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Death and Dying: The Process People who are nearing the end of their life need comfort and tender care. Someone who is dying may depend upon you totally for personal care and attention. While many of us have an underlying fear of death, do not allow your fear to prevent you from being sensitive to a person's needs. Going through the process of dying and death is a painful, but also often very rewarding process. The following are the five stages of grief, identified by Dr. Elizabeth Kubler-Ross, that apply both to patients and families. 1. Denial: The dying person is in a stage of shock, and does not accept what is happening. Give the person time to adjust, and never force them to face the truth. 2. Anger: When the person can no longer deny what is happening, he may become angry at the world, including family and caregivers. Try not to take this behavior personally. 3. Bargaining: The person tires to "make a deal" to postpone death. For example: "God, if I can just live until Janie's graduation, I promise I will be a better person." 4. Depression: There may be more crying, sleeplessness, not wanting to get out of bed, etc. and more need for comfort and understanding. As the person begins to accept death, they will gradually begin to withdraw from the world, from friends and family. 5. Acceptance: The person realizes and accepts their situation and are more at peace.
Bear in mind that these are general guidelines. Each
person is a unique individual, and as such, will experience this process
in his or her own way. These steps will not necessarily follow in
1-2-3-4-5 order, and a person may revert to a previous stage at any time.
The important thing to take away is a general knowledge of these stages,
and how the dying person's behavior reflects the process and is not a
reflection of their relationship with you.
Legal Issues and Quality of Life The right to die has
been given a lot of attention lately by the news media. Many people do not
want to be kept alive by machines or other measures. Many people make
their wishes known about prolonging death before the time comes. The
Patient Self-Determination Act and OBRA give people the right to accept or
refuse medical treatment, and make advanced directives. This must be in
writing. Ideally, the subject should be openly discussed by the patient
and all concerned family members before the need is urgent. The
following are just some of the many considerations that arise when a
person has a terminal illness, or is aged:
1. Living Wills: a person's written statement, instructing their
physician about the use of life sustaining measures when death is likely,
with specific measures to be allowed or not specified in detail 2. "Do Not Resusitate" Orders: specific written orders by the physician
allowing the patient to die in peace and dignity. Without this specific
order, the nursing home or hospital will initiate CPR and other
life-saving treatment. 3. Durable Power of Attorney: This differs from the normal Power of
Attorney in that it allows a specified family member or
appointee to make decisions about the patient's health care if he or
she is no longer able to do so. 4. Hospice: Many people are aware of Hospice and the work they do for
the terminally ill, to bring care and comfort to patients and their
families. But are you aware that Hospice, in many circumstances, can also
bring their many skills and services to the nursing home facility for
residents living there? It is very helpful to have their input on symptom
control, comfort measures, pain control, and grief counseling. To qualify,
a physician must certify that the patient has a life expectancy of 6
months or less.
Dealing With Grief
and Loss Everyone who
experiences a loss or change in their life will experience some form of
grief reaction - the question is, how severe will it be? The following are
some key points to remember when dealing with grief and loss:
1. Grief is a normal, natural response to loss or change 2. The responses experienced are emotional, physical, cognitive and
behavioral. Everyone is different. 3. The number and intensity of recent loss experiences will interfere
with or complicate the grief process. 4. Taking care of yourself while you are grieving will help the
grieving process- sleep right, exercise, eat well and do not abuse
alcohol or drugs 5. Everyone has their own timetable for working out grief and loss. 6. Find someone to talk to....and TALK!
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