Transcript Taking care of dying patients

Dying and death
HAIVN
Havard Medical School AIDS
Initiative in Vietnam
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Learning objectives
By the end of this session, participants
should be able to:
Review the five (5) emotional stages of
death and dying
Discuss five (5) things that can help
ease the dying process
Describe the course of physical death
Provide physical care for dying patients
Support patient’s family members and
others to complete 4 specific tasks at the
funeral
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5 stages of dying

The stages might not occur in exact
order
• Patients can move back and forth
between stages
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Patient’s family might experience
similar stages
Patient and his/her family members
may be in different stages, which can
make interactions difficult
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Denial stage
Patients:
DON’T believe that they are dying
DON’T want to hear the prognosis
about their remaining time
For Example:
• “Not me”
• “Not now”
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Anger stage

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Patients will be very angry and feel
that it’s not fair for them to die
before other people
It’s very difficulte to communicate
with patients at this stage
For example:
• “Why me?”
• “I am not ready for this yet”
5
Bargaining stage


Patients will try their best to bargain
For example:
• “I will be nice, very nice if you let me
live until my son grows up”
• “I will never use drugs again if you give
me a chance to fix this”
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Depression stage


Sense death is impending
Think about everyone and everything
that will happen after:
• Loss of control: cannot take care of
themselves
• Loss of mental competency: cannot work
much longer
• Loss of family and friends


Might isolate themselves and avoid
seeing people
Feel hopeless / depressed
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Acceptance stage
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Not all patients go through this stage
Patients are sad but accept that their
life will end
Sort out assets and clarify remaining
tasks for the person who will
accepted fiscal responsibility
Say “goodbye” to their family and
close friends
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Taking care of dying patients (1)

Avoid mentioning death when
communicating with patients and
their families
• Don’t make patient’s family upset

Prepare to answer patient’s
questions:
• What will happen to my body when I
die?
• What are some signs of dying?
• Will it hurt?
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Taking care of dying patients (2)

Support patients and their families:
• Comfort, encourage them to reduce /
alleviate their concerns

Patients might be concerned about what will
happen to their families after they die
• Help patients select desired /
appropriate setting:


At home or at hospital
Determine who will be at patient’s
bedside during dying process
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Resting in peace: 5 things that help
patients reconcile and obtain closure
Patients often desire to:
1. Apologize for what they have done
wrong in their lives
2. Ask for forgiveness from their family
& friends
3. Forgive other people for what those
people have done wrong to patient
4. Thank their family and friends
5. Say their goodbyes
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Support from nurses to help patients
have a peaceful death


Nurses need to be aware that it’s not
easy for patients to complete the 5
tasks listed previously
Nurses can help them to have a
peaceful death by:
• Encouraging them to think about life
• Helping them communicate with their
family and friends:



Directly
Via mail / email
Via videos
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Process of physical death of patients (1)


Death due to illness is a process, in
which physical changes will happen
over a period of time
Usually, the body will become
weaker and weaker and then stop
functioning
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Process of physical death of patients (2)

Reduce their food and drink intake
• Don’t feel hungry or thirsty much
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Become weaker and reduce their
physical movement
Might not be able to voluntarily
control urination and defecation
Experience changes in resting and
sleeping habits
• Wake up at midnight and sleep during
the day
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Process of physical death of patients (3)

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Pay less attention to surrounding,
environment
May describe odd feelings / sensations /
visions
• Visits from relative(s) who are deceased

May experience alterations in senses:
• Reduced vision, sensation in feet
• Retained sounds in ears for longer periods

May experience changes in breathing:
• Breathing might become more rapid and
shallow
• Occurrence of cessations during breathing
(apneas) increases
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Signs that death is near…(1)

More difficult to arouse/ wake patient
up
• Might need a few seconds

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When awakened, patient might not
talk
Patients “stare blankly into space”
Patients experience visual
hallucinations
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Signs that death is near…(2)
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Hands & feet are cold to touch and
become pale in color
Eyes and mouth remain ajar
Heart rate can be rapid and
peripheral veins are weak
Lower jaw drops down
Increased frequency of apneas
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Physical care for dying patients (1)

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Dying cannot be stopped
Goal of care during this time is to
help patients and their families feel
more comfortable and at ease with
process
Treatment process during dying
stage is not acute treatment but
more palliative in nature
Discuss with family what will occur
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Physical care for dying patients (2)

Do not try to force food or drink on
the patient
• Losing appetite is common for dying
patients
• Keep mouth wet / moist

Evaluate frequency of pain and
provide pain medications regularly
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Physical care for dying patients (3)

Continue taking good care:
•
•
•
•
•
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Keep patients clean and dry
Change bed sheets regularly
Change posture for patients regularly
Oral care
Keep eyes wet
Create personal space for patients
and their families
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When taking care of dying patients…

Taking care of dying patients and
their families is an emotional
challenge:
• Nurses can feel loss and sadness when
patients die

Expressing feelings is important,
therefore it is necessary to provide:
• Support for nurses and have group
discussion(s)
• Personal counseling
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Four missions of the “farewell” (1)

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Completion of 4 missions of the
farewell is a part of caring
These missions:
• Need to happen in order
• Can be applied for any loss or grief
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Four missions of the “farewell” (2)
Mission 1
• Accept loss
Mission 2
• Overcome feelings relating to loss
(sadness, depression, anger, etc.)
Mission 3
Mission 4
• Make necessary changes to move
on
• Establish new relationships
Key points
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Taking good care of dying patients
physically and mentally is very
helpful for patients and their families
Nurses, when taking care of dying
patients and suffering from loss,
need to have emotional support
Providers can assist patients’ families
to complete 4 missions of the
farewell
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Thank you!
Questions?
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