Last Offices PDF

LAST OFFICES AND THE GRIEVING PROCESS DEATH DEFINITION Brain death leading to permanent stopping of integrated functioning of the person as a whole. Death is the cessation of breath and heart beat. It is also seen as inevitable and may occur suddenly, instantly, or unexpected Sagged o...

LAST OFFICES AND THE GRIEVING PROCESS DEATH DEFINITION Brain death leading to permanent stopping of integrated functioning of the person as a whole. Death is the cessation of breath and heart beat. It is also seen as inevitable and may occur suddenly, instantly, or unexpected Sagged opened mouth with dry lips and tongue incontinence  It may be the end of old age The end of a long and protracted illness May be an outcome of a situation of life and death Severe infection or trauma STANDARD CARE FOR THE TERMINALLY ILL PATIENT Consider the preference, personality and lifestyle Make every effort to maintain functional capacity and relieve discomfort Control pain ensure Ensure safety and security of patient Encourage contact with relatives and loved ones There may be ❖Fear of pain ❖Loneliness ❖Abandonment ❖The unknown ❖Loss of dignity ❖Loss of control SIGNS OF APPROACHING DEATH ❖Circulatory system ❖Skin musculo - skeletal system ❖Facial appearance ❖Central nervous system ❖Gastrointestinal system ❖Respiratory system ❖Sight, speech, learning ❖Genito-urinay system SIGNS OF CLINICAL DEATH Absence of pulse Fixed pupils Absence of all reflexes Rigor mortis- fixation of muscles Pale face Pinched and cold nose Blue, shriveled and cod ears Cold and clammy skin Sagged opened mouth with dry lips and tongue incontinence LAST OFFICES Explanation: This refers to immediate care of the body of the dead. Steps: 1. Screen the bed 2. Contact nurse in charge to inform the doctor 3. Note time vital functions (breathing, pulse rate, respiration and blood pressure) became imperceptible and record STEPS FOR LAST OFFICES CONT’D 4. Ensure doctor certify death, before proceeding to the next step 5. Remove all bed appliances and equipment used on patient e.g. intravenous infusion, naso gastric tube or oxygen appliances 6. Straighten the limbs STEPS FOR LAST OFFICES CONT’D 7. Close eyes and mouth, if not closed, apply small wet piece of cotton wool swab and place over the closed eyelids to stabilize them. 8. Use bandage to support jaw 9. Cover head and body with a sheet and leave for one hour STEPS FOR LAST OFFICES CONT’D 10.Inform relatives if they wish to see body allow them to do so. 11.Use emotional support to the grieving family REQUIREMENTS FOR PREPARATION OF THE BODY Trolley set with the following Articles for bed bath Receiver containing forceps Gallipots Dressings Bandages Scissors REQUIREMENTS FOR PREPARATION OF THE BODY CONT’D Receiver Towel and face cloth Plaster Identification label STEPS FOR LAST OFFICES 1. The nurse works under quiet atmosphere 2. Turn patient to Lateral position with a receiver a. Place body laterally to drain oral secretions b. To the supine position, apply gentle pressure over the abdomen to empty the bladder into a receiver STEPS FOR LAST OFFICES CONT’D 3. Bed bath body with particular attention to: a. nostrils, ears and mouth b. replace dentures if any 4. (Trim the nails and shave male patient if culture allows it or else these are done by relatives at home) 5. Remove all jewelery except wedding ring STEPS FOR LAST OFFICES CONT’D 8. Pack orifices – nostrils, ears, rectum and vagina with cotton wool using forceps to prevent leakage 9. Put a label on the patient with the following:- a. Full name b. Age c. Sex STEPS FOR LAST OFFICES CONT’D 10. Label on body of patient cont’d: d. Ward e. Diagnosis f. Date and time of admission g. Date and time of death STEPS FOR LAST OFFICES CONT’D 11.Wrap body in sheet, ensuring that the face and feet are covered and all limbs are held securely in position 12.Place patient on a special mortuary trolley 13.Make arrangements to transfer the body to the mortuary by mortuary attendants STEPS FOR LAST OFFICES CONT’D 14.Check patient’s property with a second nurse. OR 15. Hand them over to the next of kin if available and ask this person to sign the book 16. Clear away any equipment used STEPS FOR LAST OFFICES CONT’D 17.Clean the bed, locker and all appliances etc. 18.Document in admission and discharge book 19.Take patient’s folder to the revenue office for calculation of hospital fee 20.Inform relatives to come to the ward prior to going to the mortuary. MANAGEMENT OF PATIENT BROUGHT IN DEAD (BID) 1. Reassure the relatives 2. Give them seats. 3. Call in doctor to certify death and fill the coroner’s forms 4. Direct relatives to send the forms to police station 5. Manage the corpse as done to those who die in hospital THE GRIEVING PROCESS ▪ Explanation: ▪ Grieving process is a procedure of giving an emotional support to a significant loss. ▪ The words sorrow and heartache are often used to describe feeling of grief. ▪ Anticipatory grief is grief that strikes in advance of an impending loss. (thinking ahead of a sick relative that he may die, lead to emotional stress and grief in advance) STAGES INVOLVED IN GRIEVING PROCESS ▪ There are five (5) stages of Grieving Process 1. Denial stage 2. Anger stage 3. Bargaining stage 4. Depression stage 5. Acceptance stage 1. THE DENIAL STAGE This is the first stage of grieving process. The stage helps the individual to survive the loss. The individual sees the world as meaningless and overwhelming. The individual is in a state of shock and denial. Shock and denial enables him to cope and make his survival possible. There is grace in denial. It is nature’s way of letting in only as much as he can handle. He often laments “This can’t be happening to me” 2. THE STAGE OF ANGER Anger is the emotion used to manage the grieving process. Anger is a necessary stage in grieving process. The victim feels angry, and anger seems endless. Anger has no limit, it can extend to friends, the doctor, family etc. THE STAGE OF ANGER CONT’D Grieving victim may ask questions such as: “Where is God in this?” “Who is to be blamed ?” 3. BARGAINING STAGE This is the third stage of grieving process. Before the death of the relation, it seems like she will do anything if only her loved one would be spared. She bargains with God, “Please God, I will never be angry at my husband again if you just let him live” BARGAINING STAGE CONT’D After a loss, bargaining may take the form of a temporary truce. “What if I devote the rest of my life to helping others. “If only ……..” or “What if ……..” statements. We want life to return to what it was, we want our love ones restored. Thus questions used in this bargaining stage – “MAKE THIS NOT HAPPEN, AND IN RETURN I WILL……..” 4. THE STAGE OF DEPRESSION After bargaining, with God, the grieving victim moves into the realty of the dead. Empty feelings present itself, and grief enters her life at the deeper level; deeper than she ever imagined. This depressive stage feels as though it will last forever. THE STAGE OF DEPRESSION CONT’D Depression is the appropriate respond to great loss. The question to ask herself is whether or not the situation she is in is actually depressing? She wonders “I am too sad to do anything” 5. THE STAGE OF ACCEPTANCE ▪Acceptance is often confused with the notion of being “all right” or “it is ok” THANKS FOR YOUR ATTENTION