Understanding the dying process and needs of the resident nearing the end of life.

Transcription

1 Unit A Nurse Aide Workplace Fundamentals Essential Standard NA2.00 Apply communication and interpersonal skills and physical care that promote mental health and meet the social and special needs of residents in long-term care. Indicator Understand the Dying Process and Needs of the Resident Nearing the End of Life. Understanding the dying process and needs of the resident nearing the end of life. Nursing Fundamentals

2 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 indicator also includes care of the body following death. Nursing Fundamentals

3 The sun setting is no less beautiful than Nursing Fundamentals

4 PSYCHOLOGICAL CHANGES OF THE GRIEVING RESIDENT Five stages of grieving have been identified by Elizabeth Kubler-Ross Nursing Fundamentals

5 ELIZABETH KUBLER-ROSS FIVE STAGES ü Not all residents go through all the stages ü Some residents may stay in one stage until death occurs ü Residents may move back and forth between grieving stages ü Family and friends of the resident will experience the grief stages Nursing Fundamentals

6 ELIZABETH KUBLER-ROSS FIVE STAGES Understanding the stages of grief helps the Nurse Aide apply psychological support to resident, family, and friends Nursing Fundamentals

7 ELIZABETH KUBLER-ROSS FIVE STAGES DENIAL Defense mechanism Buffer against reality Emotional escape hatch Resident may request another opinion Nursing Fundamentals

8 ELIZABETH KUBLER-ROSS FIVE STAGES DENIAL (continued) Resident may avoid discussion of death Feeling of, This can t be happening to me. Nursing Fundamentals

9 Care Point Nurse Aides must be ready to listen if the resident expresses their feelings Nursing Fundamentals

10 ELIZABETH KUBLER-ROSS FIVE STAGES ANGER Bitterness and turmoil Sense of unfairness Blame of others such as health care workers Feeling of, Why me? Nursing Fundamentals

11 Care Point ü Nurse Aide must not take the accusations personally ü Do not follow the urge to leave the angry resident ü Listen empathetically Nursing Fundamentals

12 ELIZABETH KUBLER-ROSS FIVE STAGES BARGAINING Turn to religious and spiritual beliefs Promises to God and others Comfort and hope when all seems lost Nursing Fundamentals

13 ELIZABETH KUBLER-ROSS FIVE STAGES BARGAINING (continued) Generally know this won t work Frustration and anger dissolve into depression If only...i will Nursing Fundamentals

14 Care Point ü Listen and reflect what is said, express understanding ü Be aware of when silence is helpful and words are not Nursing Fundamentals

15 ELIZABETH KUBLER-ROSS FIVE STAGES DEPRESSION ü Belief that hope is lost ü Overwhelming despair ü Introverted and withdrawn ü Reminiscing and reviewing life ü Sleeplessness ü I always wanted to Nursing Fundamentals

16 Care Point ü Your touch, if accepted, can be very helpful ü Understand the resident s feeling of loss ü Do not deny death is approaching Nursing Fundamentals

17 ELIZABETH KUBLER-ROSS FIVE STAGES 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. Nursing Fundamentals

18 Care Point ü Your presence lets them know you will not desert them ü Listen if they wish to discuss their death Nursing Fundamentals

19 BRAIN Unit A / Essential Standard NA2.00 / Indicator 2.01 / Letter B STORM Think Recall the conversation of a friend who had a family member to die. Did you hear any of Kubler-Ross stages of death (grieving)? Act Raise your hand and share your thoughts. Nursing Fundamentals

20 Kubler-Ross Five stages of grief Have we got it? Let s check and see Student Name A Student Name B Stick diagnostics Nursing Fundamentals

21 FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH ü Personal experiences ü Culture; some fear death others look forward to and accept death Nursing Fundamentals

22 FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH Religion ü Belief in life after death ü Reunion with loved ones ü Reincarnation ü Punishment for sins ü No afterlife Nursing Fundamentals

23 FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATH Age: ü Children view death at temporary ü Adults may develop fears of pain and suffering, dying alone, separation from loved ones ü Elderly generally have fewer fears Nursing Fundamentals

24 Individual resident s reaction to death ü Accept or be resigned to death ü Open and receptive ü Communicate about uncertainties ü Fearful or angry ü Despairing or anxious ü Hostile ü Thoughtful and meditative Nursing Fundamentals

25 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in SENSORY FUNCTION and the ability to speak VISION ü Blurred and failing vision ü Increased secretions in corner of eye ü No eye movement / staring / unfocused eye Nursing Fundamentals

26 Reduce glare and keep room lightening low Nursing Fundamentals

27 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in SENSORY FUNCTION and the ability to speak SPEECH ü becomes difficult ü hard to understand ü may be unable to speak Nursing Fundamentals

28 ü Do not expect an answer ü Observe body language of the resident ü Anticipate needs Nursing Fundamentals

29 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in SENSORY FUNCTION and the ability to speak HEARING last sensory function to be lost Nursing Fundamentals

30 Be careful what you say! Nursing Fundamentals

31 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in SENSORY FUNCTION and the ability to speak TOUCH SENSE OF TOUCH IS DEMINISHED Nursing Fundamentals

32 Resident can no longer turn themselves, SKIN CARE IS PARAMOUNT Nursing Fundamentals

33 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in CIRCULATION AND MUSCLE TONE and the ability to speak LOSS OF MOVEMENT, MUSCLE TONE, AND FEELING ü Body is limp ü Jaw may drop ü Mouth may stay partly open Nursing Fundamentals

34 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in CIRCULATION AND MUSCLE TONE and the ability to speak CIRCULATION FAILS ü Heat is lost from the body ü Mottling (bruised appearance), spotting, or blotching of skin caused by poor circulation Nursing Fundamentals

35 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in CIRCULATION AND MUSCLE TONE and the ability to speak CIRCULATION FAILS ü Hands and feet cold to touch ü Face becomes pale or gray and mottled ü Perspiration may increase (DIAPHORESIS) Nursing Fundamentals

36 COMMON PHYSICAL SIGNS OF Changes in VITAL SIGNS IMPENDING DEATH BLOOD PRESSURE DECREASES Nursing Fundamentals

37 COMMON PHYSICAL SIGNS OF Changes in VITAL SIGNS IMPENDING DEATH PULSE: Abnormally slow, rapid, or irregular Nursing Fundamentals

38 COMMON PHYSICAL SIGNS OF Changes in VITAL SIGNS IMPENDING DEATH TEMPERATURE: Rising or belownormal Nursing Fundamentals

39 COMMON PHYSICAL SIGNS OF Changes in VITAL SIGNS IMPENDING DEATH RESPIRATIONS: Slow, irregular alternating with rapid, shallow aka Cheyne-Stokes Nursing Fundamentals

40 COMMON PHYSICAL SIGNS OF Changes in VITAL SIGNS IMPENDING DEATH RESPIRATIONS: fish out of water breathing aka Agonal Breathing Nursing Fundamentals

41 COMMON PHYSICAL SIGNS OF Changes in VITAL SIGNS IMPENDING DEATH RESPIRATIONS: Rattling or gurgling sound referred to as Death Rattle Nursing Fundamentals

42 Elevate HOB to facilitate breathing Nursing Fundamentals

43 BRAIN Unit A / Essential Standard NA2.00 / Indicator 2.01 / Letter B Think STORM Why do you think the vital signs change as they do when a resident is dying? Act Raise your hand and share your thoughts. Nursing Fundamentals

44 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in BOWEL AND BLADDER ELIMINATION URINARY AND ANAL INCONTINENCE Nursing Fundamentals

45 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Changes in BOWEL AND BLADDER ELIMINATION ü DECREASED PERISTALSIS ü ABDOMINAL DISTENTION ü RELEASE OF FLATUS Nursing Fundamentals

46 BRAIN Think STORM Why do you think the changes in bowel and bladder elimination occur? Act Raise your hand and share your thoughts. Nursing Fundamentals

47 COMMON PHYSICAL SIGNS OF IMPENDING DEATH DECREASED PAIN Nursing Fundamentals

48 COMMON PHYSICAL SIGNS OF IMPENDING DEATH DECREASED INTAKE OF FOOD AND FLUID Nursing Fundamentals

49 Modify diet. Do not force feed. Fluids most important. Nursing Fundamentals

50 COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals

51 Physical Signs of impending Death Have we got it? Let s check and see Student Name A Student Name B Stick diagnostics Nursing Fundamentals

52 NURSE AIDE CARE FOR THE DYING RESIDENT Observe Care Points in previous slides related to sensory function Nursing Fundamentals

53 NURSE AIDE CARE FOR THE DYING RESIDENT Care of Nose and Mouth: ü Give mouth care often; if resident unconscious, every two hours ü Apply lubricant such as a lip balm, to lips and nose ü Olive oil is a good lubricant for lips Nursing Fundamentals

54 NURSE AIDE CARE FOR THE DYING RESIDENT Care of SKIN: ü Give bed baths and incontinence care as needed ü Bathe perspiring patients often ü Keep skin clean and dry ü Change sheets and clothes for comfort ü Keep sheet wrinkle free Nursing Fundamentals

55 NURSE AIDE CARE FOR THE DYING RESIDENT Care of SKIN: ü Reposition resident often, use supportive devices as needed ü At least every 2 hours or prn Nursing Fundamentals

56 NURSE AIDE CARE FOR THE DYING RESIDENT Promote COMFORT: ü Observe for signs of pain and report them! ü Frequent changes of position, back massage, and body alignment ü Elevate head of bed (HOB) to facilitate breathing Nursing Fundamentals

57 NURSE AIDE CARE FOR THE DYING RESIDENT Control ENVIRONMENT: ü Place resident s favorite objects and photographs where resident can see them ü Provide appropriately lit and well-ventilated room without odor ü Place call bell in reach, even if resident unresponsive Nursing Fundamentals

58 Control Environment Features of resident s room: Contains personal items which provide comfort and reassurance Pictures Mementos Cards Flowers Religious objects Nursing Fundamentals

59 Nurse Aide Role - Respect Treat religious objects with care and respect: medals pictures statues Bibles Encourage family and friends to be included Nursing Fundamentals

60 Nurse Aide s Role - Support Source of strength and comfort Open and receptive Know own feelings about death and do not project those feelings onto resident. Nursing Fundamentals

61 Nurse Aide s Role - Support Empathetic Calm and efficient Normal tone of voice Good listening skills Non-judgmental Nursing Fundamentals

62 Nurse Aide Role Support to Family & Friends Offer comfort measures such as drinks, food, chairs, blankets etc. within facility policy. Use good communication skills Listen and provide understanding throughout the grief/loss stages Answer questions or refer to supervisor Nursing Fundamentals

63 Nurse Aide Role Support to Family & Friends Available for support Use touch as appropriate Courteous and considerate Respect right to privacy Let family assist with care, if they desire, where appropriate Nursing Fundamentals

64 Nurse Aide Role Spiritual Support Priest, rabbi, minister or other clergy may be contacted at request of resident or family Privacy to be provided when clergy with resident Nursing Fundamentals

65 Nurse Aide Role Spiritual Support 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 Nursing Fundamentals

66 Nursing Fundamentals

67 Hospice Care Hospice Care 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 Nursing Fundamentals

68 Hospice Care 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. Nursing Fundamentals

69 Hospice Care Provides counseling for individual and family: Emotional Psychological Spiritual Financial Bereavement Family included in all aspects of care as desired Nursing Fundamentals

70 Nursing Fundamentals

71 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 Nursing Fundamentals

72 Postmortem Care Genenral Guidelines Begin care when instructed by supervisor Treat body to privacy, respect and gentleness Give care before rigor mortis sets in Nursing Fundamentals

73 Training Lab Assignment Engage in the Skill EXPLORATION Process for: SKILL Postmortem Care Nursing Fundamentals

74 a END b Understanding the dying process and needs of the resident near the end of life. Nursing Fundamentals