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Chapter 44
End-of-Life Care
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
End-of-Life Care
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End-of-life care describes the support and
care given during the time surrounding death.
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End-of-life care may involve days, weeks, or
months.
 Sometimes death is sudden, but often it is
expected.
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Your feelings about death affect the care you
give.
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You must understand the dying process.
• Then you can approach the dying person with caring,
kindness, and respect.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Terminal Illness
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An illness or injury for which there is no reasonable
expectation of recovery is a terminal illness.
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Hope and the will to live strongly influence living and
dying.
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Types of care
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Palliative care involves relieving or reducing the intensity of
uncomfortable symptoms without producing a cure.
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Hospice care focuses on the physical, emotional, social, and
spiritual needs of dying persons and their families.
• The goal is to improve the dying person’s quality of life.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Attitudes About Death
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Experiences, culture, religion, and age
influence attitudes about death.
Attitudes about death often change as a
person grows older and with changing
circumstances.
Practices and attitudes about death differ
among cultures.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Culture, Spiritual Belief, and Age
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Culture and spiritual needs
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Practices and attitudes about death differ among cultures.
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Attitudes about death are closely related to religion.
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Reincarnation is the belief that the spirit or soul is reborn in
another human body or in another form of life.
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Many religions practice rites and rituals during the dying
process and at the time of death.
Age affects a person’s attitudes and feelings about
death.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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The Stages of Dying
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Dr. Elisabeth Kübler-Ross described five stages of
dying.
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Denial is the first stage.
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Anger is the second stage.
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Bargaining is the third stage.
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Depression is the fourth stage.
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Acceptance of death is the last stage.
Dying persons do not always pass through all five
stages.
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A person may never get beyond a certain stage.
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Some move back and forth between stages.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Comfort Needs
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End-of-life care involves addressing physical, mental,
emotional, and spiritual needs.
Comfort goals are to:
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Prevent or relieve suffering to the extent possible
Respect and follow end-of-life wishes
Dying persons may want to see a spiritual leader.
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Provide privacy during prayer and spiritual moments.
Be courteous to the spiritual leader.
Handle the person’s religious objects with care and respect.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Physical Needs
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Dying may take a few minutes, hours, days,
or weeks.
To the extent possible, independence is
allowed.
Every effort is made to promote physical and
psychological comfort. The person is allowed
to die in peace and dignity.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Physical Needs (Cont’d)
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Pain
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Skin care, personal and oral hygiene, back
massages, and good alignment promote comfort.
Frequent position changes and supportive devices
promote comfort.
Breathing problems
Vision, hearing, and speech
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Vision blurs and gradually fails.
Hearing is one of the last functions lost.
Speech becomes difficult.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Physical Needs (Cont’d)
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Mouth, nose, and skin
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Oral hygiene promotes comfort.
Crusting and irritation of the nostrils can occur.
Circulation fails and body temperature rises as
death nears.
Nutrition
Elimination
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Urinary and fecal incontinence may occur.
Constipation and urinary retention are common.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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The Room
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The person’s room
The person’s room should be comfortable,
pleasant, well lit, and well ventilated.
 Unnecessary equipment is removed.
 Equipment upsetting to look at is kept out of the
person’s sight if possible.
 The person and family arrange the room as they
wish.
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All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Mental and Emotional Needs
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Mental and emotional needs are very
personal.
Some persons have specific fears and
concerns, such as:
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Severe pain
When and how death will occur
What will happen to loved ones
Dying alone
The doctor may order medications for anxiety
or depression.
Simple measures may soothe the person.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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The Family
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This is a difficult time for the family.
The family usually is allowed to stay as long
as they wish.
You must respect the right to privacy.
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You cannot neglect care because the family is
present.
The family goes through stages like the dying
person.
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They need support, understanding, courtesy, and
respect.
A spiritual leader may provide comfort.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Legal Issues
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The Patient Self-Determination Act and OBRA:
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Give persons the right to accept or refuse medical treatment.
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Give the right to make advance directives.
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Nursing centers must inform all persons of the right to
advance directives on admission.
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Living wills
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Durable power of attorney for health care
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“Do Not Resuscitate” (DNR) orders
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Even if you do not agree with care and resuscitation
decisions, you must follow the person’s or family’s wishes
and the doctor’s orders.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Signs of Death
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Signs that death is near may occur rapidly or slowly.
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Movement, muscle tone, and sensation are lost.
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Peristalsis and other gastro-intestinal functions slow down.
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Body temperature rises.
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Circulation fails.
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The respiratory system fails.
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Pain decreases as the person loses consciousness.
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The signs of death include no pulse, no respirations,
and no blood pressure.
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A doctor pronounces the person dead.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Care of the Body After Death
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Care of the body after death is called post-mortem
care.
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It begins when the doctor pronounces the person dead.
It is done to maintain a good appearance of the body.
The right to privacy and the right to be treated with
dignity and respect apply after death.
Within 2 to 4 hours after death, rigor mortis develops.
An autopsy is the examination of the body after
death to determine the cause of death.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Care for the Caregiver
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Nursing assistants and staff grow close to the
people they care for.
When death takes a person you are close to,
it can be a very sad time.
Sometimes just talking can be helpful.
Healing comes with time.
It is also important to consider the feelings of
other residents.
Some nursing centers may have a chapel
where a memorial service takes place.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Quality of Life
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Quality of life is important to dying persons and their
families.
A person has the right to die in peace, with dignity.
The dying person has these rights under OBRA:
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To privacy before and after death
To visit others in private
To confidentiality before and after death
To be free from abuse, mistreatment, and neglect
To be free from restraint
To have personal possessions
To a safe and home-like setting
To personal choice
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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