Death and Dying
Death often referred to as “final stage of growth”
Experienced by everyone/cannot be evaded
Young people tend to ignore its existence.
Usually elderly, who have lost a spouse or friends, begin to think of their own deaths. \n
Terminal Illness
Disease that cannot be cured that will result in death.
Some patients react with fear, anxiety, fear of pain, abandonment, and loneliness
Fear of unknown
Become anxious about their loved ones
Become anxious about unfinished work or dreams
Some pts view death as final peace
Anxiety diminishes in certain pts
Feel they have had full life
Have strong religious beliefs regarding life after death
Know it will bring an end to loneliness, pain and suffering. \n
Dr. Elisabeth-Kubler-Ross
She has done extensive research on the process of death and dying.
Known as a leading expert on this topic.
Results of her research:
We now feel pt should be told of his/her approaching death.
However, pt should be left with “some hope” and knowledge that they will “not be left alone”.
Important all staff knows the extent of info given to pt and how pt reacted.
She identified the 5 stages of grieving
Dying patients and their families/friends may experience stages in prep for death.
Stages may not occur in order
May overlap or be repeated several times
Patients may not progress through all stages
Stages are Denial, Anger, Bargaining, Depression, and Acceptance \n
1st stage: Denial
“No, not me” stage
Usually occurs when a person is first told of terminal illness.
Used when cannot accept reality of death or when feel love ones can’t accept truth.
Make statements like: “The doctor does not know what he’s talking about.” or “The tests are wrong.”
May seek another medical opinion or request additional tests.
May refuse to discuss illness and avoid any reference to it.
Role of healthcare worker during this time:
Important for pt to discuss these feelings
We should listen to pt
Try and provide support w/out confirming or denying.
Statement such as “It must be hard for you,” or “You feel additional tests will help?, are appropriate.
Allow patients to express feelings and move on to next stage. \n
2nd stage: Anger
Occurs when pt is no longer able to deny death.
Common statements are: “Why me?” or “It’s your fault”
May strike out @ anyone who comes in contact w/them.
May become hostile/bitter
May blame themselves, their loved ones, or health care personnel for illness \n
Role of healthcare worker:
Important to understand that anger is not a personal attack
Recognize that anger is due to situation pt experiencing
Provide understanding and support
Listen to the patient
Make every attempt to respond to pt’s demands quickly and w/ kindness.
Stage continues until anger is exhausted or pt has other concerns to attend to. \n
3rd stage: Bargaining
Occurs when pt accepts death but wants more time
Patient frequently turns to religion and spiritual beliefs.
Will to live is strong
Patient fights hard to achieve goals set such as see child graduate or get married, want time to arrange for family, hold new grandchild.
Makes promises to God to obtain more time. \n
Role of health care worker:
Be supportive and good listener
Help patients meet their goal whenever possible.
4th stage: Depression
Occurs when patient realizes death will be soon.
They will no longer be w/their families
They won’t be able to complete goals
May express these regrets or may withdraw and become quiet.
Experiencing great sadness and overwhelming despair.
Role of Health Care worker:
Let patient know that “it’s okay” to be depressed.
Provide quiet understanding and support.
Provide a simple touch
Allow patients to cry or express grief
5th stage: Acceptance
Understand and accept fact that they are going to die
May complete unfinished business
May try to help those around them deal w/ death
Gradually separate themselves from world and other people
At the end, they are @ peace and can die w/dignity. \n
Role of health care worker:
Provide emotional support
Realize presence is important, even if it is just touch of hand. \n