mital patel

1. TIM SPECIFIC CONTENT TEACHING LEARNING
E OBJECTIVE A.V. ACTIVITIES EVALU
AIDS TEACHER STUDENT ATION
To introduce INTRODUCTION: Teacher Students
3 the topic. will will
min Death is often referred to as ―the final stage of growth.‖ Life is a moving White introduce understand
process, it begins at birth, but it ends with death. board the topic. the topic.
Mosby’s medical, Nursing & Allied Health Dictionary says Death is:
The cessation of life as indicated by the absence of activity in the brain
and central nervous system, the cardiovascular system, and the
respiratory system as observed and declared by a physician.
Nurses are very committed to life and health. The dying patient is a
contradiction to a nurse's commitment. Occasionally people in the
medical field react to the dying person as if they represent a failure in
their care, or their skills. Although there is really nothing a human being
can do to stop the destiny/ process of another human being. We can help
the dying patient and their families in their final hours with our
education and compassion.
FACTORS AFFECTING GRIEF AND DEATH :
To explain Children :children do not understand death as the adults do but its effect Teacher Students Which
9 factors is tremendous. Both terminally ill children and their siblings are likely to White will will take are the
min affecting ask questions about death.they require parental love and support at all board explain part in factors
grief and stages. The children’s development may be retarded due to death of a by discussion affecting
death. parent or the child regresses. discussion . grief and
.. death ?

2. young and middle aged people :
They approach death reluctantly. Separation from loved ones is difficult
to accept .The elderly person, however, often looks upon death with less
dread. For him death may represent peace and relief from suffering. For
the person who has always been healthy and suddenly becomes critically
ill,death is often feared.
Family :
The patient’s families react to death and dying in a variety of a ways.
They feel lost as to what to say, and how to act in an aggressive manner
towards the nurse and the health agency when the patient is critically ill
or after death. This can be an expression of feelings of helplessness and
frustration.
Patient :
Patients react to death in many ways.some people frankly express their
feelings and their fears while fears while others hide them in an air if
superficially.some become aggressive , hostile or withdrawn;others
maintain a composure , which hides many anxieties.
Nurse :
The nurse also reacts in different ways to the dying patient and to death.
Her reactions largely depends on her own past experiences , beliefs and
needs. She has to be very alert with relatives covert or overt actions of
cultural practices during the last stages.
Socio – economic factors :

3. A bereaved family may suffer more acutely if there is no other earning
member in the family. They not only have loss of a loved one , but also
economic loss that may further disrupt family life.
Cultural influences :
Culture also influences an individual’s expression of grief. In many
families , grief is a private matter shared only with the family. Many
individuals internalise their feelings of grief and may not express grief
or feelings of loss to others.on the other hand , cultural background may
necessitate the family to display emotion and distress with loud weeping
and mourning which may disturb the other patients in the ward.
MEETING THE NEEDS OF GRIEVING AND DYING
INDIVIDUALS : Teacher
To discuss White will how will
10 the needs of The client’s needs are met by attending the following aspects like : board discuss Students you
min dying needs of will provide
individuals. Physical needs : dying participate care to
individual in dying
s by discussion person ?
asking
Dying may take a few minutes, days or weeks. There is a general questions .
slowing down of the bodies' processes as a person is dying. They
become weak; levels of consciousness may change. It is very important
to allow the patient as much independence as possible. As they become
weaker or less responsive the nursing team will need to help with basic
needs. As the death nears the patient might become totally dependent on
the nursing staff for all of their ADL’s.
Every effort is given to provide the best care, physically and
psychological to a dying patient. This person needs be allowed to die in

4. comfort and with DIGNITY…
VISION, HEARING and SPEECH- Vision may become blurred and
gradually fail, this person will automatically turn towards the light, a
very dark room may frighten them. Keeping some light in the room is
important, but not real bright lights. The eyes may stay half-open, this
will cause dryness and accumulation of secretions in the corners, and
frequent eye care is necessary. Always talk to the patient and let them
know you are there and keep some light in the room. Hearing is the last
sense to go, ALWAYS remember the patient can hear you even when
you think there is no way they could, they can! So talk to them, continue
to explain what you are doing and why, keep your normal tone of voice,
offer words of reassurance and comfort. Remember to never offer false
promises.
MOUTH, NOSE and SKIN- oral hygiene is a must! A dying person’s
mouth many times become very dry and their lips crack. Mouth care is
important and needs to be done frequently with glycerin swabs, or
toothettes. You do not want to put a lot of water, or fluids in the dying
person's mouth. Many times they are unable to swallow and too much
fluid can cause them to aspirate. When giving mouth care always have
the head of the bed up and their heads turned to the side. Part of mouth
care is applying lubricant to the patients' lips. The nostrils may become
dry or crusted from drainage or oxygen, assess these areas frequently.
CIRCULATION decreases and then fails. Body temperature may
increase as death approaches. Even though the body temperature goes up
the skin becomes cool, pale, and mottled. Perspiration increases, many
times profusely. Good skin care, bathing, and prevention of decubitis
ulcers are very important nursing measures.
Positioning the patient frequently and keeping them comfortable as

5. possible, you may use pillows to help with positioning and to avoid skin
to skin contact.
ELIMINATION- the dying person may become incontinent of bowel
and bladder. Remember DIGNITY. Bed protectors or attends may be
needed. Perineal care is very important.
Psychological needs :
Patients' insight into their condition should be assessed. Issues relating
to dying and death should be explored appropriately and sensitively.
Clients differ in their emotional responses when recognizing that death
is inevitable. some person speak of their fears of death. Responses
include fear of the unknown , separation , pain of leaving loved ones
,loss of dignity and so on. .nurse should be involved in giving hope
,while helping the client to deal with reality. No matter what the
behaviour of client is,it should be accepted by the nursing staff. A fear
of isolation of having to face the death alone is a primary fear of the
dying person . yhe nurse supports the client by providing her/him full
attention.presence of members of the family needs to be encouraged.
Social needs :
The family's insight into the patient's condition should be assessed and
issues relating to dying and death explored appropriately and sensitively.
The family should be told that the clinical expectation is that the patient
is dying and will die. Use of ambiguous language such as ―may not get
better‖ can lead to misinterpretation and confusion. A constant source of

6. frustration and anger voiced by bereaved relatives is that no one sat
down and discussed the fact that their loved one was dying. If relatives
are told clearly that the patient is dying they have the opportunity to ask
questions, stay with the patient, say their goodbyes, contact relevant
people, and prepare themselves for the death. Relatives of patients dying
in the community should be given contact telephone numbers so that
they have access to help and advice on a 24 hour basis.
Spiritual needs :
Sensitivity to the patient's cultural and religious background is essential.
Formal religious traditions may have to be observed in the dying phase
and may also influence care of the body after death. After the patient's
death, relatives should be dealt with in a compassionate manner. A
leaflet explaining issues related to grieving can be helpful.
Hospice care :
Hospice care is end-of-life care provided by health professionals and .
volunteers. They give medical, psychological and spiritual support. The
goal of the care is to help people who are dying have peace, comfort and
dignity. The caregivers try to control pain and other symptoms so a
person can remain as alert and comfortable as possible. Hospice
programs also provide services to support a patient's family.
Usually, a hospice patient is expected to live 6 months or less. Hospice
care can take place
At home

7. At a hospice center
In a hospital
In a skilled nursing facility
STAGES OF DYING :
To describe Teacher Students Which
7 stages of Clients’ reaction to impemding death is unique to everyone,Dr .elizabeth will will are the
min dying. kubler-ross studied responses to death and her findings have been used lcd explain verbalise stages of
using a.v stages of dying ?
extensively by nursing and other professionals. According to kubler
aids. dying.
ross, the stages of dying are (1) Denial and isolation (2) Anger (3)
Bargaining (4) Depression (5) Acceptance
1. Denial and Isolation
The first reaction to learning of terminal illness or death of a cherished
loved one is to deny the reality of the situation. It is a normal reaction to
rationalize overwhelming emotions. It is a defense mechanism that
buffers the immediate shock. We block out the words and hide from the
facts. This is a temporary response that carries us through the first wave
of pain.
2. Anger
As the masking effects of denial and isolation begin to wear, reality and
its pain re-emerge. We are not ready. The intense emotion is deflected
from our vulnerable core, redirected and expressed instead as anger. The
anger may be aimed at inanimate objects, complete strangers, friends or
family. Anger may be directed at our dying or deceased loved one.

8. Rationally, we know the person is not to be blamed. Emotionally,
however, we may resent the person for causing us pain or for leaving us.
We feel guilty for being angry, and this makes us more angry..
The doctor who diagnosed the illness and was unable to cure the disease
might become a convenient target. Health professionals deal with death
and dying every day. That does not make them immune to the suffering
of their patients or to those who grieve for them.
Do not hesitate to ask your doctor to give you extra time or to explain
just once more the details of your loved one’s illness. Arrange a special
appointment or ask that he telephone you at the end of his day. Ask for
clear answers to your questions regarding medical diagnosis and
treatment. Understand the options available to you. Take your time.
3. Bargaining
The normal reaction to feelings of helplessness and vulnerability is often
a need to regain control–
If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…
Secretly, we may make a deal with God or our higher power in an
attempt to postpone the inevitable. This is a weaker line of defense to
protect us from the painful reality.
4. Depression
Two types of depression are associated with mourning. The first one is a

9. reaction to practical implications relating to the loss. Sadness and regret
predominate this type of depression. We worry about the costs and
burial. We worry that, in our grief, we have spent less time with others
that depend on us. This phase may be eased by simple clarification and
reassurance. We may need a bit of helpful cooperation and a few kind
words. The second type of depression is more subtle and, in a sense,
perhaps more private. It is our quiet preparation to separate and to bid
our loved one farewell. Sometimes all we really need is a hug.
5. Acceptance
Reaching this stage of mourning is a gift not afforded to everyone.
Death may be sudden and unexpected or we may never see beyond our
anger or denial. It is not necessarily a mark of bravery to resist the
inevitable and to deny ourselves the opportunity to make our peace. This
phase is marked by withdrawal and calm. This is not a period of
happiness and must be distinguished from depression.
Loved ones that are terminally ill or aging appear to go through a final
period of withdrawal. This is by no means a suggestion that they are
aware of their own impending death or such, only that physical decline
may be sufficient to produce a similar response. Their behavior implies
that it is natural to reach a stage at which social interaction is limited.
The dignity and grace shown by our dying loved ones may well be their
last gift to us.
Coping with loss is a ultimately a deeply personal and singular
experience — nobody can help you go through it more easily or
understand all the emotions that you’re going through. But others can be
there for you and help comfort you through this process. The best thing
you can do is to allow yourself to feel the grief as it comes over you.

10. Resisting it only will prolong the natural process of healing.
THE RIGHT TO DIE:
To explain
3 the rights to There are legal issues involved in dying. The right to die. Many people Teacher Have
min die. do not want to be kept alive by machines or other measures. Consent will Students you ever
must be given to do any treatment on a patient. If the patient is not able White discuss will heard
to do so, the nearest living relative will be asked. People need to make board rights of understand about
their own decisions while they are able.. dying rights of informed
individual. dying consent ?
The self-determination Act and Obra give a person the right to accept or individual.
refuse medical treatment. They also have a right to make advance
directives (a written document stating a person’s wishes about health
care when the stated person is unable to do so for themselves). Living
will (a person’s written statement about the use of life-sustaining
measures, feeding tubes, ventilators, and CPR are a few). Durable power
of attorney (the power to make decision about health care is given to
another person, family or friend, or sometimes a lawyer) These are
common forms of advance directives.
All health care agencies must inform patients of their right for advance
directives on admission. This information must be in writing. The
patient’s medical record must have documentation of their advance
directives.
Do Not Resuscitate Orders… When death is sudden and unexpected,
every effort to save life is given. CPR and any and all emergency
treatment is given to sustain a person life.
Things are different with a long term or chronic illness, the patient has a

11. right to have their doctor write a ―No Code," or Do Not Resuscitate
DNR order. This means that no attempts will be made to resuscitate a
terminally ill person. The person is allowed to die in peace and with
dignity. The orders should only be written after the MD speaks with the
patient and then with the family, significant others.
THE DYING PERSONS BILL OF RIGHTS:
Teacher
I have a right to- be treated as a living human being until I die transper will ask Students Listout
5 To enlist the ancy questions will the dying
min dying persons I have a right to- maintain a sense of hopefulness, however changing its to participate persons
bill of rights. focus may be. students. in bill of
discussion rights.
To be cared for by those who can maintain a sense of hopefulness, .
however changing that may be.
To express my feelings and emotions about my approaching death, in
my own way.
To participate in decisions concerning my care.
To expect continuing medical and nursing attention even though I have
comfort only goals.
To Be free from pain!
To have my questions answered honestly.
Not to be deceived.
Have help from my family accepting my death.

12. To die in peace and DIGNITY.
To retain my individuality and not be judged for my decisions.
To discuss and enlarge my religious and spiritual beliefs.
To expect the sanctity of my human body will be respected after death.
To be cared for by caring, sensitive, knowledgeable people who will
attempt to understand my wants and needs, and will gain some sort of
satisfaction in helping me face my death.
SIGNS OF DEATH :
Signs of death or strong indications that a person is no longer alive are:
5 To identify Teacher Students How will
min signs of death will will you
 Cessation of breathing White discuss verbalize assess the
 Cardiac arrest (No pulse) board with signs of sign of
 Pallor mortis, paleness which happens in the 15–120 minutes after students. death. death ?
death
 Livor mortis, a settling of the blood in the lower (dependent) portion
of the body
 Algor mortis, the reduction in body temperature following death.
This is generally a steady decline until matching ambient
temperature
 Rigor mortis, the limbs of the corpse become stiff (Latin rigor) and
difficult to move or manipulate

13. Decomposition, the reduction into simpler forms of matter, accompanied
by a strong, unpleasant odor
CARING FOR THE BODY AFTER DEATH :
10 After the physician has pronounced death and legally documented the
min death in the medical record, care of the dead body is usually performed
by nurse. An autopsy consent may be requested and obtained , if
To enumerate required . if the patient is to be an organ donor ,arrangements will be
the purposes made immediately. The family also wishes to view the body before final Teacher Students What
and preparation are made. They may be allowed . demons will will
interventions tration explain redemonst
of care of by rate the
dead body. PURPOSES : demonstra procrdure,.
The nurse care for the body immediately following death to : tion.
- Make the body look as natural and beautiful as possible.
- Perform last duty tenderly
- Do everything you can for the relatives
- Protect other patient from unpleasant sights and sounds which
could frighten them.
Interventions:
The interventions of last offices begin soon after a doctor certifies the
cause of death . The practical interventions of last offices provided for
the patient are categorised according to hygienic, aesthetic and legal
reasons. Although correct compliance with recommended practical
procedures for last offices is important, the sensitive and respectful
manner of the carer was found to be as important .
Respect for a patient's dignity is epitomised by closing the curtain

14. around his or her bed immediately after death . Talking to other patients
who may have seen the patient die will help allay their fears. No
confidential information should be imparted.
1 ) Hygiene
Before beginning the last offices the nurse should put on plastic gloves
and an apron to reduce the risks of infectious contamination to staff and
cross-contamination to patients from body fluids .
The main risk of infection is via body fluids , so intravenous devices
need to be carefully removed and disposed of. Entrance sites must be
covered with a waterproof dressing. Sometimes the body can continue to
excrete fluids after death, so pressure should be applied to the lower
abdomen to express any residual urine. As further excretion of bodily
waste is not expected, the routine packaging of orifices is unnecessary .
2 )Aesthetics
Death can alter a patient's appearance, and friends and relatives might
find this disturbing. The following course of care is suggested as a
means of preparing a patient's body for those who wish to pay their
respects and to preserve dignity . This intervention can be justified on
the basis that the patient would have adjusted his or her own appearance
had he or she been able to.
The eyes should be closed with downward pressure and the jaw closed
and supported by a bandage tied around the head. This seems a more
appropriate and dignified intervention and has less potential to cause
harm or leave pressure marks on the patient's face or neck . The patient's
dentures should then be removed and cleaned, the inside of the mouth
cleaned and the dentures replaced. This ensures that any unpleasant
odours are eradicated .

15. After undressing, the patient should be given a sponge bath and dressed
in according to hospital policy. Bed linen should be removed and
replaced with clean sheets, and the bedside area tidied.
Dressing the patient in a shroud can make him or her look inappropriate
and unnatural. There is no obvious reason that patients should not be
dressed in their own, or even in hospital clothes, other than it is not
always hospital policy.
Next the patient's head should be placed on a pillow and the arms and
legs straightened. It has been suggested that laying the arms by the side
of the body may cause the hands to blacken, and this would be a concern
if relatives wished to hold the deceased's hand later. .
Before removal of the body to the mortuary, it should be wrapped tightly
in a sheet, to avoid damage during transfer. It is fortunate that other
patients do not have to suffer this dehumanising intervention when being
transferred by trolley around the hospital; a set of bedrails and a careful
porter would seem to suffice. The body is then taken away in a special
hospital trolley designed to secrete the body, a protective gesture.
3 )Legal issues
The final intervention involves providing a means to easily identify the
patient's body and taking an accurate record of all the personal
belongings. Attaching hospital identity bands to a patient's wrist and
ankle aids identification. A notification of death certificate can also be
attached to the sheet in which the patient is wrapped. The certificate
should be attached with tape, rather than with a pin, as this may present
a hazard to staff handling the body .
All personal items should be documented in the patient's property book
in the presence of another staff member.

16. SUMMARY :
5 Up till now we have discussed about following topics :
min Introduction , factors affecting grief and death, meeting the needs of
dying person,stages of dying, dying persons bill of rights, signs of death
, interventions of dead body including personal hygiene , aesthetics
and legal issues.
CONCLUSION :
1
min Caring for the dead is a unique aspect of nursing because the deceased
will never be aware of it. Although the necessity of providing a high
standard of care on the basis of 'upholding and enhancing the good
reputation of the professions' is reason enough to provide excellent care,
it is respect for the dignity and individuality of all patients .
RECAPITULATION :
Encourage students to ask questions and to clarify their doubts.
1 ASSIGNMENT :
Min Write an assignment on end care of dead body.
Date of submission :
Student’s Bibliography
1.The trained nurses association of India. New delhi: chandu
publication; 2007.p.138 -140.
2.Taylor C. fundamental of nursing. 4th ed. Lippincott: new yourk;
p.1079-1089.
3.Barbara Koizer,Glenora Erb,Audrey Jean Berman.Fundamental Of

17. Nursing 6th edition. India:Published by Person education;2003.p.822
Teacher’s Bibliography
1.Patricia A. Potter,Anne Grffin Perry.Fundamentals Of Nursing.6th
edition.New Delhi : Published by Elsevier;2005.p.390-393
2.Carol Taylor,carol Lillins,Priscilla Le Mone. Fundamental Of Nursing
The art and scince of nursing care. 6th edition.Philadelphia:Lippincott
publications;2005.p.94-100
3.The Trained Nurses Association of India. Fundamentals Of Nursing 1st
edition.New Delhi:Publlished by Secretary-General of TNAI;2005.p.13-
15.
4.Ruth F. Craven.Fundamental Of Nursing.5th edition.Philadelphia:
Lippincott Williams & Wilkims Publication;2006.p.89-104

18. CENTRAL OBJECTIVE :
Caring for the dying and dead illustrates nurses to possess not only practical skills but a knowledge of the professional, ethical and legal
factors that are intrinsic to holistic care.
SPECIFIC OBJECTIVE :
After studying this topic, students will be able to :
- list the factors affecting grief and death
- analyse and discuss the needs of dying individuals.
- enlist the rights of dying individuals.
- identify the sign of death
- demonstrate the care of the body after death.

19. INFORMATION ABOUT CLASS & TEACHER
Title of course : B.Sc. Nursing
Topic : Death and dying
Unit :
Level of student : 1st yr B.Sc. nursing
No. of student :
Date :
Time :
Venue :
Teaching method : Demonstration cum discussion
AV AIDS : white board,poster, LCD.
Name of evaluator : Mrs. Niru patel
Previous knowledge of students :Students are having some knowledge regarding care of dead and dying.
INFORMATION ABOUT STUDENT TEACHER
Name : Mrs. Mital s. patel

20. Year : 1st yr M.Sc.Nursing
SANDRA SHROFF ROFEL COLLEGE OF
NURSING VAPI
SUBJECT – NURSING EDUCATION
PRACTICE TEACHING ON DEATH AND DYING
SUBMITTED TO: SUBMITTED BY:
MRS. NIRU PATEL PATEL MITAL S.
ASSISTANT PROFESSER F.Y.M.Sc NSG
S.S.R.C.N S.S.R.C.N
VAPI VAPI

21. DATE OF SUBMISSION: