_________________________________________________ Chapter 24 Loss, Death, and End-of-Life Care 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the basic concepts of palliative care.
• Discuss different types of losses.
• Discuss grief and distinguish between
adaptive grief and dysfunctional grief.
• Discuss cultural differences in the grieving
process.
• Ask each student to write a short description
of his or her feelings, attitudes, and beliefs
about death and dying. Are there any
specific cultural or religious considerations?
Ask for volunteers to share their description
with the class. Discuss the descriptions as a
class.
• Present the following scenario to the class:
• A 69-year-old man has recently had a
lung biopsy and is told that he has
metastatic lung cancer. He and his wife
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
16 Chapter 24 Loss, Death, and End-of-Life Care _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.1
2
DISCUSS
• Discuss stages of grieving. Compare and
contrast the theories of Kübler-Ross,
Martocchio, and Rando.
• Discuss common signs and symptoms of
grief and describe physical signs and
symptoms and appropriate nursing
interventions.
• Discuss awareness of terminal illness,
comparing closed awareness, mutual
pretense, and open awareness.
• Discuss common fears associated with illness
and death and describe how a nurse can help
the patient effectively overcome each fear.
• Divide the class into groups and present the
following scenario:
• A 61-year-old patient has terminal brain
cancer. He has accepted his condition,
but fears that his wife is struggling with
the thought of going on without him. She
constantly berates the patient’s
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
Kübler-Ross’ stages of grief. Provide a brief
example of a time when you have witnessed
someone in one of these stages of grief.
Please do not include names or any
identifiers.
_________________________________________________ Chapter 24 Loss, Death, and End-of-Life Care 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.1
3
DISCUSS
• Discuss different physical manifestations of
approaching death and define cerebral
death.
• Discuss rigor mortis, algor mortis, and livor
mortis.
• Divide the class into small groups. Have
each group discuss nursing diagnoses for
the patient in the following scenario:
• A teenage girl receiving chemotherapy
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
that compares and contrasts rigor mortis,
algor mortis, and livor mortis.
4
DISCUSS
• Discuss the assessment of the terminally ill
or dying patient and describe the elements
of the functional assessment, the physical
assessment, and the neurologic
assessment.
• Discuss the frequency of assessment of the
terminally ill or dying patient and the need to
ensure frequent checks without imposing
unnecessary assessments.
• Discuss resolution of grief as a goal for the
nursing diagnosis of Grieving.
• Divide the class into groups. Have each
group discuss a list of nursing goals based
on the following scenario:
• A 45-year-old man is in the hospital
POST AND COMMENT
• Post the following discussion topic online
and have students comment. You are the
nurse providing care for a patient who is in
the process of dying and the family is at the
bedside. List adjustments in your care that
may need to be made. Explain.
18 Chapter 24 Loss, Death, and End-of-Life Care _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.1
Critical Thinking Question
A patient has recently been diagnosed with a terminal disease. He appears to be unaffected
by the diagnosis and he avoids any conversations about his illness and death. His wife is
very upset, and she keeps saying that she can’t believe that God is doing this to them. At
what stage is each of these people in the grieving process? What are some other factors
that could be influencing the way they grieve?
Discussion Guidelines: There are several different theories on stages of grief; one of the best
Instructor Notes/Student Feedback
_________________________________________________ Chapter 24 Loss, Death, and End-of-Life Care 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
Instructor Preparation
Textbook Objectives Covered
6. Explore the needs of the nurse who works with terminally ill patients.
7. Identify issues related to caring for the dying patient, including advance directives,
do not resuscitate decisions, brain death, organ donations, and pronouncement of death.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying loss, death, and end-of-life care, including:
• Grief, the grieving process, and stages of grieving
• Fears associated with terminal illness and death
• Clinical signs of impending death
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• advance directive (p. 378)
• algor mortis (p. 375)
• cerebral death (p. 374)
• denial (p. 370)
• grief (p. 369)
• mourning (p. 369)
• palliative care (p. 368)
Assignments 2 hours
READ – Textbook (pp. 368-377)
REVIEW
• Table 24-4: Preparation of the Body for Family Viewing After Death (p. 376)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 8, 9 (p. 383)
READ – Textbook (pp. 377-378)
REVIEW
ANSWER – Text
• Review Questions for the NCLEX Examination: 10 (p. 383)
20 Chapter 24 Loss, Death, and End-of-Life Care _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
READ – Textbook (pp. 378-382)
REVIEW
• Figure 24-1: Sample advance directive (p. 381)
• Figure 24-2: The Five Wishes™ document (p. 382)
ANSWER – Study Guide
• Part IA: 1, 15-17 (pp. 137-138)
• Part IID: 3-17 (pp. 139-140)
Lecture Outline 20 minutes
Slide 37
Interventions
• Priority interventions for Anticipatory and Dysfunctional grief: provide an environment that
allows the patient to express feelings
TALKING POINTS:
• Nurses need to be aware of how grief affects them personally.
Slide 38
Interventions (cont.)
• Identify person’s stage of grief (denial, anger, bargaining, depression, acceptance)
• Awareness of the stage permits the nurse to react according to individual needs
• Respect for the person’s right to privacy, right to have emotions, and right to talk when he
Slide 39
Interventions (cont.)
• Meeting patient’s physiologic needs and needs for safety are priorities
• Physical requirements for oxygen, nutrition, pain relief, mobility, elimination, and skin care
Care of the Body After Death
• Following death, the body must be prepared for transfer to the morgue or the funeral
home
_________________________________________________ Chapter 24 Loss, Death, and End-of-Life Care 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
Slide 41
Care of the Body After Death (cont.)
• Legal and moral issues may affect the care required for the disposition of the body
• Autopsy
• A postmortem examination of the deceased
• Autopsy may be requested by the next of kin, suggested by the physician, or required by
law
Slide 42
Care of the Body After Death (cont.)
• The family may want to view the body before it is transported to the mortuary or the
morgue
• It is important to make the environment as comfortable for the family as possible
Slide 43
Care of the Body After Death (cont.)
• Gently holding the eyelids closed for a few seconds helps them to remain closed
• Dentures may be inserted gently to maintain the normal facial appearance
• The mouth should be closed
TALKING POINTS:
• If the dentures cannot be inserted easily, do not force them.
• What should be done with the deceased person’s jewelry?
Slide 44
Care of the Body After Death (cont.)
• Straighten top linens; pull up to the shoulders
• Family may view the body after preparation is complete
• When the family leaves, apply additional identification tags to the wrist and ankle or toe
TALKING POINTS:
• What is a shroud?
22 Chapter 24 Loss, Death, and End-of-Life Care _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
Slide 45
Organ Donation
• May be made by anyone who is legally competent
• Any body part or the entire body may be donated
• Decision to donate may be made before death
TALKING POINTS:
• Some states allow for organ donation to be marked on driver’s licenses.
• What are common names of agencies that handle organ donation?
Slide 46
Cardiopulmonary Resuscitation
• Much written about the right to die and right to choose
• Many believe that the patient or the patient’s family has the right to decide whether
cardiopulmonary resuscitation (CPR) will be used
• It is no longer the sole decision of the physician
Slide 47
Advance Directive
• Written statement of person’s wishes regarding medical care
• Developed 1974 by Euthanasia Education Council
Cardiopulmonary Resuscitation (cont.)
• Types of CPR decisions
• Complete and total heroic measures
Durable Power of Attorney for Health Care or Medical Power of Attorney
• Allows individuals to select someone to make health care decisions for them if unable to
do so themselves
_________________________________________________ Chapter 24 Loss, Death, and End-of-Life Care 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
Slide 50
Five Wishes™
• Developed by Aging with Dignity
• Better care for individuals and families facing the end of life
• Personal, medical, spiritual, and emotional needs
• It includes
• The name of the person to make decisions for health care if the patient cannot do it
TALKING POINTS:
• The Five Wishes™ document (www.agingwithdignity.org) helps patients communicate
express their wishes on various issues.
Activities
Classroom Choose from below to make 30 minutes
Online
5
DISCUSS
• Discuss the needs of a dying patient’s
significant others.
• As a class, identify potential needs of each of
the patient’s family members in the following
scenario.
• A 35-year-old mother of three has
terminal breast cancer that has
metastasized. Her children are 5, 12,
and 15 years old. Her husband has no
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe five
specific ways you feel a nurse can intervene
to improve the experience of both the patient
who is terminally ill and the family.
24 Chapter 24 Loss, Death, and End-of-Life Care _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
6
DISCUSS
• Discuss ways that nurses can help the dying
patient’s friends and family deal with the
patient’s impending death.
• Discuss communication skills and behaviors
class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss some
responses nurses may have to a patient’s
death.
7
DISCUSS
• Discuss organ donation and how awareness
of a patient’s and family’s wishes regarding
organ donation can facilitate nursing care.
• Discuss cardiopulmonary resuscitation.
Explain the role of advance directives.
Explain the role of medical professionals
when an advance directive does not exist.
• Have students research advance directives
in your state. What are the laws regarding
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
of advance directives a terminally ill patient
may have in place.
• Post the following discussion topic online
and have students comment. Describe when
brain death occurs.
Critical Thinking Question
A 56-year-old patient has been diagnosed with terminal lung cancer. He has a wife and
several children. As his illness progresses and death becomes imminent, how can the nurse
intervene to ensure a comfortable death for the patient while providing appropriate support
to the family?
Discussion Guidelines: The patient should be kept as comfortable as possible; he should be
_________________________________________________ Chapter 24 Loss, Death, and End-of-Life Care 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 24.2
Instructor Notes/Student Feedback
26 Chapter 24 Loss, Death, and End-of-Life Care _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
24
Assessments for
Loss, Death, and End-of-Life Care
CHAPTER OBJECTIVES
Lesson 24.1:
2. Describe responses of patients and their families to terminal illness and death.
4. Assist in the development of a care plan for the terminally ill.
Lesson 24.2:
6. Explore the needs of the nurse who works with terminally ill patients.
7. Identify issues related to caring for the dying patient, including advance directives,
do not resuscitate decisions, brain death, organ donations, and pronouncement of death.
Assessments by Lesson & Objective
Lesson 24.1
Study Guide
• Part IC: 1-12 (pp. 138–139)
Evolve Instructor Resources
Evolve Student Resources
• Prioritization: 4, 5
Study Guide
• Part IA: 2-11 (p. 137)
• Part IB: 1-13 (p. 138)
• Part IIIE: 1, 2 (p. 140)
Evolve Instructor Resources
• Test Bank: 2, 5, 7-10, 15, 23-26, 29, 31-32
Evolve Student Resources
• NCLEX Review: 1, 6
• Prioritization: 1
Study Guide
• Part IA: 12-14 (p. 138)
Evolve Student Resources
• NCLEX Review: 7
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Study Guide
• Part IIIE: 5, 6, 8 (p. 141)
Evolve Instructor Resources
• Test Bank: 6, 22, 27
Lesson 24.2
Evolve Instructor Resources
• Test Bank: 3, 4, 20
Evolve Instructor Resources
• Test Bank: 21
Study Guide
• Part IA: 1, 15-17 (pp. 137-138)
• Part IID: 3-17 (pp. 139-140)
Evolve Instructor Resources
Instructor’s Notes/Student Feedback