Death and dying in nursing is something that all nurses will encounter at some point during their career. It is important to be prepared for this difficult task, and to know how to provide quality end-of-life care for your patients.
We will discuss the basics of caring for death and dying in nursing. We will cover topics such as preparing for death, providing comfort to the patient and family, and handling common complications.
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What is the difference between palliative care, end-of-life care, and terminal care?
Palliative care is a type of medical care that focuses on relieving symptoms and improving the quality of life for patients with serious illnesses. It is often used in conjunction with other treatments, such as curative or disease-modifying therapies such as chemotherapy, radiotherapy, and palliative surgery.
End-of-life care is a type of care that is provided to patients who are nearing the end of their life. This type of care is focused on providing comfort and support, rather than on curing the underlying illness. Patients typically have weeks to months to live and most of the care is around symptom management, spiritual healthcare, psychosocial support, hospice care/home support, and ongoing medical treatment as appropriate.
Terminal care is a type of end-of-life care that is provided to patients who have been diagnosed with a terminal illness. This type of care is focused on providing comfort and support, rather than on curing the underlying illness. Patients typically have days to hours of life and focus on symptom management, spiritual care, and psychosocial support of the patient/family.
How can nurses prepare for death and dying patients?
There are a few things that nurses can do to prepare for caring for death and dying patients.
First, it is important to understand your own feelings about death and dying. This will help you to be more comfortable with the topic. You can assess your own feelings by asking yourself questions such as:
- How do I feel about death?
- What are my beliefs about what happens after death?
- What are my feelings about end-of-life care?
- Do I have any experience with death and dying? If so, how did I feel about it?
Second, be sure to familiarize yourself with the policies and procedures of your facility regarding end-of-life care. This will ensure that you are providing the best possible care for your patients and that you are following the guidelines set forth by your facility.
Third, it is important to develop a relationship with the patient and their family. This will help you to better understand their needs and wishes. It is imperative to build this relationship and trust before the patient enters the end-of-life phase, as this will make it easier to discuss difficult topics and make decisions about care.
Fourth, be sure to keep up with your own education and training on end-of-life care. This will help you to stay up-to-date on the latest evidence-based practices.
What are the common stages at end of life?
There are four common stages in end of life:
Stage One: Pre-Active phase
In this stage, the patient is not yet actively dying, but they are aware that death is near. They may begin to make preparations, such as putting their affairs in order. This phase usually occurs two to three weeks prior to death. The patient may experience:
- Restlessness, confusion, agitation
- Increased periods of sleep and lethargy
- Hallucinations of previously deceased loved ones
- Withdrawal from social interaction
Stage Two: Active phase
In this stage, the patient is actively dying. They may have periods of lucidity where the patient will recognize family members and the healthcare team in between the times of confusion. They will require more medical interventions and support. This phase usually occurs two to three days before death. The patient may experience:
- Inability to swallow food or drinks
- Abnormal breathing patterns
- Urinary and/or bowel incontinence
- Low blood pressure
- Cold extremities
Stage Three: Transition phase
In this stage, the patient is no longer breathing on their own and their heart rate begins to slow. They may be unresponsive to stimuli. This phase usually occurs one to two hours before death. The patient may experience:
- Agonal breathing (gasping for breath)
- Loss of consciousness
- Pupil dilation
Stage Four: Death
In this stage, the patient has passed away. The body will begin to cool and the muscles will relax.
What are some of the most common complications associated with death and dying in nursing patients?
The most common complications associated with death and dying in nursing patients are:
- Agonal breathing (gasping for breath)
- Cardiac arrest
- Dyspnea (shortness of breath)
- Loss of consciousness
- Nausea and vomiting
- Respiratory arrest
- Terminal restlessness
What are some common comfort measures for patients and families during this time period?
There are a few things that nurses can do to provide comfort for patients and families during the end-of-life phase.
It is important to keep the lines of communication open. The patient and their family should feel comfortable communicating with the healthcare team. This will help to ensure that everyone is on the same page and that all decisions are being made with everyone’s input.
Provide support and reassurance. This can be in the form of offering hope, listening to fears, and providing comfort. Are there any spiritual symbols located in the room? Has a spiritual advisor spoken with the family? If not, I would reach out and ask if they would like a visit and what their religious beliefs are.
Make time to speak with the patient and family who are having a difficult time accepting the situation. This can be a difficult and emotional time for everyone involved. It is important to be available to listen and offer support.
It is important to keep the patient comfortable. This can be done by providing pain relief, keeping them clean and dry, and repositioning them often if it’s not painful.
It is important to keep communication open regarding pain control. The patient should be able to tell the healthcare team what level of pain they are experiencing and what their preferences are for pain management. It is also important that the patient doesn’t wait until the pain is severe to seek pain control as it becomes much harder to treat by waiting
Create a pain management schedule with the patient for when the next PRN can be given and write it on their information board. It is also best to ask if they would like to be woken up for pain medications or would prefer to sleep.
There are many things that can be done to provide comfort without the use of medication. Some of these things include:
It is important to keep the patient comfortable. This can be done by providing pillows for support, keeping them clean and dry, and repositioning them often if it’s not painful.
The environment can have a big impact on the patient’s comfort. It is important to keep the room quiet and calm. The lights should be dimmed and the blinds should be closed if the patient is sensitive to light.
You may also want to consider warm blankets, aromatherapy towelettes, heating packs, ear plugs, and calming music.
Provide the Patient Autonomy to Make Decisions
It is important to allow the patient to make decisions regarding their care. This includes things like what time they would like to sleep, what type of music they would like to listen to, and what type of food they would like to eat.
It is also important to respect the patient’s wishes regarding their care.
What are the Five Stages of Grief?
The five stages of grief were first proposed by Dr. Elisabeth Kübler-Ross in her book On Death and Dying. The stages are:
Denial and Isolation
In the denial stage, patients experience a sense of numbness and disbelief. They may try to deny that the diagnosis is real or that it will have a major impact on their lives.
Patients may become angry with themselves, the healthcare team, God, or fate. They may feel like they have been wronged or that they are being punished.
In the bargaining stage, patients may try to make deals with God or the universe in order to change the diagnosis. They may also try to find a silver lining or some positive aspect of the situation.
In the depression stage, patients may become withdrawn and start to lose hope. They may begin to think about all of the things they will never be able to do.
In the acceptance stage, patients are able to come to terms with the diagnosis and their prognosis. They may still experience sadness and grief but they are able to start moving forward with their lives.
It is important to remember that not everyone will experience all of the stages and that the order of the stages is not always linear.
What are Some Ways to Support a Grieving Family?
The death of a loved one is a difficult time for everyone involved. There are many things you can do to support a grieving family. Some of these things include:
It is important to just be there for the family. Sometimes the best thing you can do is just listen.
Asking What You Can Do
The family may not know what they need, so it is important to ask them what you can do. They may need help with practical things like water, food, and blankets. Or they may just need someone to talk to.
Giving Them Space
It is important to respect the family’s need for space. They may not want to talk about what happened or they may just need some time alone.
The patient has passed on. Now what?
Once the patient has passed away, it is important to follow the family’s wishes. They may want to spend time with the body or they may want the body to be removed immediately.
It is also important to alert the healthcare team so that you can start the process of performing post-mortem care and removing the body. There may be religious preferences for the care of the body. Work closely with the spiritual care team to make sure you are following these wishes.
The family will also need to be given information about what to do next. This includes things like where to go for support, how to arrange a funeral, and what to do with the patient’s belongings.
Take Care of Yourself
It is important to take care of yourself during this time. It takes a very special nurse to provide end-of-life care and no matter how you feel you will always take a piece of the experience with you in your practice. This is a difficult and emotional experience and it is okay to need some time for yourself. Make sure you are eating and sleeping well and taking breaks when you need them.
If you find that you are struggling to cope, please reach out for help. There are many resources available to support you.
Caring for a patient who is dying can be a difficult but rewarding experience. It is important to remember the five stages of grief and to be there for the family during this difficult time. You can also take care of yourself by taking breaks and reaching out for help when you need it.
What are some of your experiences with caring for death and dying? Share your stories in the comments below.