End of life care in detail , with terminologies used in end of life care, theories of grief including kubber ross theory and other , Grief management ,hospice care, care of body after death.

1. KING GEORGE’S MEDICAL UNIVERSITY
KING GEORGE’S ,COLLEGE OF NURSING
SEMINAR ON
END OF LIFE CARE
SUBMITTED TO: SUBMITTED BY:
MRS. PRIYANKA SINGH DIVYA PAL
CLINICAL INSTRUCTOR M.SC. N. 1ST YEAR
K.G.M.U. COLLEGE OF NURSING K.G.M.U. COLLEGE OF NURSING
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2. OUTLINES
• Introduction
• Definition of end of life care
• Terminologies
• Types of grief
• Theories of grief
• Indications of death
• Psychosocial manifestation of approaching death
• Physical manifestation of approaching death
• Care of the body after death
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3. INTRODUCTION
End –of -life care includes physical, emotional, social and spiritual support for
patients and their families. The goal of end -of -life care is to control pain and other
symptoms so the patient can be as comfortable as possible.
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4. DEFINITION
“End-of –life care refers to health care, not only of patients in the final hours or
days of their lives, but more broadly care of all those with a terminal illness or
terminal disease condition that has become advanced ,progressive and incurable.”
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5. TERMINOLOGIES
Loss:- an aspect of self no longer available to a person.
Death:- cessation of life.
Grief:- pattern of physical and emotional responses to bereavement.
End of life:- final phase of a patient’s illness when death is imminent.
Death rattle:- a sound that is something heard coming from a dying person’s
throat or chest.
Palliative care:- making life as easy as possible for patients and families living
with serious illness.
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6. Hospice care:- Hospice care is given when there is life expectancy of 6 months
or less.
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7. DEFINITION OF GRIEF
Grief is a strong sometime overwhelming emotion for people, regardless of
whether their sadness stems from the loss of a loved one or from a terminal
diagnosis they or someone they love have received.
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8. TYPES OF GRIEF
Normal grief:- Complex emotional, social, physical, behavioural and spiritual
responses to loss and death.
Anticipatory grief:- Associated with the normal grief response before the loss
actually occurs.
Delayed or inhibited grief:- Absence of evidence of grief when it ordinarily
would be expected.
Distorted grief:- Symptoms associated with normal grieving are exaggerated.
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9. Chronic or prolonged grief:- Maintaining personal possessions aimed at keeping
a lost loved one alive.
Disenfranchised grief:- When relationship to the decreased person is not socially
sactioned.
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10. Ambiguous loss:- The lost person is physically present but not psychologically
available.
Complicated grief:- Prolonged or significantly difficult time moving forward
after a loss.
Masked grief:- Disruptive behaviour due to loss and ineffective grief resolutions.
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11. KUBLER-ROSS THEORY
5 STAGES OF GRIEVING(1969):- The five stages of grief model or the kubler ross
model is popularly known as a model that describes a series of emotions
experienced by people who are grieving:-
DENIAL
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE
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13. BOWLBY 4 PHASES OF MOURNING (1980)
Bowlby and markes (1980) identify four phases of mourning :-
 Numbing
 Yearning and searching
 Disorganization and despair
 Reorganization
NUMBING:- feeling “stunned” or “unreal” can be interrupted by periods of
intense emotion. 13

14. YEARNING AND SEARCHING:- Full effects of emotional outbursts and
uncontrollable crying.
DISORGANIZATION AND DESPAIR:- Evaluation of loss, may become angry at
perceived person at fault.
REORGANIZATION:- Person begins to move forward with life, roles , skills and
relationships.
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15. WORDEN’S FOUR TASKS OF MOURNING
WORDEN’S FOUR TASKS OF MOURNING(1991):-
Task 1:- To accept the reality of the loss.
Task 2:- To work through the pain and grief.
Task 3:- To adjust to the environment in which the decreased is missing.
Task 4:- To emotionally relocate the decreased and move on with life.
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17. INDICATIONS OF DEATH
Relaxed muscles
No pulse
No breathing
Fixed eyes
Total lack of response to external stimuli.
No muscular movement , especially breathing.
No reflexes
A bowel or bladder release
No response
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18. PSYCHOSOCIAL MANIFESTATIONS OF APPROACHING DEATH
Altered decision making
Anxiety
Helplessness
Life review
Peacefulness
Unfinished business
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19. Restlessness
Saying goodbyes
Decreased socialization
Fear of loneliness
Fear of meaninglessness
Unusual communication of one’s life
Fear of pain
Vision like experience
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20. PHYSICAL MANIFESTATION OF APPROACHING DEATH
Sensory:- decreased sensation , perception, blurring of vision, siking and glazing
of eyes, blink reflex absent, eyelids remain half open.
Integumentary:-mottling on hands ,feet, arms and legs , cold, clammy skin,
cyanosis on nose, nail beds, knees , wax like skin when very near to death.
Respiratory:- increased respiratory rate , chyne-stokes respiration , inability to
cough or clear respiration , secretions resulting in grunting , gurgling.
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21. Urinary:- decreased urine output , urinary incontinence, unable to urinate.
Gastrointestinal :-accumulation of gas, distension, nausea , loss of sphincter
control.
Musculoskeletal :- inability to move, sagging of jaw , difficulty in swallowing ,
difficulty in maintaining posture and alignment , loss of gag reflex, jerking.
Cardiovascular:- increased heart rate, slower and weakening pulse, irregular
rhythm . decreased in blood pressure , delayed absorption of drugs.
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22. CARE OF BODY AFTER DEATH
PROCEDURAL GUIDELINES:-
EQUIPMENTS:- Bath towels, wash clothes, wash basin, scissors, shroud kit with
name tags, bed linen , room deodorizer, documentation forms.
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23. NURSES:-
 Make arrangements for staff, spiritual advisor or other to stay with the family
while the body is prepared for viewing.
Prepare the death care tray.
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24. Cleanse body thoroughly, apply clean sheets.
Brush and comb clients hair.
Encourage family to say good bye through both touch and talk.
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25. Do not rush good bye process.
Remove all equipments and ornaments.
Clarify the personal belongingness to handover the personal objects and body.
Do not discard items found after the family is gone, tell them what is found. 25

26. Apply name tags.
Cover the body while shifting on the death trolly.
Complete documentation
Follow all protocols and policies to meet all legal requirements in caring for the body.
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27. APPROPRIATE DOCUMENTATION
Time of death and actions taken to prevent or cardiac arrest record if applicable.
Name of the person that pronounced the client’s death.
Make special preparation and type of donation , including time, staff, company.
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28. The name of the family member or friend who was called and who came to the
hospital- donor organization, morgue, funeral home, chaplain.
Time of discharge and destination of the body , location of the name tags on the
body, special requests .
 Made by the family ,any other statements that might be needed to clarify the
situation.
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