What The Dying Patient Can Expect From The Bedside Nurse

Of all human experiences, none is more overwhelming than death. In the course of their work day, nurses frequently deal with the dying… and death. As such, they realize that death is a natural and universal experience, a part of life and a component of health care. They are educated to be better informed about dying and death and to incorporate this knowledge into the care they administer to their patients. They know that death has deep cultural and religious meaning that shapes how it is understood and determines what is considered appropriate behavior, both for the dying person and loved ones, as well as for the entire health care team.

Nurses who care for dying patients share emotional pain with them and their families. Nurses know that denying death creates a barrier to becoming involved with the dying patient and their families and interferes with personal growth. Since death is not specific to any age or population and can occur in any health care setting, every nurse must be prepared to face the reality of a patient dying. Death can be slow and torturous or sudden and unexpected. Preparing the patient and his or her family for an expected death is usually very different from caring for grieving family members after an unexpected death. Nurses who work with patients who have terminal conditions, need to face the challenge of helping the dying person master his or her own death.

Be assured that all nurses have been educated about death and the dying process. While it is the doctor who is usually responsible for informing patients of the nature and seriousness of their illness, it is the nurse who is usually committed to honoring the dying patients right to know the seriousness of his or her medical condition. The nurse-patient relationship is based on honesty rather than on the false pretense that recovery will occur. The nurse respects the patient’s right to determine how to spend the rest of his or her life. The nurse will keep the person company – talking, watching movies, reading or just being present. The nurse will allow for and encourage the expression of fears and concerns about dying.
 S/he will reminisce with the patient about his life, learning his story.
 The nurse will include the patient in discussions about issues that concern him.
 S/he will provide reassurance that all of the patient’s wishes as described in the Advance Directives will be honored.
 The nurse will respect the person’s need for privacy. S/he will encourage, support and assist the patient in finishing up any unfinished business. The nurse will also encourage, promote, and support meaningful communication between the patient and family. The nurse will continue to provide hope to the patient and family, even when the situation is dire. S/he never diminshes the care being given…or the caring.

Nurses recognizes the value of communicating a spirit of hopefulness and in doing so will do everything possible to make the patient’s remaining days meaningful. They will use whatever appropriate treatment and comfort measures they can as they dignify death and support the patient and the family.

Elisabeth Kubler-Ross was a physician who studied death and dying. She described the 5 reactions that dying patients often exhibit: (1) denial, (2) anger, (3) bargaining, (4) depression and (5) acceptance. Nurses are knowledgeable in these reactions and in the ways that patients and families respond to terminal illness. With such knowledge and compassion, they can help guide patients and families through the grieving process.

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