Lecture 10: Death, Dying, Grief, and Death Notification PDF

⚰️ Lecture 10 Death, Dying, Grief, and Death Notification Course: PARA 127, Week 10 Learning Objectives 1. Identify common causes of death across age groups. 2. Recognize the stages experienced by dying patients and th...

⚰️ Lecture 10 Death, Dying, Grief, and Death Notification Course: PARA 127, Week 10 Learning Objectives 1. Identify common causes of death across age groups. 2. Recognize the stages experienced by dying patients and their family members. 3. Understand the needs of the dying patient. 4. Explore the concepts and theories of grief. 5. Describe Kübler-Ross’ stages of grief. 6. Identify situations requiring paramedics to deliver death notifications. 7. Review research on paramedic death notification experiences. 8. Summarize the approach and sequence of delivering death notifications. 9. Differentiate therapeutic from non-therapeutic language in death notification. 10. Apply these principles through simulated scenarios. Leading Causes of Death (Statistics Canada, 2021) ❊ Tested on the order they fall in 1. Malignant Neoplasms (Cancer): Consistently the leading cause (e.g., 80,152 deaths in 2019). 2. Diseases of the Heart: Second most common cause (e.g., 52,541 deaths in 2019). Lecture 10 1  3. Unintentional Injuries (Accidents): Ranked third, showing a rising trend over time. 4. Cerebrovascular Diseases: Fourth-leading cause, with relatively stable rates. 5. Chronic Lower Respiratory Diseases: Fifth, often linked to smoking or environmental factors. 6. Other notable causes: 7. Diabetes Mellitus 8. Influenza and Pneumonia 9. Alzheimer’s Disease 10. Intentional Self-Harm (Suicide) 11. Chronic Liver Disease and Cirrhosis 25. Assault (Homicide) Kübler-Ross Stages of Grief 1. Denial: Initial disbelief or rejection of reality. 2. Anger: Frustration and resentment directed inward or outward. ( Anger usually expressed to medical directives, god) 3. Bargaining: Attempting to negotiate or find a way to reverse the situation. 4. Depression: Profound sadness and withdrawal. 5. Acceptance: Coming to terms with the loss. (doesn’t mean they are over the loss Key Notes: These stages may not occur in a specific order. Some individuals may revisit stages or experience them multiple times. may not make it through all stages Lecture 10 2  Factors Influencing Reactions to Death Cultural and personal preferences about death Flowers, food, and rituals. Whether to grieve alone or together. Location of death: hospital or home. Decisions about autopsies, organ donation, funerals (weeping vs. socializing). Timing of funerals (quick or delayed) and method of disposition (burial or cremation). Visitation or not? Location: funeral home or private residence? HOSPICE(people tend to go here for peaceful death) Types of Losses Loss of personal possessions. (i.e. natural) Loss of a familiar environment. Loss of a significant person (including pets). Loss of a part of oneself (e.g., body part, identity). Loss of control over one’s life. Developmental Understanding of Death 1. Infants: Experience the absence of care (feeding, clothing, love). 2. Toddlers: Anxiety over caregiver absence but lack distinction between animate and inanimate. 3. Ages 3–5: View death as reversible. 4. Ages 6–10: Show curiosity and ask questions about death. 5. Adolescents: Fascinated yet fearful; often repress or deny feelings.(unless one of their own dies - than they talk about it) Lecture 10 3  6. Adults: Reflect on mortality and examine the meaning of their lives. 7. Elderly: Grieve aging, the loss of friends, and the loss of independence. Grief and Gender Men: Tend to struggle with expressing emotions. (men tend to die within a few months or their spouse dies due to grief) Women: More likely to express grief openly. Unique challenges: Loss of a child: Particularly difficult for parents.(i.e. miscarriage, etc) Anticipatory grief: Begins before the loss and is often helpful. Dysfunctional grief: May lead to physical symptoms, stress-related illnesses, and altered relationships. Grief vs. Major Depression → grief can appear to be depression but its different Grief Major Depression Dominated by emptiness Dominated by depressed mood Dysphoria occurs in waves Dysphoria is persistent Capacity for positive emotions Limited pleasure or positivity Self-esteem preserved Feelings of worthlessness Fleeting thoughts of joining the deceased Suicidal ideation to escape life End-of-Life Care Decisions Advanced Directives / Living Will: Legal documents stating care preferences. Do Not Resuscitate (DNR): Instructions to forgo resuscitation efforts. Therapeutic Response to the Dying 1. Accept individuals where they are. Lecture 10 4  2. Acknowledge cultural beliefs and values response. 3. Listen actively to both spoken and unspoken emotions. 4. Avoid false assurances and superficial platitudes. → Can’t force someone out of denial → Don’t take expressed anger personally → Don’t take embarrassed by emotions of pt, families, or self → Don’t give false assurance or avoid uncomfortable discussions → Refer pt & families as necessary 5. Be honest, simple, and straightforward. 6. Respect patients' wishes, even if they differ from personal beliefs. 7. Provide dignity to the dying and their families. Situations Requiring Notifications Medical TOR Obvious Death Stillbirth/ Miscarriage Traumatic death (not the focus of this session) → Trauma TOR → Pt ruled out by triage Paramedic Role in Death Notification After resuscitation is terminated, paramedics must handle the emotional needs of: Spouse/Partner Family members Friends Next critical tasks include: Lecture 10 5  1. Notification: Informing survivors of the death. 2. Initial Grief Support: Offering emotional and practical assistance. Challenges in Death Notification Lack of training and experience. Fear of blame or survivors’ emotional reactions. Fear of showing emotion or acknowledging personal mortality. Fear of not knowing the answers Fear of our own death (McLauchlan) Research highlights: Stressful Nature: Paramedics experience heightened stress during death notifications (Norton et al., 1992; Smith-Cumberland & Feldman, 2006). Increased risk of stress-related illnesses (Regehr & Bober, 2006). Paramedic actions can significantly impact survivors' grieving processes (McGahey-Oakland et al., 2007; Edwardsen, 2002). Our Research Focus Groups: Conducted with 28 paramedics from urban and rural settings. Findings: 1. Stress for New Paramedics: Higher levels of stress in new situations. 2. Role Transition: Difficulty shifting from clinical roles (resuscitation) to emotional support roles. 3. Importance of Communication: Recognized the need for clear, compassionate communication with families. 4. Minimal Formal Training: Many paramedics lack structured training in death notification. Lecture 10 6  5. Primary Support: Relied heavily on peers for emotional support, with divided trust in management Effective Death Notification (Key Strategies) 1. Anticipation: Anticipate the call outcome and consider allowing family access if appropriate. (allowing family member access, it helps them - but they have to be respectful) 2. Testing the Waters: If termination is likely, update family members during resuscitation efforts. 3. TOR (Termination of Resuscitation): Obtain permission from the Base Hospital (BH) physician. 4. Mental Transition: Shift mentally from clinical resuscitator to compassionate notifier. 5. Approach Survivors: Be on the same physical level as the family (e.g., seated together). Maintain eye contact without staring. 6. Delivering the News: Use clear, unambiguous language: e.g., "death," "died," or "dead." 7. Allow Responses: Give survivors space for their emotional reactions and acknowledge their loss. 8. Physical Support: Use touch appropriately (if culturally acceptable and invited). 9. Active Listening: Acknowledge survivors’ feelings as valid and normal. Lecture 10 7  10. Assist with Next Steps: Be available to answer questions and guide survivors on the immediate steps to take. Survivors’ Reactions to Death Notification Common Reactions: Typical: Disbelief. Guilt. Anger. Crying and acute distress. Acceptance. Less Typical: Absolute denial. Violent anger. Relief (in cases of domestic conflict). Making accusations or blaming others. What Helps Survivors?: 1. Compassion and Professionalism: Maintain a supportive, empathetic demeanor. 2. Clarity: Provide clear, simple explanations. 3. Presence: Stay physically present and available for assistance. 4. Kindness: Offer small gestures (e.g., water, tea) to show care. Lecture 10 8  5. Practical Assistance: Help survivors with immediate next steps (e.g., notifying other family members, contacting authorities). Therapeutic Phrases “I’m so sorry for your loss.” “This must be so hard to accept.” “Tell me about [the deceased] and your life with them.” “You’re not alone; I’m here to help.” Non-Therapeutic Phrases to Avoid: “Time heals all wounds.” “At least they lived a long life.” “Something good always comes from tragedy.” Research Insights Families benefit from viewing resuscitation and spending time with the deceased. Procedures for allowing family access vary, but suspicions of foul play restrict access. Key Considerations Paramedics must switch roles from technical care providers to compassionate communicators. Survivors’ reactions to death notifications are highly variable and influenced by numerous factors. Effective death notifications rely on clarity, compassion, and professionalism. Lecture 10 9