Unit 12

Caring For Resident When

Death Is Imminent and
Following Death
Nurse Aide I Course

DHSR Approved Curriculum-Unit 12 1

 Caring for Resident When Death Is
Imminent and Following Death
Introduction
Death 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.
DHSR Approved Curriculum-Unit 12 2
DHSR Approved Curriculum-Unit 12 3
12.0 Explore personal feelings
concerning the concept of death.

DHSR Approved Curriculum-Unit 12 4

 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

DHSR Approved Curriculum-Unit 12 5

 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

DHSR Approved Curriculum-Unit 12 6

 Caring For Resident When Death Is
Imminent and Following Death
(continued)
• Factors influencing
attitudes
– Age
• Children view death
as temporary

DHSR Approved Curriculum-Unit 12 7

 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
DHSR Approved Curriculum-Unit 12 8
DHSR Approved Curriculum-Unit 12 9
12.1 Identify the special needs of a
dying resident.

DHSR Approved Curriculum-Unit 12 10

 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
DHSR Approved Curriculum-Unit 12 11
 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
DHSR Approved Curriculum-Unit 12 12
12.2 Identify eight comfort measures
that may be used with the dying
resident.

DHSR Approved Curriculum-Unit 12 13

 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
DHSR Approved Curriculum-Unit 12 14
 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
DHSR Approved Curriculum-Unit 12 15
 Special Needs Of Dying Resident
(continued)
• Comfort Measures
– Head of bed elevated to facilitate
breathing
• Modified diet

DHSR Approved Curriculum-Unit 12 16

DHSR Approved Curriculum-Unit 12 17
12.3 Describe the nurse aide’s role in
relationship to the to the needs of
the dying.

DHSR Approved Curriculum-Unit 12 18

 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.

DHSR Approved Curriculum-Unit 12 19

 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

DHSR Approved Curriculum-Unit 12 20

DHSR Approved Curriculum-Unit 12 21
12.4 Review the various reactions
residents may have as they face
death.

DHSR Approved Curriculum-Unit 12 22

 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
DHSR Approved Curriculum-Unit 12 23
DHSR Approved Curriculum-Unit 12 24
12.5 List and describe the five
stages of grief, death and
dying.

DHSR Approved Curriculum-Unit 12 25

 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

DHSR Approved Curriculum-Unit 12 26

 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.”

DHSR Approved Curriculum-Unit 12 27

 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?”
DHSR Approved Curriculum-Unit 12 28
 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
DHSR Approved Curriculum-Unit 12 29
 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”

DHSR Approved Curriculum-Unit 12 30

 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”
DHSR Approved Curriculum-Unit 12 31
 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.”
DHSR Approved Curriculum-Unit 12 32
DHSR Approved Curriculum-Unit 12 33
12.6 Recognize the signs of
approaching death.

DHSR Approved Curriculum-Unit 12 34

 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
DHSR Approved Curriculum-Unit 12 35
 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

DHSR Approved Curriculum-Unit 12 36

 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)
DHSR Approved Curriculum-Unit 12 37
 Signs Of Approaching Death
• Changes in circulation and muscle
tone (continued)
– Muscle tone
• body limp
• jaw may drop
• mouth may stay partly open

DHSR Approved Curriculum-Unit 12 38

 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)
DHSR Approved Curriculum-Unit 12 39
 Signs Of Approaching Death
• Changes in Vital Signs (continued)
– Pulse
• rapid
• weak and irregular
– Blood pressure drops
– Temperature
• elevated
• subnormal
DHSR Approved Curriculum-Unit 12 40
 Signs Of Approaching Death

• Urinary and anal incontinence

• Decreased peristalsis, abdominal
distention
• Release of flatus
• Decreased pain
• Loss of consciousness
DHSR Approved Curriculum-Unit 12 41
DHSR Approved Curriculum-Unit 12 42
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.
DHSR Approved Curriculum-Unit 12 43
 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

DHSR Approved Curriculum-Unit 12 44

 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
DHSR Approved Curriculum-Unit 12 45
 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
DHSR Approved Curriculum-Unit 12 46
DHSR Approved Curriculum-Unit 12 47
12.9 Identify the needs of the family as
they encounter the dying process.

DHSR Approved Curriculum-Unit 12 48

 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
DHSR Approved Curriculum-Unit 12 49
 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
DHSR Approved Curriculum-Unit 12 50
DHSR Approved Curriculum-Unit 12 51
12.10 Discuss the hospice philosophy.

DHSR Approved Curriculum-Unit 12 52

 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
DHSR Approved Curriculum-Unit 12 53
 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.
DHSR Approved Curriculum-Unit 12 54
 Hospice Care
(continued)
• Provides counseling for individual and
family:
– Emotional
– Psychological
– Spiritual
– Financial
– Bereavement
• Family included in all aspects of care
as desired
DHSR Approved Curriculum-Unit 12 55
DHSR Approved Curriculum-Unit 12 56
12.11 Discuss the meaning of
postmortem care.

DHSR Approved Curriculum-Unit 12 57

 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

DHSR Approved Curriculum-Unit 12 58

12.12 List five reasons for doing
postmortem care.

DHSR Approved Curriculum-Unit 12 59

 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
DHSR Approved Curriculum-Unit 12 60
DHSR Approved Curriculum-Unit 12 61
12.13 Demonstrate the procedure for
postmortem care.

DHSR Approved Curriculum-Unit 12 62

DHSR Approved Curriculum-Unit 12 63