End of Life Care in Nursing
Advocating for the Dying Patient Pain Management Universal Grief
Aug 18, 2007
When a patient reaches the end of life care, he or she is dying. The doctors can do nothing more to help. The patient ,now considered terminal, usually has a DNR or Do Not Resuscitate Code status. Most medical personnel have great difficulty giving end of life care, unless he or she sees death as part of the circle of life. Some nurses consider being with a patient as he or she dies to be a great honor. There is never a time in someone’s life where being a nurse can make more of a difference.
Universal Grief
Experiencing the grief that comes with finding out a loved one is dying is one of the most difficult parts of life for anyone. Families of a terminal patient do not know what to do or how to feel or if even what they are feeling is normal. What nurses must remember is grief is universal. Grief affects a person’s whole body, physically, emotionally and mentally. The impact of grief plays a role into how a family member acts towards other family members and the medical staff. The best thing nurses can do is simply listen and offer emotional support.
Family Dynamics
Family dynamics are complicated and often affect the way one grieves. The bitterness directed at a dying father may be due to unresolved anger issues based on a childhood of alcoholism or abuse. A spouse that refuses to leave a bedside may be atoning for feelings of guilt in a loveless marriage based on lies and cheating. Nurses are not here to judge the patient or family and our professionalism is above that level. Our first priority is always to protect the patient, providing care and comfort in his or her final days, regardless of the type of person he or she may have been prior to arriving at death’s doorway.
Good Care
Good physical care is still mandatory for a dying patient. Simply because a patient is dying and may only have a few days left to live does not give medical staff a reason to stop performing the basic activities of daily living. Good physical hygiene and oral hygiene will provide a sense of comfort as the end draws near. A sponge bath may soothe aches and pains unlike any pain medicines are capable of doing. Hand massages with lotion are an amazing way to help someone forget about his constant pain, at least temporarily, and helps to connect with the patient while talking one on one.
Patient Advocate
Nurses must educate families and patients that a PCA (Patient Controlled Analgesic) device is “patient controlled.” Families are not to administer medication by pushing the button, as this can cause decreased respirations if the patient is not controlling the amount of medication. A nurse is the patient’s advocate and in the end, patients deserve adequate pain control. If the patient is having break through pain the nurse must alert the doctor.
Hold Their Hand
Finally, often a dying patient will not “leave” until everyone has come to say goodbye or until everyone has left the bedside. Mothers know their children would not be able to handle “that” moment even though children profess the need to be there. Many patients die within minutes of family members leaving the bedside for the first time in weeks. When family members leave, nurses need to sit and hold the patient's hand, because no one should die alone. Every patient deserves the utmost respect and the gentlest of care at the end of his or her life.
