for a dying patient who is experiencing pain? a. Assess pain every 8 hours b. Prevent pain from developing c. Utilize morphine for any type of pain d. Minimize the pain response of the confused
b. Prevent pain from developing For the dying patient, the goal of pain management is to PREVENT pain from developing rather than to treat it once it occurs.
Death is an ....experience
inevitable, unequivocal, and universal