LOSS, GRIEVING and DEATH&DYING

LOSS
LOSS IS AN ACTUAL OR POTENTIAL SITUATION IN WHICH SOMETHING THAT IS VALUED IS CHANGED OR NO LONGER AVAILABLE.

General Types of LOSS

1. ACTUAL LOSS-Can be recognized by others.
1. PERCEIVED LOSSexperienced by one person but cannot be verified by others.

3. Maturational loss- result of natural developmental process. Ex. First child with new sibling 4. Situational loss- unpredictable event, traumatic injury, disease, death, national disaster. 5. Anticipatory loss- a person displays loss and grief behaviors for a loss that has yet to take place. Ex. Serious and life threatening illness in a family member.

Loss can be viewed as SITUATIONAL LOSSES-e.g. loss of ones job, the death of a child, loss of functional ability because off illness or injury DEVELOPMENTAL LOSSES-e.g. departure of grown children from the home, retirement from a career, death of aged parents.

Types of Losses
According to: Maslows hierarchy Physiologic losses: Loss of adequate air exchange, loss of adequate functioning of the pancreas, loss of limb, and other somatic related symptoms. or conditions represent physiologic losses

 SAFETYY LOSSES: Loss of a safe environment, such as in domestic and public violence, may be the starting point of a long journey of grief LOSS OF SECURITY Sense of belonging-loss occurs when relationships change through birth, marriage, divorce, illness and death.

 LOSS OF SELF ESTEEM: Self-esteem needs are threatened or perceived as losses whenever there is a change in how a person is valued at work and in relationships. Ones sense of selfworth maybe challenged and experienced as a loss when perceptions of oneself change.

 LOSS related to self- actualization: Personal goals and individual potential may be threatened or lost when some external or internal crisis blocks or inhibits the striving toward fulfillment.

SOURCES OF LOSS
1. Loss of an aspect of oneself-the loss of an aspect of self changes a persons body image, even though the loss may not be obvious. e.g. a face scarred from a burn(obvious to people) loss of part of stomach(not obvious)

2. Loss of an object external to oneselfincludes LOSS OF INAMINATE OBJECTS that have importance to the person. e.g. loss of money LOSS OF ANIMATE e.g. pets 3. Separation from an accustomed environment 4.LOSS OF A LOVEDOR VALUED PERSON

GRIEF Is the total response to the emotional experience related to loss.

Grieving/Grief- emotional reaction to loss. A loss cause by separation or death. Ex. Divorce, loss of body part, job, house, pet.

TYPES OF GRIEF RESPONCES

A normal grief reaction may be ABBREVIATED GRIEF OR ANTICIPATORY.

ABBREVIATED GRIEF- is brief but genuinely felt ANTICIPATORY GRIEF- Is experienced in advanced of the event.

UNHEALTHY GRIEF
That is, pathologic or complicated griefexist when the strategies to cope with the loss are maladaptive.

Dysfunctional grief- prolonged emotional instability, withdrawal from usual tasks or activities that previously gave pleasure. Must have a support system. Behavioral signs: - Over activity without a sense of loss - Altered relationship with family and friends - Hostility in a person - Agitation, insomnia, suicidal tendencies - Diminished participation in a religious group - Unable to discuss a loss without crying

 DISENFRANCHISED GRIEF- OCCURS WHEN A PERSON IS UNABLE TO ACKNOWLEDGE THE LOSS TO OTHER PERSON

Disenfranchised grief- societal norms do not define the loss as a loss. Client is not acknowledged for the loss and does not gain support from others. Ex. Children behavior at school, grades, interest, broken relationship, death, loss of child due to abortion.

Coping mechanism to grief and loss

T- to accept the reality of loss E- experiencing the pain of loss A- adjustment to an environment that no longer includes the lost person, object or aspect of self R- reinvesting emotional energy into new relationship

BEREAVEMENT
Is the subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship.

. BEREAVEMENT- IS THE STATE BEING SUFFERED A LOSS

Bereavement- state of grieving where a person goes through grief reaction.( neglecting their health )

MOURNING
Is the behavioral process through which grief is eventually resolved or altered; it is influenced by culture, spiritual belief, and custom.

Mourning- period of acceptance of loss and grief during which the person learns to deal with the loss. ( return to more normal living habits )

STAGES OF GRIEVING
Kubler-Rosss(1969) DENIAL-NO, NOT ME (Client behavioral responses) Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg May assume artificial cheerfulness to prolong denial. .

 . Nursing Implications) Verbally support client but do not reinforce denial. Examine your own behavior to ensure that you do not share in clients denial.

Denial Client or family may refuse to accept the situation. Client or family may not believe the diagnosis. Client of family may be seeking second and third opinions. Client or family may claim that the tests were wrong. Client or family may claim that the tests were mixed up with those of someone else. Client may sleep more or be overly talkative or cheerful.

ANGER
WHY ME(Client behavioral responses) Client or family may direct anger at nurse or staff about matters that normally would not bother them. (Nursing Implications) Help client understand that anger is a normal response to feelings of loss and powerlessness. Avoid withdrawal or retaliation; do not take anger personally. Deal with the needs underlying any angry reaction. Provide structure and continuity to promote feelings of security.

BARGAINING
YES ME BUT (Client Behavioral Responses) Seeks to bargain to avoid loss. May express feelings of guilt or fear of punishment for past sins, real or managed. (Nursing Implications) Listen attentively, and encourage client to talk to relieve guilt and irrational fear

Bargaining
You should: Offer frequent chances for the client or family to talk. Offer visits from clergy or other supports. Because many with the bargains may be with a divine power, the period may pass unnoticed.

DEPRESSION
YES, ME (Client Behavioral Responses)

Grieves over what has happened and what cannot be. May talk freely(e.g. reviewing past losses such as money or job),or may withdraw. (Nursing Implication) Allow patient to express sadness. Communicate nonverbally by sitting quietly without expecting conversation Convey caring by touch

Depression Some clients or families may not have a good outlet for their depression. You should: Not force cheerful or important conversation. Allow the client or religious supports.

ACCEPTANCE- I AM READY
(Client Behavioral Responses) Comes to terms with loss. May have decreased interest in surroundings and support people. May wish to begin making plans. (Nursing Implications) Encourage client to participate as much as possible in the treatment program.

Acceptance Client may want to be alone and families may feel rejected. You should: Encourage family to come often but for brief visits. Offer visits from clergy. Offer cultural or religious support.

ENGELS STAGES OF GRIEVING(1964)

1. Shock and disbelief- Refuses to accept loss Has stunned feelings Accepts the situation intellectually, but denies it emotionally.

 2. DEVELOPING AWARENESS- Reality of loss begins to penetrate consciousness Anger may be directed at agency, nurses, or others. 3.RESTITUTION- Conducts rituals of mourning (e.g., funeral)

 4. RESOLVING THE LOSS- Attempts to deal with painful void. Still unable to accept new love object to replace lost person or object 5. IDEALIZATION-Produces image of lost object that is most always devoid of undesirable features. Represses all negative and hostile feelings toward lost object.

 May feel guilty and remorseful about past inconsiderate or unkind acts to lost person Unconsciously internalizes admired qualities of lost object Reminders of lost object evoke fewer feelings of sadness Reinvest feelings to others

 6.OUTCOME- Behavior influenced by several factors; importance of lost object as source of support, degree of dependence on relationship, degree of ambivalence toward lost object, number and nature of other relationships, and number and nature of previous grief experiences

 Engels Theory- 3 phases:

Theories of grieving process

1st- individual denies reality of loss: reactions are fainting, nausea, diarrhea, rapid heart rate, insomnia, fatigue all related to a fight or flight response produced by increased epinephrine when one is under stress. 2nd- begins to feel the loss, experience desperation, anger, guilt, frustration, depression. Crying is the initial reaction. 3rd- reality of loss is acknowledged. New self - awareness develops. After experiencing reactions from this loses, one can deal with future loss.

RANDOS(1991)
1.AVOIDANCE- There is shock, denial, and disbelief of the loss occur. 2. CONFRONTATION-The grief is most intense and felt most acutely 3. ACCOMODATION- There is gradual actions of acute grief to the beginning of an emotional and social reentry into the everyday world.

DEATH AND DYING

DEATH
Is AFUNDAMENTAL LOSS, BOTH FOR DYING PERSON AND FOR THOSE WHO SURVIVE

Death

Affects our perceptions of life in beneficial ways such as giving an appreciation for living, helping us savor life and giving us a sense of real existence

 Death- present when an individual sustained either: 1. Irreversible cessation of circulatory and respiratory functions 2. Irreversible cessation of all functions of the entire brain, including the brain stem

Signs of impending death

Inability to swallow Pitting edema Decreased GI and GUT activity Bowel and bladder incontinence Loss of motion, sensation, and reflexes Elevated temperature, but cold or clammy skin, cyanosis Lowered BP Noisy or irregular respiration Cheyne Stokes respiration ( with periods of apnea )

3 PHASES OF DEATH
1. When the heart ceases to beat and respiration cease 2. Brain Death- When insufficient oxygen reaches the brain Lack of receptivity& responsiveness, movement or breathing, reflexes & flat encephalogram. 3. cellular Death-When different cells of the body die at different times.

Dying Is an integral part of life. It is natural and predictable as being born. Death is dreaded while birth is of welcome and celebrated. Death is an issue to be avoided

DYING
Dying- occur as a sudden result of an accident, injury, or pathologic crisis, such as heart attack; or it may occur after a prolonged experience of debilitating disease, such as cancer, AIDS, etc.

Common causes of Death Diseases Accidents Wars Homicides& suicides Sacrificial deaths Legal execution and symbolic death owing to banishment and incarceration Abortion, infanticide, and genocide

Nursing Process and Grief

Assessment Factors in assessing: 1. Personal Characteristics- age, sex, role, education, socioeconomic status Ex. What is the child response to the loss? Does the age of the dying make a difference? How does the gender of the client affect the response to death as described by the society? What resources do clients have to cope with a loss? ( insurance, costs for schooling )

2. Nature of relationships- functions of the family, community, society Ex. How long have you known the dying client? What role did the dying client play in your family? What contribution have been made by the client? 3. Social support system- availability of health care workers, timing, family needs Ex. Who is present? Absent? Supportive? Nonsupportive? Are they always actually available or they just say Call me if you need me ? Do they use a listening ear approach rather than a judgmental approach? Is the clients self esteem build up and supported?

4. Nature of loss- death issues: personal, family, community; private or group; actual versus perceived Ex. What is your belief about death? What passed experiences have you had? Outcomes? What has helped you cope in the past? Can you identify coping behaviors? 5. Cultural and spiritual beliefs- values, practices, attitudes, spiritualists Ex. How does the client or significant other perceive physical death? Meaning of life? How should the body be treated when removed? Can religious practices interfere with medical treatment?

6. Loss of personal life goals- actual or perceived individual loses affecting future decisions and options Ex. How have things change since an accident ( automobile causing permanent paralysis )? What planning has occurred for your own life? 7. Hope- goals, worth, adaptations to future changes Ex. What do you expect now that.? How do you feel about yourself? Tell me what you will do now that?

8. Phases of grief- relate to theorists Ex. Contrast the stage of the client to the stage of the significant other Validation of feelings expressed in emotion ( allow the client to talk and express his concerns )

9. Familys grief for dying client- relationship, involvement with the dying process Ex. Observation What has helped you deal with problems in the past? What has not helped?

10. Risks factors in survivors- high risks, sudden death, violent death, loss of a child Ex. Lack of social support, mental health problems, guilty feelings, and any interventions done to solve the problem. 11. Nursing role in grief- stage of nurse grief, role perceived by nurse, by client and family, therapeutic communication Ex. What stage of grief am I in? Am I blaming myself? What could I have done differently?

 Planning Goals for the dying client: 1. Gaining and maintaining comfort 2. Maintaining independence in daily activities 3. Maintaining hope 4. Achieving spiritual comfort 5. Gaining relief from loneliness and isolation Implementation

1.

Health promotion- through increasing family awareness that unspoken needs are not bad. Stressors commonly felt can be understood when others share the same feelings. Includes adaptation to a loss, stress management activities, coping strategies and available community resources.

2. Health restoration- focus on long-term goals 3. Health rehabilitation- to maximized the client remaining strength Sensitivity to the client is important if the nurse is to function effectively. Sensitive to culture. Ethnicity, lifestyle, social class of the client and family. Most of all to their limitations as a nurse.

Therapeutic communication- open ended questions and reflective statements to validate observations. It also allows client to speak about their concerns.

Sample Nursing Care Plan

The nurse admits Mr. Miller, a 40 year old man from the emergency department to the ICU with a massive MI after he collapsed at a tennis match. He had no previous cardiac episodes but does have a family history of severe cardiovascular disease. The terminal prognosis has been explained by the physician. As the nurse continues to give updates on his condition to the wife, the wife asks, Will he be OK? I am sure that he will be better; his brother recovered from a heart attack!

 She does not exhibit any understanding of the seriousness of his condition and the futility of recovery from this extensive damage of the heart. The wife calls her husbands office and reassures them that he will be back in a few weeks. She also continues to make calls to plan a business party later in the week. The staff have explained organ donation and have tried to encourage her to make a decision about such, but she keeps saying, He will be fine, thats not important right now!

NURSING DIAGNOSIS
Dysfunctional grieving related to husbands sudden illness and absence of expected anticipatory grief.

 Planning
Goals Expected outcomes
Clients wife will accept impending Wife will verbalize within the next 6 death of client within 48 hours. hours that death is actually impending. Wife will not deny reality of loss while waiting. Wife will make decision about organ donation within the next 12 hours. Wife will state several immediate lifestyle changes that will occur as a result of clients hospitalization and death.

Clients wife will demonstrate Wife will demonstrate feelings of effective grieving characteristics. sadness and exhibit anticipatory loss within the next 24 hours. Wife will demonstrate characteristics of grieving as related to theory such as Kubler-Rosss ( DABDA )

 Interventions
Interventions Rationale

Display interest in wifes situation Recognizing denial gives the staff and accept her behaviors of denial. direction for planning unique interventions based on theory.

Establish trust and a positive regard by creating an atmosphere of sharing. Offer privacy and security.

Loss is directed by psychosocial, spiritual, and cultural expectations. Privacy offers a place of security to exhibit personal needs and to work through feelings. Mutual trust.

Offer encouragement to explore Encouragement refocuses on and verbalize feelings of grief. current needs and minimizes dysfunctional adaptation behaviors by facilitating resolution of grief by increasing problem-solving skills.

Interventions

Rationale

Identify personal coping strategies Previously successful coping used in the past; evaluate strategies are the first to be used effectiveness and offer as needed. when one is under stress. Discouraging maladaptive behaviors will minimize dysfunctional grieving. Include resources of community support: significant others; family, Professionals can use their expertise clergy, or other health care workers. and skills to direct the grieving process. Trust and relationships already formed will speed the therapeutic communication process. Answers wife support questions in a non-threatening and unbiased Exploration of potential reality manner. allows better-informed choices. Encourage wife to become involve and talk with the spouse even if she Involvement gives the family to gets no response, give wife minimized feelings of hopelessness permission to grieve. or helplessness. Hearing considers the last sense to leave before death.

 Evaluation
- Plan a conversation for wife to discuss her feelings about what has happened to her husband. - Within several hours explore with wife her interest in organ donation. - Give wife the opportunity during a conversation to openly grieve. - Ask if wife is ready to explore funeral arrangements with clergy and staff.

Development of the Concept of Death

AGE INFANCY TO 5 YEARS BELIEFS/ ATTITUDES Does not understand concept of death. Infants sense of separation forms basis for later understanding of loss and death Believes death is reversible, a temporary departure, or sleep Emphasizes immobility and inactivity as attributes of death Understands that death is final Believes own death can be avoided Associates death with aggression or violence Believes wishes or unrelated actions can be responsible for death

5 to 9 years

 9 to 12 years- Understands death as the inevitable end of life 12-18 years- Fears a lingering death May fantasize that death can be defined, acting out defiance through reckless behaviors(e.g., dangerous driving, substance abuse)

 Seldom thinks about death, but views it in religious and philosophic terms. May seem to reach adult perception of death but be emotionally unable to accept it. May still hold concepts from previous developmental stages

 18- 45 years- Has attitude toward death influenced by religious and cultural beliefs

45-65 years- Accepts own mortality Encounters death of parents and some peers Experiences peaks of death anxiety Death anxiety diminishes with emotional well-being

 65+ years- Fears prolonged illness Encounters death of family members and peers Sees death as having multiple meanings (e.g., freedom from pain, reunion of already deceased family members.

Competencies Necessary for Nurses to Provide High-Quality Care to Patients and Families During the Transition at the End of Life

1. Recognized dynamic changes in health care and service delivery that improves professional preparation for end-of-life care. 2. Promote comfort care to the dying client. 3. Communicate effectively and compassionately with the patient, family and health care team members about end-of-life issues.

Recognized ones own attitude, feelings, values and expectations about individuals death, any existing cultural and spiritual belief. 5. Demonstrate respect for the patients view and wishes during end-of-life care.
4.

6. Collaborate with interdisciplinary team members

while implementing nursing roles. 7. Use scientifically based tools to assess symptoms ( pain, DOB, altered cognition ) experienced by client.

8. Evaluate the impact of traditional, complementary

therapies on patient centered outcome. 9. Assist the patient, family, colleagues and self to cope with suffering, grief, loss and bereavement. 10. Apply legal and ethical principles in the analysis of complex issues in the end-of-life care.

Nursing Interventions with Impending Death

Personal care
Good mouth care: keep mouth moist Skin care: use lotions, massage, and good lip care. Artificial tears, if eyes are open. Adequate pain control with medications, massage, positioning.

 Suctioning if there are increased secretions, to ease breathing. Clean and straighten linens often. Change position of client as needed to promote comfort. Provide adequate hydration.

 Recognize Special Needs

Encourage visits by clergy. Assess for the need for Last Rites, Holy Communion. Allow for religious music, holy books, and other supports.

Allow time for the family or friends to pray. Encourage cultural or religious rituals or practices.

 Preparing the Family

Describe the physical changes that may be taking place as death approaches. Allow the family as much time as possible with the dying client. Offer the family opportunities for cultural or religious rituals. Keep the family updated as to the time of approaching death.

 .
Allow for sleep and hygiene needs of the family or friends. Allow family or friends time to voice fears and concerns Allow the family time for questions. Allow the family time for tears.

Legal Considerations

Coroners Case. Those deaths in which the county coroner must be made aware: deaths such as homicides, suicides and suspicious or accidental deaths. .

Death Certificate. The legal document that identifies the date, time, and cause(s) of death. Documentation. The date and time of death, along with the health care workers final activities, should be noted in the clients chart.

Do not Resuscitate. Because these words may have different meanings for different people, it should be clearly documented what the meaning is for each client. Health care facilities will want to make sure that the wishes of the person and family are being carried out completely

Establishing the time of death. Absence of response to external stimuli, heart rate, respiration and papillary reflexes. Final disposition. Final destination for the body. The hospital or county morgue or funeral home is generally the final disposition of the body.

Life Sustaining procedure. Any medical procedure that in the judgment of the physician would only prolong the dying process. Living will. A document that informs the physician that in the event of a terminal illness or injury the person wishes to have life sustaining procedures stopped and withheld.

Organ Donations. The law requires all hospitals that receive Medicare Dollars to ask for organ donations on death. Persistent Vegetative state. A condition of irreversible cessation of all functions of the cerebral cortex that results in complete chronic and irreversible cessation of all cognitive functions. This condition must be documented by the physicians.

Power of Attorney for Health Care. A legal document in which a person specifies other person to make his or her medical decisions in the event the person cannot. Postmortem / Autopsy. An examination conducted to determine the exact cause of death. Pronouncement. Certification as to the time of death. In most states, only a physician is responsible for this procedure

The Dying Persons Bill of Right

 I have the right to concerning my care.

participate

in

decisions

I have the right to expect continuing medical and nursing attention even though cure goals must be changed to comfort goals. I have the right not to die alone.
I have the right to be free from pain.

 I have the right to be treated as a living human being until I die.

I have the right to maintain a sense of hopefulness however changing its focus may be. I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this might be. I have to express my feelings and emotions about my approaching death in my own way.

 I have the right to have my questions answered honestly. I have the right not to be deceived. I have the right to have help from and for my family in accepting my death. I have the right to die in peace and dignity. I have the right to retain my individuality and not be judged for my decisions, which may be contrary to beliefs of others.

 I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others. I have the right to expect that sanctity of human body will be reported after death.
I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.

Signs and Symptoms of approaching death

 The arms and legs may become cool to the touch and the underside of the body may become darker in color. These symptoms are the result of the blood circulation slowing down. The patient will spend more and more time sleeping during the day and at times will be difficult to arouse. This results from slowing of the bodys metabolism.
The patient may lose bladder or bowel control, resulting in incontinence.

 The patient will have a decreased need for food and drink. The patients breathing pattern will change during sleep to an irregular pace with 10-30 seconds periods of no breathing. Signs of death include no breathing, no heartbeat, no response to shaking or shouting, loss of bladder and bowel control, eyelids slightly open with eyes fixed on one spot, and jaws relaxed and mouth slightly open.

Care After Death

 1.Physicians must certify the death- time pronounced, therapy used, actions taken. 2. Physicians may request an autopsy, especially for unusual circumstances. 3.Trained staff member provides an option for donations of organs or tissue- personal, religious and cultural needs should be included during this process

 4.Nurse provide dignity and sensitivity to the client and the family A. Check orders for any specimens or special orders needed by the physician. B. Make arrangements for staff, minister, or others to stay with the family while preparing the body for viewing; ask for special request for viewing(e.g.), shaving, a special gown, Bible in hand, rosary at the bedside

 C. Shaving of male clients must be done before removal of the beard. The family may want the client left in the current unshaven state if it was his custom to wear beard. D. Remove all equipment, tubes, supplies, and dirty linens according to protocol (unless organ donation is to take place; in that case leave support systems in place

 E. Cleanse the body thoroughly, apply clean sheets, and remove all trash from the room. F. Position according to protocol- the eyes should be closed by gently holding them down a few minutes; dentures should be in the mouth to maintain facial alignment; packing should not be visible during viewing. Hairpieces may be in place, but no make up is required.

 G. Cover with a clean sheet up to the chin with arms outside covers if possible. H. Lower the lighting and spray a deodorizer if possible to remove unpleasant odors. I . Give the family the option to view or not to view and go with them.

 J. Clarify that either option is acceptable K. Encourage the family to say goodbye through both touch and talk. L. Do not rush this process. Once the family is more comfortable, ask if they they would like to be left alone. Remind them that they can call you if needed

 M. clarify personal belongings that are to stay with the body or who has taken personal items; documentation will require both a descriptor of the objects and the name of who received it, with the time and date.

 N. Discard nothing if items; are found after the family is gone- call the family and tell them what was found and ask who might pick it up- describing the articles will be helpful in the decisionmaking process for the clients family.

PHASES OF DEATH

 Acute Crisis Phase - Characterized by such experiences as high anxiety, immobilization, conscious state changes, feelings of inadequacy and various defenses

 Chronic Living Dying Phase - Characterized by fear of the unknown, fear of loneliness, fear of sorrows, fear of losing family and friends, fear of loss of body, fear of loss control, fear of suffering and pain, fear of loss of identity and fear of regression.

Terminal Phase - Characterized by withdrawal into ones self, during this phase the four types of death are accomplished.

POST MORTEM CARE

 Rigor Mortis: - The stiffening of the body that occurs about 2 to 4 hours after death. It results from a lack of adenosine triphosphate which causes the muscles to contract and in turn immobilizes the joint.
Intervention- Position body in normal anatomical alignment, close eyelids and mouth and insert dentures in mouth.

 Algor mortis: - The gradual decrease of the bodys temperature after death. When the blood circulation terminates and the hypothalamus ceases to function, body temperature falls about 1 C per hour until it reaches room temperature.
Intervention- Remove tape and dressings gently to avoid tissue breakdown. Avoid pulling on skin or body parts.

 Livor Mortis: - After the blood circulation has ceased, the RBC breakdown, releasing hemoglobin which discolors the surrounding tissues.
Intervention- Elevate head to prevent facial discoloration.

 Softening and liquefying of body tissues by bacterial fermentation. Intervention- Store body in cool place in hospital morgue or other designated area.

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Patient may wish to be placed on the floor to be closer to the earth in death. Family is encouraged to wash and prepare the body. The Bhagavadgita, and the holy book, is read, chapters 2, 8, and 25.

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JUDAISM
(CONSERVATIVE/ORTHODOX)
The body is washed by the burial society and wrapped in white linen. No embalming or flowers are used. A cantor will assist the rabbi in the funeral. Burial should be done within 24 hours and should not be done on the Sabbath.

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CONFUCIANISM
Belief in reincarnation; burning incense and flowers are laid at the bedside to assist the spirit on its journey

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BUDDHISM
Belief in reincarnation; Last Rites and chanting at the bedside are encouraged.

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LUTHERAN
May accept Holy Communion, and Last Rites are optional.

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METHODIST AND BAPTIST

D aaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaaaaaaaaaMay wish to invite religious clergy to be near at the time of death.

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MUSLIM
Chapter 36 of the Qur'an is read to the patient. The family will encourage the patient to recite, There is no god but Allah before dying. The family will assist in washing the body and wrapping it in the white cloth.

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SHINTO
All jewelry is to be removed and the body is washed and dressed in a white kimono.

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TAOISM
The family may wish to have a priest at the bedside at the time of death.

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ROMAN CATHOLIC
Anointing of the sick and Holy Communion is encouraged. A rosary service the evening before the funeral us often done.

CULTURAL CONSIDERATION
Culture- Specific Rituals

African Americans Cremation is not permitted the deceased is wrapped with special cloths before burial.
Haitian Americans Practice vodun (vodoo), also called root medicine.- practice of calling on a group of spirits with one periodically makes peace during specific events in life. Chinese Americans Have strict norms for announcing death, preparing the body, arranging the funeral and burial and mourning after burial. Burning of incense, reading of scriptures. For a year later a bowls of foodmay be placed on table for the spirit.

Japanese Americans Filipino Americans Wearing black clothes Announcements to be placed in local newspapers asking for prayers and blessings on the soul of the deceased. Vietnamese Americans Buddist . The deceased is bathed and dressed so that he or she can buy a drink as the spirit moves on afterlife. Hispanic Americans Native Americans