Introduction

At one time or another, every one of us will pass from this life to the one yonder. This can be either expected or unexpected in nature. Either way, the traumatic nature of such an event cannot be underestimated. In the nursing career, coming across such an occurrence would be inevitable. Irrespective of the number of times you will be facing this, it is always important to have an idea as to what you should expect as well as what you should. This would be important in changing the traumatizing situation into the most impressive care giving action in your career.

Roles

Underlining the whole duty of the nurses as far as dealing with dying patients and their families is the fact that they should transform the hospital environment into a completely therapeutic one by knowing what to look out for in the dying patients and having a clear understanding as to how they should deal with it. In this case, they will require to have the appropriate attitude as well as special posture which will encompass cognitive and empathetic observation mode. This will enable them to deal with the nonverbal as well as verbal behaviors of the dying patients thereby empathizing with the patient’s experience.

The first role of the nurse as far as a dying person is concerned is to determine when the time is nigh. This may be quite a difficult prediction to make since there is no uniformity in the way different individuals will look when dying. However, the nurse could be on the lookout for such physical signs like profound weakness, cold skin, low blood pressure, problems swallowing, disinterest in drinks and food as well as looking pale and gaunt. Patients also complain of numbness and experience changes in the breathing patterns. Gurgling sounds may also appear and be misconstrued as choking sounds. In such instances, it is always important that the nurse shares his or her observations about the happenings while assisting the grieving friends and family to come to terms with the process the dying patient is going through in order to ease the stress.

While taking care of the dying patient, it will be important that you look at the various aspects of their lives that will be affected. These include the physical aspect, the psychological and spiritual aspect. Dealing with these will be important in ensuring that the patient dies in a more or less “comfortable” manner.

Psychological care of the patient

This is very important in management of the dying patient having in mind that the main goal would be ease or even prevent patient suffering. Paying attention to the psychological facet of the dying patient and the situation of the family would help in minimizing distress in the family and sense of bereavement. This would also make the situation less stressful for you. Distancing yourself as a nurse with the patient’s and their families’ emotional needs while pressing on to the unreachable objective of cure would definitely speak of insufficient training as well as experience. What are the psychological or emotional needs of the dying patient? What role would the family be playing in all this?

It can be a herculean task to determine or predict a dying patient’s psychological needs and state. This is because there are variations in the state depending on age, dying process, cultural background, economic status and education level. Nevertheless, there are particular aspects that cross cut all these boundaries

To begin with, dying patients are unlikely to get into the dying process in single mindsets. The patient would be undergoing stages of anger, denial, depression and bargaining before finally accepting death. As much as these observations have remained controversial, the fact remains that the dying patients’ psychological needs change. In this case, the nurse would need to incorporate compassionate care so that they can tune into the changes as well as meet new ones that may arise.

Secondly, dying patients would be having specific fears. In most cases, they are afraid of dying alone or feeling abandoned especially in medical technology settings separated from their loved ones or dying while being denied the human contact. They may also fear that others are keeping away from them. This may be due to bad odor, characteristics that are socially offensive, loss of control of the bodily secretions or even insufficient pain relief. The nurse will have a duty to protect the patient from feeling isolated or losing his or her self-image.

Certain issues have been identified as bearing quite a lot of significance to people close to their death. These include being close to their family and friends, the physical expressions including hugging, kissing, and caring-touching. The patient would also desire to know the truth and still have control in the making of decisions pertaining to their care. In addition, they would need to discuss practical issues pertaining to dying like family future and finances, reviewing past pleasures, accomplishment, pains and regrets. They would also be concerned about their social presentability, cleanliness and personal appearance. Also, they would be concerned about their spirituality and religion although not much on the afterlife.

When all these concerns are viewed collectively, they show that dying persons would go smoothly through the process when they feel in control as well as involved in decisions pertaining to their care. They would grab the opportunities to close the curtain on their lives at a more or less practical level by putting their affairs in order as well as negotiating modifications in the family roles. In this case, it would be the role of the nurse to ensure that they are fed on truth as well as intellectual integrity and not evasion and denial.

Having in mind that family members may be providing care, they may be involved in imp[ortant roles such as hygienic routines, medication delivery monitoring symptoms aand signs as well as providing the right psychological support. However, there are situations when they may feel that the continued survival of the patients is causing unnecessary suffering to the family and therefore believe that death is the only option. In such instances, it would be important avail counseling as to how they could make the last moments count.

In cases where the nurse is dealing with dysfunctional families or those that have preexisting emotional problems, substance abuse patterns and undesirable family dynamics, there would be need for physician advocate who would shield the dying from evitable conflicts with family member(s). In essence, if particular family members are adding to the stress and suffering of the patient, it would be important that their efforts be directed away from the dying patient.

It can be a herculean task to determine preferences and needs of dying patients as well as the care that would meet these needs. Presenting the patient with options would be the basic rule in giving good care. As much as the needs of the patient may be altered as he or she goes through various changes, the options have to be assessed and reviewed periodically. It is a tough call to provide details and information that is fitting the patient’s needs. However, the patient still has the right both to know and to be denied the information in cases where their inclination is towards confrontation or denial with truth. The nurse would have a responsibility to adjust to the changes in desire for the information.

In some degree, the nurses will have to provide care to the family members that will be affected by the death of the patient. During bereavement, the loved ones would be in physical vulnerability and suffer from behavioral problems and impaired status of immunity. It is therefore imperative that the physician provides counseling in order to help them adjust them come to terms with the impeding loss.

Management of pain

It is always the duty of the nurse to ensure that the patient does not experience physical and psychological distress. This could be by administration of medications, epidural catheters, sedatives, stimulants and anti-emetics. In some cases, the comfort of the patient has to be considered over and above the side effects that may occur due to intervention. Double effect doctrine invokes the fact that the intervention may carry some risks even to the extent of rushing death. In this case, the nurse has to define the objectives of the therapy clearly, explain the possible complications of the therapy and incorporate the family and the patient in making the decision as much as possible. This would help in coming up with multifaceted pain management which will involve the family, the patients, nurses, physicians and psychotherapists, clergy and pharmacists.

Conclusion

The importance of the nurses’ duties in the dying process cannot be underestimated. This is as far as helping the family come to terms with the stages their loved one is going through as well as ensuring that the patient is not in pain when dying. They also help him or her make decisions not only as pertaining to their care but also to the changing roles after they are gone.

References

HYPERLINK “http://www.asrn.org/journal-nursing-today/290-caring-for-the-dying-patient.html” http://www.asrn.org/journal-nursing-today/290-caring-for-the-dying-patient.html

February 1, 2008 | American Society of Registered Nurses®

Caring For the Dying Patient 0710877654

HYPERLINK “http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303052/pdf/westjmed00360-0074.pdf” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303052/pdf/westjmed00360-0074.pdf

Clinical Management of Dying Patients

JONATHAN GAVRIN, MD, and C. RICHARD CHAPMAN, PhD, Seattle, Washington

HYPERLINK “http://books.google.co.ke/books?id=Ec1F0xrGzg0C&pg=PA44&lpg=PA44&dq=Principles+of+Management+of+the+Dying+Patient&source=bl&ots=w3–rFfUBe&sig=dLAvb5BPwF9iC86NEEoO8O1HUxY&hl=sw&ei=PVyRTpOiMYXItAav7_z6Dw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCkQ6AEwAg#v=onepage&q=Principles%20of%20Management%20of%20the%20Dying%20Patient&f=false” http://books.google.co.ke/books?id=Ec1F0xrGzg0C&pg=PA44&lpg=PA44&dq=Principles+of+Management+of+the+Dying+Patient&source=bl&ots=w3–rFfUBe&sig=dLAvb5BPwF9iC86NEEoO8O1HUxY&hl=sw&ei=PVyRTpOiMYXItAav7_z6Dw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCkQ6AEwAg#v=onepage&q=Principles%20of%20Management%20of%20the%20Dying%20Patient&f=false

Medical care of the dying patient

 By Robert DeBellis

International Journal of Nursing and Midwifery Vol. 2(1), pp. 1-9, June 2010

HYPERLINK “http://www.academicjournals.org/ijnm” http://www.academicjournals.org/ijnm

ISSN 2141-2499 ©2010 Academic Journals