Certified Nurse Assistant Module 16: Death and Dying
Key Terminology
- Importance of spelling, pronouncing, and using terms correctly.
Five Stages of Grieving (Dr. Kubler-Ross)
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Emotional and Spiritual Needs of Terminally Ill Patients and Families
Emotional Needs of the Dying
- Encourage contact with loved ones.
- Promote family visits and provide privacy.
- Facilitate communication and active listening.
- Allow expressions of emotions: guilt, anger, frustration, anxiety, depression, reminiscence.
Cultural and Spiritual Needs of the Dying
- Respect and communicate beliefs.
- Encourage rights and rituals.
- Respect solitude and wishes regarding autopsy, funeral, and post-mortem care.
Approaches
- Respect religious and cultural practices.
- Provide comfort (physical, emotional, spiritual).
- Accept and report patient emotions or needs to licensed nurse.
Rights of the Dying Patient or Resident
A. Right to be treated as a living human being until death.
B. Right to maintain hopefulness.
C. Right to be cared for by hopeful individuals.
D. Right to express feelings about approaching death.
E. Right to participate in care decisions.
F. Right to expert medical and nursing care.
G. Right to not die alone.
H. Right to be pain-free.
I. Right to honest answers.
J. Right to not be deceived.
K. Right to family assistance in accepting death.
L. Right to die in peace and dignity.
M. Right to retain individuality and not be judged.
N. Right to discuss religious and spiritual experiences.
O. Right to have body sanctity respected post-death.
P. Right to be cared for by understanding people.
Signs of Approaching Death vs. Biological Death
Impending Signs of Death
- Decreasing consciousness, cold extremities, diaphoresis, pale skin.
- Loss of muscle tone, labored breathing, death rattle.
- Weak or irregular pulse, blank expression, dropping jaw.
- Skin mottling, slowed peristalsis, loss of sensation, decreased pain.
Signs of Biological Death
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No pulse, no breathing, no blood pressure.
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Fixed pupils, hearing last to disappear.
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Maintain professionalism, communicate with patient, and explain procedures.
Comfort Measures for Dying Patient
- Monitor and observe for status changes.
- Provide care and comfort measures.
Hospice Care
Philosophy and Goals
- The first modern hospice: St. Christopher's Hospice, London (1960s).
- Nurse Assistant's Role: Attitudes and skills in hospice care.
Role of the Hospice Nurse
- Focus on comfort and palliative care rather than curative.
Postmortem Care Procedures and Responsibilities
- Assist as directed by a licensed nurse.
- Follow facility procedures, respect privacy, and provide support.
- Respect family beliefs regarding post-mortem care.