cutting. To remove by cutting, cast cutters, spreaders,
and bandage scissors are necessary. Cuts are made
laterally and medially along the long axis of the cast,
then widened with the use of spreaders. The padding is
then cut with the scissors.
THE TERMINALLY ILL PATIENT
LEARNING OBJECTIVE: Evaluate the
needs of the terminally ill patient.
The terminally ill patient has many needs that are
basically the same as those of other patients: spiritual,
psychological, cultural, economic, and physical. What
differs in these patients may be best expressed as the
urgency to resolve the majority of these needs within a
limited time frame.
Death comes to everyone in
different ways and at different times.
patients, death is sudden following an acute illness.
For others, death follows a lengthy illness. Death not
only affects the individual patient; it also affects family
and friends, staff, and even other patients. Because of
this, it is essential that all healthcare providers
understand the process of dying and its possible effects
Individuals Perspective on Death
People view death from their individual and
cultural value perspectives.
Many people find the
courage and strength to face death through their
religious beliefs. These patients and their families
often seek support from representatives of their
religious faith. In many cases, patients who previously
could not identify with a religious belief or the concept
of a Supreme Being may indicate (verbally or
nonverbally) a desire to speak with a spiritual
There will also be patients who,
through the whole dying experience, will neither
desire nor need spiritual support and assistance. In all
these cases, it is the responsibility of the healthcare
provider to be attentive and perceptive to the patients
needs and to provide whatever support personnel the
patient may require.
An individuals cultural system influences
behavior patterns. When we speak of cultural systems,
we refer to certain norms, values, and action patterns of
specific groups of people to various aspects of life.
Dying is an aspect of life, and it is often referred to as
the final crisis of living. In all of our actions, culturally
approved roles frequently encourage specific behavior
For example, in the Caucasian,
Anglo-European culture, a dying patient is expected to
show peaceful acceptance of the prognosis; the
bereaved is expected to communicate grief. When
people behave differently, the healthcare provider
frequently has difficulty responding appropriately.
Five Stages of Death
A theory of death and dying has developed that
provides highly meaningful knowledge and skills to all
persons involved with the experience. In this theory of
death and dying (as formulated by Dr. Elizabeth
Kubler-Ross in her book On Death and Dying), it is
suggested that most people (both patients and
significant others) go through five stages:
anger, bargaining, depression, and acceptance.
The first stage, denial, is one of nonacceptance.
No, it cant be me! There must be a mistake! It is not
only important for the healthcare provider to recognize
the denial stage with its behavior responses, but also to
realize that some people maintain denial up to the point
of impending death. The next stage is anger. This is a
period of hostility and questioning: Why me? The
third stage is bargaining. At this point, people revert
to a culturally reinforced concept that good behavior is
rewarded. Patients are often heard stating, Id do
anything if I could just turn this thing around. Once
patients realize that bargaining is futile, they quickly
enter into the stage of depression.
In addition to
grieving because of their personal loss, it is at this point
that patients become concerned about their family and
putting affairs in order. The final stage comes when
the patient finally accepts death and is prepared for it.
It is usually at this time that the patients family
requires more support than the patient. It is important
to remember that one or more stages may be skipped,
and that the last stage may never be reached.
Support for the Dying
Despite the fact that we all realize our mortality,
there is no easy way to discuss death. To the strong and
healthy, death is a frightening thought. The fact that
sooner or later everyone dies does not make death
There are no procedure books that tell
healthcare providers how to do death. The how to
will only come from the individual healthcare provider
who understands that patients are people, and that,
more than any other time in life, the dying patient
needs to be treated as an individual person.