The psychological aspects are different for each person it depends how they react to the thought of a person dying, some people may feel that it’s their own fault or that they have done something wrong taking the blame for it or someone may feel as if their being useless and feel like there’s things that can be done to help but in actual fact there isn’t. In the person’s last days if known others may like to spend a lot of time with the person but others may not want to see them like that and just want to have the better memories as people can’t handle seeing the person looking very frail as this cannot be very nice, but it all depends on how each person can handle the situation and it is also hard as you don’t know whether to expect the worst each time you go into their room as they could have passed away. It can cause a lot of stress within the home setting and people will be very sad but we have to do our best to try and keep them as happy and as calm as they can be.
Common signs of approaching death, you can never know when someone is going to die but there is always a sign such as they May- Lose their appetite the person may begin to resist or refuse to eat meals or any drink fluids. Become very fatigue or sleepy- The person may begin to sleep the majority of the day and night as metabolism slows and the decline in food and water contribute to dehydration. Physical weakness- As the person is declining food and sleeping a lot they will find that they have no energy. Confusion or disorientation- Organs begin to fail including the brain they may start to forget where they are or what they are doing. Change in breathing- Breath intakes and exhales can become very irregular. Social withdrawal- As the body starts to shut down they may gradually lose interest in being around those that are close to them. Swelling in feet and ankles-
Coolness in tips of fingers and toes.
Good end of life care helps patients with life-limiting conditions to live as well as possible until they die, and to die with dignity. End of life care encompasses palliative care, which focuses on managing pain and other distressing symptoms, providing psychological, social and spiritual support to the patients, and supporting those that are close to the patient. All patients should be treated with dignity and respect throughout the course of their care. Patients who are dying must receive the same standard of care as all other patients. Their privacy, dignity and wishes must be respected at all times, by listening and achieving their wishes can make them feel more relaxed and less distressed. Making sure your patient has good pain relief, making sure they are always comfortable, having other people around them to keep them occupied or even little things like listening to the radio or watching television if they enjoy doing this. Making sure your patient has everything and everyone they need around them, some people may not want to be like this some people may want to go alone and this needs to be respected even if their family members or loved ones want to be with them you have to respect the fact they want to be alone as long as they are comfortable.
There are rules governing when life-prolonging treatment can be withheld or withdrawn when the patient’s consent is not available, the relatives and friends of the person receiving the treatment and the healthcare professionals in charge of the person’s care, should decide whether treatment should be continued or not. They should consider whether the treatment is in the best interests of the client in terms of quality of life and how long they will live and if the treatment is helping to improve their condition. If the patient still has the capacity to decide whether or not they want to carry on or stop with the treatment it is their own choice as they still have the capacity to their rights. Also it needs to be remembered that the client should always be center of the care. Some of the signs that death has occurred are they-
Have stopped breathing
Loss of bowel and bladder control
Eyelids slightly open
Eyes fixed on a certain spot
Mouth slightly open
The body cools
When a client does become to near the end of life or even ill from the start you have to work with other professionals at first you may start with the GP to diagnose the patient and they would then refer them to the hospital if required if not they would give you prescriptions for the right medication to treat them. You would also work with district nurses if required if a client had a bed sore. You would work with the pharmacy to make sure you receive all the medication and on time and to order when needed. A patient should be monitored regularly; everything that the patient does should be recorded and documented correctly making sure they are legible, accurate, relevant and clear. Things that may get monitored- Food intake charts
Fluid intake Charts
Body maps to mark if they have any bed sores
If they were in pain or how much pain.
Some people may not be able to tell you how much or if they are in pain so in some care homes they use pain rating scales, Faces tool, Disability distress assessment tool (DisDat), Body charts/ Maps or its even suggested if the patient is able to keep a pain diary. Everyone approaching the end of life should have their needs assessed and their wishes and any preferences discussed, any actions reflecting their choices they make about the care they would like to receive should all be recorded in their own personal care plan especially as some people in advance want to refuse treatment, the care plan should be regularly reviewed. Once a client enters into the dying phase the care providers need to adapt their care and support according to the care plan, also the client may have a preferred place of death which they had discussed in their care plan this should be reviewed to make sure the care providers are aware.
Advanced care planning should be completed as it gives people the opportunity to make their wishes and preferences known should they deteriorate and lose the mental capacity to make informed choices. When a client’s needs change we make sure all staff and any other professionals are aware and know fully of all the changes and any requirements or adjustments that need to be made such as ways of working, making sure all changes are documented in their personal care plan, in staff communication books, also making sure that all risk assessments are updated, reviewed and changed as needed. Making sure the client has everything that they need to meet their needs to the changes. This also helps everyone to follow the same way of working to support the client when any changes do happen.
Some family members/carers may wish to assist with the personal care in acknowledgement of individual wishes, religious or cultural requirements. If it is down to the staff to carry out this task then the Staff should be Prepared before they do this as there are changes to the body after death and they should also be aware of manual handling and infection control issues. Some people may not want their family or staff to do so, once the patient has died you should refer to their plan of care to see and follow their wishes if any after death.
In private nursing homes the personal care after death is the responsibility of a registered nurse, although this and the packing of the property may be delegated to a trained healthcare assistant. The registered nurse is responsible for correctly identifying the deceased person and communicating accurately with the mortuary or funeral director (in line with local policy). In care homes without a registered nurse, the home manager is responsible for ensuring that professional carers are trained appropriately and to ensure that they are competent in their role. The death should be documented straight away the time the date and the people that are present, this also has to be reported to the care quality commission within 24 hours.
After the persons death the Last offices should be carried out or some people may call it Personal care after death, two members of staff should carry out last offices but this can only be done once the death has been officially confirmed. The staff should wear all protective equipment such as gloves and apron when carrying out last offices.
There is a a list of national guidelines, policies and legislations that are required after a death they are –
Health and Safety at work act 1974
Control of substances hazardous to health regulations 2002 (COSHH) Code of Conduct
Health and social care act 2008
It is always important that the care plan is referred to before after death as the client may have left their wishes and preference that they would like to be carried out and these should always be followed, as the client may have requested that they would not like any family to carry out last offices as this can be distressing for them, they may have requested that their belongings should be given to a charity or some kept with them and many more examples but the point is that their wishes should always be respected and followed.
All staff knows and are fully aware that when a client has passed that all procedures in place must be followed when handling the decease and moving their belongings, gloves and aprons must be worn, all of their personal belongings such as bedding, bed cloths and clothing should be disposed of in the correct way.
Everyone is different to how they react to somebody passing, there are different types of ways such as-
Emotional- Sadness, anger, blame, depression and loneliness. Physical- Weakness in muscles, hollowness in stomach, tightness in throat and shortness of breath. Cognitive- A person may experience mental difficulties, such as poor concentration, forgetfulness and day dreaming. Behavioural- Some people may react by crying, loss of interest and withdrawal. Spiritual- They may start to question their spiritual beliefs but others may find solace.
When telling family or friends that their loved one has passed you have to be prepared for different types of reactions as above, people should always be allowed to spend time by the deceased and their privacy should always be respected. Offering a cup of tea and going into a quiet space where they will not be disturbed so that they can talk about what happens next, sometimes people may find it hard to absorb any information so the care staff should write up a simple and clear guide for them. When talking or telling close family or friends you should always use good listening skills show empathy, always make yourself available and give people time to express themselves and talk, offer any help to register death or organise a funeral or even just offer any advice.
In a care setting the rest of the house should be told what has happened and this should not be hidden from them as they all have the right to know, they should all be told in a tactful and sensitive way. Offer support and let them know that staff will always be available if they feel they need to talk. Family or People in a care setting all have the right to be told and known about bereavement support services that are available to them. When a person dies majority or all staff care workers often experience grief, staff can attend the funeral or pay their respects in some way, by attending the funeral this will allow people to express grief and maybe bring closure. People may actively grieve by crying and it is acceptable to cry and let others know that the person will be missed, some people may be tearful or stressed then they should take time out in a quiet area. Talk to others as they might be feeling the same way as you.
There is also carer’s support groups that are available that help yourself or staff members to deal with bereavement. You can talk to family or friends, employer, bereavement charities or if this doesn’t help you can get specialist support from your GP.