Death is the termination of lie and its related clinical signs and has been defined in several ways. Death has various stages, signs, and actors affect it that has physiological and ethical responses. It is the nurse’s responsibility to facilitate coping to the dying and the family members, friends and significant other of that person dying.

Death is defined in various ways such as Heart-Lung Death, Whole Brain Death and Higher Brain Death. Taylor, Lillis in her book states that Heart-Lung Death is : “The irreversible cessation of spontaneous respiration and circulation”, this definition emerged from the historical idea that the flow o body fluids was essential or lie. Whole Brain Death is defined as “The irreversible cessation o all functions of the entire brain, including the brain stem”. Higher Brain Death is defined as “The irreversible loss of all higher’ brain functions, of cognitive function and emerged from the belief that the brain is more important than the spinal cord and critical functions are the individuals personality, conscious life, uniqueness, capacity, judging, reasoning, acting, enjoying, and worrying”.

The clinical signs of impending or approaching death includes the following: inability to swallow; pitting edema; decreased gastrointestinal and urinary tract activity; bowel and bladder incontinence; loss of motion, sensation, and reflexes; elevated temperature but cold or clammy skin; cyanosis; lowered blood pressure; and noisy or irregular respiration. The client may or may not loss consciousness. The indicators o imminent death is outlined by authors Black, Hawks and Keene states that, “Certain physical, cognitive, and behavioural changes occurs as a person enters the active dying process. The human body, like any other living organism, seeks survival; in doing so, it oten alters normal physiology. As the body begins to dieblood is commonly shunted to the brain and the heart, the two most common important organs. Thus, peripheral circulation is limited, leading to mottling of cyanosis. Because the kidneys are no longer perfused adequately, there is a decrease in urine output. Slowly, all body systems become involved in the dying process. Tachycardia and diminished dodo pressure are observed in acute phase of decompensation of the cardiovascular system. The respiratory system works to compensate or metabolic deficiencies, causing tachypnea, byspnea, or both”.

Responses to dying and death are as follows: denial and isolation, anger, bargaining, depression and acceptance. Taylor, Lillis and LeMone in their book reviews the Kubler-Ross Grief and Death states that, “In denial and isolation stage the client denies that he or she will die, may repress what is discussed, and may isolate themselves from reality. The client expresses rage and hostility in the anger stage and adopts a why me’ attitude. In the bargaining stage the client barters for more time. Many clients put personal affairs in order, make wills, and fulfil last wishes. It is important to meet these wishes, if possible, because bargaining helps clients move into later stages of dying. In depression stage, the client goes through a period of grief before death. Crying and not speaking much characterize the grief. When the stage of acceptance is reached, the client feels tranquil. He or she has accepted death and is prepared to die”.

In the case of terminal illness the physician usually decides how the clients should be informed, all involved with the clients care should know exactly what the client and family has been told. The impact of terminal illness does affect both client and family. Taylor, Lillis, and LeMone states: “Clients must be allowed to go through the stages of the grieving process and to make decisions about their care, and must be supported in their decisions making. The family and significant others o terminal ill clients should be encouraged to participate in planning the client’s care. Healthcare workers should be available to discuss the client’s condition with the family members and should offer support and care as the family begins the grieving process”.

There are many factors affecting grief and death, they are developmental considerations, family, socio-economic factors, cultural influences, religious influences and the cause of death. Brill and Levine in their book states: “the level of growth and development of individuals plays a major role in their recognition and reaction to death. Infants are not believed t understand the concept but there is a ear o separation. Children have a growing awareness; often feels death is avoidable and magical and fears pain and mutilation accompanying death. Preadolescent and adolescent has a developed philosophy o death and realization of it for self does not consider it until faced with the situation. The middle-aged often become preoccupied with death as age approaches whereas older adults ear lingering, incapacitating illness and realizes the imminence e death. While the individual is suffering the primary loss, the family and/or significant other must deal with not only the individual reactions, but also with the current loss. The family con provide a support system for the way in which the individual may deal with the loss. They mutually share feelings and openly communicate both negative and positive emotions related to death. In contrast the family in some way is responsible for the death and may thus eel guilty. They may express feeling of anger, shame, overprotection, withdrawal, and identify with the loss or they may feel helpless or hopeless. In assessing the family reaction the nurse should identify the prior interaction style of the system”.

Although socio-economic status does not influence the degree of emotion experienced, the support system available to channel the emotions is affected. Financial resources – including insurance policies, pensions and saving may provide the dying individual with more options to deal with the death.