Chapter 14: Death and Dying

Introduction

• Understanding death is inevitable and part of life.
• Nurses frequently deal with death.
• Reactions to death vary based on:
  • How death occurred (sudden vs. expected)
  • Age of the deceased
  • Cultural and spiritual beliefs

Grief and Mourning

• Grief: Feeling or expression of loss in response to death.
• Anticipatory Grief: Experienced when anticipating the loss due to terminal illness.
• Mourning: Process that follows death, leading to the resumption of normal life.
• Maladaptive Grief: Persistent difficulty recovering from loss.
• Bereavement: State of having lost someone.

Theories of Loss and Grief

• Kubler-Ross's Stages of Grief:
  1. Denial - Blocking the reality of death.
  2. Anger - Upset and looking for someone to blame.
  3. Bargaining - Seeking more time.
  4. Depression - Sadness and despair.
  5. Acceptance - Preparing for death.
• Bulby's Stages of Mourning:
  • Protest, Despair, Detachment
  • Numbing, Painful Stage, Disorganization, Reorganization

Types of Losses

• Loss of a spouse, parent, child, fetus, or sibling.
• Different impacts based on relationship, age, and circumstance.

Facing One's Own Death

• Patients may express awareness of impending death.
• Importance of listening and discussing fears and needs.

Developmental Understanding of Death

• Varies by age group:
  • Children - Limited understanding.
  • Adolescents - Feel invincible.
  • Young adults - Unexpected.
  • Middle adults - Aware of aging.
  • Older adults - Preparation and acceptance.

Signs of Approaching Death

• Withdrawal, decreased senses, activity changes, breathing changes (e.g., Shane Stokes respirations), vital sign changes, loss of control, body cooling.

Legal and Ethical Considerations

• Self-Determination Act: Opportunity for advanced directives.
• Advanced Directives and Living Wills: Legal documentation of treatment wishes.
• Durable Power of Attorney: Assigning someone to make medical decisions.
• DNR Orders: No resuscitation desired.

Ethical End-of-Life Issues

• Euthanasia and Right to Die: Assisted death, controversial topic.
• Palliative Care: Focus on symptom management and comfort.
• Hospice Care: Comfort-focused, not curative; requirements include life expectancy of <6 months.

Care After Death

• Autopsy considerations and family time.
• Importance of offering support and clergy involvement.

Hospice and Palliative Resources

• Support groups and counseling available.
• Local resources (e.g., Hospice of Southern West Virginia).

Conclusion

• Importance of understanding and responding to grief, mourning, and ethical considerations at end-of-life.
• Refer to provided handouts for further information.

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This concludes the notes for Chapter 14 on Death and Dying. Be sure to review the specific handouts and resources mentioned for a deeper understanding of hospice and palliative care.