Death & Dying

Chapter 30: Dying, Death, and Grieving

Objectives

  • Life-saving Measures: Describe the evolution of life-saving measures and their impact on end-of-life issues.

  • Palliative and Hospice Care: Discuss the role of palliative care and hospice in supporting patients and families facing chronic diseases and terminal illnesses.

  • Stages of Dying: Identify stages of the dying process as described by Kübler-Ross.

Death and Dying

  • Advancements in Technology:

    • Blurred the line between life and death.

      • Artificial nutrition and hydration.

      • Artificial breathing and blood filtering.

      • Transplants.

  • Aging Population:

    • Unprecedented strains on the healthcare system.

Models for End-of-Life Care

  • Hospice Care:

    • Standard care for patients facing death.

    • Begins after treatment has ceased.

    • Focuses on patient care and symptom reduction.

  • Palliative Care:

    • Promotes comfort and quality of life.

    • Can begin at the time of diagnosis.

    • Focuses on care for people living with serious illness.

Key Components of Both Models

  • Honoring Patient and Family Experiences.

  • Respecting Autonomy and Informed Choice.

  • Directing Care by Patient and Family.

  • Honoring the Dignity of the Patient and Family.

Case Study: Mr. Dietrich

  • Presentation of terminal diagnosis and initial reactions.

  • Emotional dynamics between Mr. and Mrs. Dietrich as they navigate the news of brain cancer.

Kübler-Ross's 5 Stages of Grief

  1. Denial and Isolation.

  2. Anger.

  3. Bargaining.

  4. Depression.

  5. Acceptance.

Facilitating Death

  • Artificial Nutrition and Hydration: Not a comfort measure.

  • Euthanasia and Legally Assisted Death:

    • Relevant arguments include individual liberty, autonomy, quality of care, nonmaleficence, and beneficence.

Advance Care Planning

  • Advance Directives:

    • Statement for medical decision-making if unable to do so.

    • Includes durable power of attorney and living wills.

  • Provider Orders for Life-Sustaining Treatment (POLST):

    • Based on patient’s preferences related to cardiopulmonary arrest.

Case Study: Mr. and Mrs. Dietrich's Hospice Meeting

  • Discussion on advance care planning and concerns about pain management and suffering.

Audience Response Questions

  • Identify Kübler-Ross stage currently experienced by Mr. Dietrich.

  • Mr. Dietrich's interest in writing an advance directive against mechanical ventilation.

Nursing Care at End of Life

  • Communication:

    • Establish therapeutic relationships to aid difficult decision-making.

  • Art of Presence: Fostering supportive environments.

  • Symptom Management: Addressing both physical and emotional symptoms.

Practice the Art of Presence

  • Ask open-ended questions to understand patients' feelings and concerns.

Anticipatory Grief

  • Future loss is mourned in advance, impacting daily adjustments and emotional states.

Palliative Care for Patients with Dementia

  • Anticipation of needs, support for meaningful connections, patient goals identification, and family education are key.

Developmental Tasks of Dying

  • Completion of personal and relational affairs and acceptance of life’s finality.

The Dying Process

  • Key Indicators:

    • Growing weakness, loss of appetite, and increasing drowsiness.

    • Circulatory changes and skin mottling indicating nearing death.

At Time of Death

  • Family should contact hospice provider for guidance on post-mortem care and necessary procedures.

Distinctive Concepts

  • Grief: Reaction to loss.

  • Bereavement: Period of grieving after a death.

  • Mourning: Coping mechanisms people employ.

Grieving Theories Overview

  1. Freud: Grief work concept.

  2. Kübler-Ross: Emotional phases aligned with grieving.

  3. Bowlby: Phases from shock to recovery.

  4. Worden: Four tasks of moving on.

  5. Stroebe: Dual process model.

Grief and Technology

  • An outlet for expression and ongoing connection with deceased loved ones.

Grief versus Major Depressive Disorder

  • Contrast on feelings, intensity, self-esteem, and thoughts about death.

Types of Grieving and Associated Nursing Care

  • Acute Grieving: Supportive techniques include attentive listening.

  • Persistent Complex Bereavement Disorder: Addressing prolonged grieving with safety.

  • Disenfranchised Grief: Individual therapy and group support are essential.

  • Public Tragedy Grief: Community loss validation is necessary.

Self-Care for Caregivers

  • Importance of recognizing personal feelings and seeking support.

Audience Response Question

  • Identification of grief type felt by hospice nurse after Mr. Dietrich’s death.