Death and Dying – Nursing Issues.
Death is not easy subject to deal with. It difficult for the dying who is dying, and those around him/her. This article is written by a registered nurse with more than twenty years experience who has witnessed many deaths. There is no predicting when death will strike or whom it will strike next. Could be me, could be you. Just like taxes, it is real. Is has always happened, is happening and will continue to happen until at least the end of my life.
Picture A. Sudden Death in a young person is more traumatic than the death of an elderly person with chronic disease.
Issues discussed are death, fear of dying, insurance, next of kin, structured settlement, legal, death insurance, last rites, funeral insurance, funeral home
People who are dying have a life and are living it. As long as they are alive they have all the emotions, feelings and wishes that all of us have. This article is based on lengthy lonely talks sitting with dying patients on the night shift.
The night time is the most difficult time for the dying patient. The fear of death is real. Many Nurses will give the patient prescribed medications and say their “good night” and “will see you in the morning”. This is standard care, the medication is expected the patient to sleep. All family members are told to go home and get some sleep. The reality is very different. Patients cannot sleep, the fear of death is real. Switching off the lights, it’s like switching off life. In my experience, many patients have requested the light to be left on and I have not had any problem. Of course, I as a nurse, was subjected to the usual pressure from my bosses who would give me a lecture on how the quality of sleep is not so good when the lights are on. I have had many lengthy talks about “fear of dying” with many patients. As a Nurse, please respect the patient’s wishes, the fear is real and I will talk about it in the next paragraph.
Many patients fear of dying. The fear of dying is because many patients feel that death is preceded by pain. Death is not painful to many patients. The process of dying is usually the result of pathological disturbances which first alter blood chemistry which alter the level of consciousness of the patient. When the LOC (level of consciousness) is decreased the patient is not in pain and is not aware when the last breath will be. Pain can be controlled effectively by medications. Medications must be administered correctly. Please see: Administering Oral Medications (PO) Correctly
When a patient knows that he or she is going to die, he/she is usually “in crises”. He will seek company, be prepared to sit with the patient and make the patient comfortable. Patients who are dying are usually very nice and friendly and may seek your assistance because you are the person who is most readily available. Most patients want to leave on good terms with all around them. So try and anticipate what the patient needs and try to satisfy his/her needs. Being in crises also means that the person will be constantly negotiating with god and others around him/her. They are always hoping that god will grant them more time for more time here on earth.
Sometimes a patient will want to speak with close family members. If your patient is orientated, be kind, call the relatives. I know that it might breach the policies of some hospitals. You are an advocate for your patient; his/her rights come first. If your patient is confused, be prepared to sit and comfort him. Sometimes, family members would have left specific instructions for you to follow. Call them as per the agreement, the time on earth is not of any relevance to them.
Hospitals are difficult places for the relatives and friends of the patient. All communications must be done in accordance with the patient’s wishes, if these are known and if the patient is alert, conscious and orientated to person, place and time. If your patient is confused, all communications must be in accordance with the instructions of the next of kin. If there is a conflict in directions and your patient is orientated to time, person and place, the directions of the patient take priority and Should be respected.
Some Hospitals have contracts with specific funeral homes and the funeral home will have provided information about coffin and funeral arrangements. Even coffins can be quite expensive or may be part of a prepaid insurance policy. These may be some of the things a relative may ask you.
It is very distressing to see a patient with Cancer of the Bronchus or respiratory disease die. These patients are usually short of breath and it affects all around them. Positioning the patient and giving all the right medications will help. Interventions for patients with breathing difficulties are listed at: Respiratory Tract Infections Treatment & management
