How to care for people or even just
one dying person in the last few weeks of his or her life, often presents a
serious challenge that involves care, compassion and concern by doctors and
other professional medical caregivers including palliative care nurses, as
well as family members, friends and others.
Here are some basic guidelines
with respect to caring for people who are dying.
Be aware that each scenario
that involves a dying patient who is living out the last few weeks of his or her
life, will be different and unique. No two situations are exactly alike; nor
should anyone expect them to be the same.
Acknowledge the patient’s
feelings.
Globally, the fear of death and
dying reigns as the primary feeling of many patients who are suddenly
confronted with the reality of pending death. Many people panic because they
are afraid of death and dying. Some people, but certainly not all of them, are
ready for imminent death. Many people remain in a state of denial right until
the moment of death.
Help the patient to bring about
effective resolution to his or her affairs.
When suddenly confronted with
an end to their lives, immediate resolution of every aspect of their lives, is the desire of many people. This may not be possible, particularly
when the dying patient is extremely ill or pending death is imminent. As a
palliative care nurse or caregiver, you may need to assume the role of
proactive facilitator or encourage family members and/or lawyers to assist in
bringing about effective resolution of the patient’s affairs. Has the patient
assigned a member of his or her family the power of attorney?
The patient may want to
participate in making his or her own funeral arrangements, in conjunction with
a minister or priest.
Help the patient to understand
his or her mental, emotional, physical and spiritual status.
Determining the status of the
patient will be an important factor in his or her care, particularly during the
last few weeks of life. What does the patient know and understand about his or
her own situation? Is he or she willing to discuss what is happening or able to
do so? Is he or she aware of pending death?
Determine the basic needs and
desires of the patient.
Depending upon the scenario,
medical and nursing care needs of the patient may have to take precedence, but
the desires of the dying patient are equally important. The patient may have
hitherto, unspoken wishes and unexpressed desires.
Listening to the patient is
extremely important at this time. While it is not always possible to follow up
on what the dying patient requests, attempting to do so will allow the dying
patient to be at peace.
Respect ‘do not
resuscitate’ orders.
If a dying patient has
expressed the request not to be resuscitated, when he or she dies, it is
important to allow the patient’s wishes and desires to take priority over those
of others. While this may cause conflict or anguish among family members, the
dying patient does have the right to make this request.
“The Dying Patient’s Bill of
Rights, as reported by the Learning Place Online, maintains that patients must
be treated as living individuals with human rights until the moment of death.
They must be given a say in all decisions made on their behalf, and they should
not be pejoratively judged for their choices even if they are in contrast
others’ opinions.” (1)
Determine if the patient has a living will.
Dying patients may have
previously written, health care oriented statements expressing their
specific wishes and desires with regard to medical treatment, if they are not
able to express their informed consent. This is a living will or “a document,
made by a person when still legally fit to do so, expressing his desire to be
allowed to die instead of being kept alive by artificial means, in the event of
being severely disabled or suffering from a terminal illness.” (2)
Help the dying patient to
maintain a sense of dignity.
When a person is dying, he or
she may sense the loss of control of his or her life and personal affairs. The
patient will rest more comfortably knowing that everything important to him or
her is being looked after appropriately and that he or she is still loved and
respected by others.
Following these guidelines will
make it easier for the patient to transition beyond this life.
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