1 dying and death haivn havard medical school aids initiative in vietnam
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Dying and death
HAIVN
Havard Medical School AIDS Initiative in Vietnam
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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 processDescribe the course of physical death Provide physical care for dying patientsSupport patient’s family members and others to complete 4 specific tasks at the funeral
Learning objectives
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The stages might not occur in exact order• Patients can move back and forth
between stages Patient’s family might experience
similar stages Patient and his/her family members
may be in different stages, which can make interactions difficult
5 stages of dying
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Patients:DON’T believe that they are dyingDON’T want to hear the prognosis about their remaining timeFor Example: • “Not me” • “Not now”
Denial 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”
Anger stage
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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”
Bargaining stage
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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
Depression 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
Acceptance stage
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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?
Taking care of dying patients (1)
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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
Taking care of dying patients (2)
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Patients often desire to: 1. Apologize for what they have done wrong in their lives 2. Ask for forgiveness from their family & friends3. Forgive other people for what those people have done wrong to patient4. Thank their family and friends5. Say their goodbyes
Resting in peace: 5 things that help patients reconcile and obtain closure
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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
Support from nurses to help patients have a peaceful death
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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
Process of physical death of patients (1)
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Reduce their food and drink intake• Don’t feel hungry or thirsty much
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
Process of physical death of patients (2)
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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
Process of physical death of patients (3)
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More difficult to arouse/ wake patient up• Might need a few seconds
When awakened, patient might not talk
Patients “stare blankly into space” Patients experience visual
hallucinations
Signs that death is near…(1)
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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
Signs that death is near…(2)
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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
Physical care for dying patients (1)
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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
Physical care for dying patients (2)
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Continue taking good care:• 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
Physical care for dying patients (3)
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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
When taking care of dying patients…
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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
Four missions of the “farewell” (1)
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Four missions of the “farewell” (2)
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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
Key points
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Thank you!
Questions?