10. Helping the Dying | Home Nursing Basics

As hard as it may be to admit, death is and will always be an inevitable part of the human experience. In everyday life, most people avoid thinking about what awaits them at the end of it, and therefore are often lost when they find themselves in a situation where their relatives find themselves on their deathbed. How to organize care for a helpless patient, how to talk to a dying person, how to make dying easier—all these difficult questions, as a rule, people try to put off “for later.” There really are no definitive answers, but proper preparation can not only help a terminally ill person cope with the reality of their impending death, but also bring some peace to their loved ones.

Psychology of Dying

Although at the everyday level in Russia and many other European countries there is an unspoken taboo on discussing death and the dying process itself, in recent years scientists have been paying increasing attention to these topics. A great contribution to the understanding of a dying person was made by psychologist and physician Elisabeth Kübler-Ross, who developed the concept of psychological assistance to terminally ill people. She has written more than 20 books, including “On Grief and the Experience of Grief”, “Live Now! Life lessons from people who have seen death”, “AIDS: the final challenge”. But a special place in her scientific heritage is occupied by “On Death and Dying,” which sets out the famous model of the path of five stages of the perception of death. This work has still not lost its relevance and is used by most professionals working with dying patients.

Denial and isolation

Having received a terminal diagnosis, the patient refuses to accept what he hears: “No, not me!”, “It must be a mistake,” and “This cannot happen to me.” The state of shock is a form of psychological defense that helps mitigate the initial shock and collect thoughts. Depending on the circumstances under which the person was given this news, this condition may be more or less pronounced. In some cases, this phase may continue until death or may return periodically at different stages of dying.

Anger (Protest)

When a person realizes what is happening, he is overcome by feelings of anger, indignation and envy of the healthy. Trying to find a simple and understandable answer to the question “Why me?”, he splashes out these emotions on others. The patient blames doctors, believing that they prescribe him the wrong treatment, nurses for their seeming indifference or importunity, and relatives for reminding him of the approaching end.

Trade

The patient hopes to “negotiate” with fate and bargain his life with promises and deals: “If I pull out the hidden card, I will survive,” “I promise to quit smoking/donate money/go to church if I survive this disease.” If his wish comes true, he wishes for the next one, trying to delay the inevitable ending. From the hope of prolongation of life, the dying person gradually moves to the hope of a few days without pain or constant discomfort.

Depression

After numbness, denial, anger and attempts to make a deal with the disease, a feeling of despair and horror comes. Psychologists distinguish reactive and preparatory types of this stage. In the first case, the dying person suffers from a feeling of guilt and regret for the life he has lived, trying to understand “What did he do to deserve this.” In this state, he is open to communication, trying to share his experiences and anxieties with loved ones. In “preparatory grief,” as Kübler-Ross called this alternative type of depressive phase, the dying person withdraws into himself, aware of the inevitability of the end, and is largely silent. The term "preparatory" here means that the suffering is caused by future losses and not by past actual or perceived wrongdoing.

Acceptance (Humility)

Not all patients survive to the final phase – acceptance of death. A person who has come to terms with his death reflects on it with calmness and prudence. Exhausted from the fight against the disease, he finally wants to rest from his torment and fall asleep. The patient sleeps a lot, gradually loses interest in communicating with doctors and family, and hopes for a quick death.

What not to say to someone who may be dying

No matter how much you would like to support a seriously ill person, it is not worth citing positive statistics or talking about your ex-husband’s cousin who “fully recovered from a similar illness.” Such phrases are not always encouraging.

Such statements to some extent ignore the feeling of “uniqueness” that every seriously ill person experiences, and also delay the important stage of “accepting” one’s own condition.

The phrases “nothing happens for nothing”, “everything is God’s will” are also prohibited. Such clichés can cause a seriously ill patient to think that illness is a punishment for something.

Often in the first few days after diagnosis, a person may deny their condition and feel depressed. The patient is simply not ready to face his fears and engage in active struggle. Therefore, in most cases it is better to use a simple rule: “if you don’t know what to say, keep silent.”

Support for the Dying

Is it possible to tell a dying person the truth about his condition is the first question that the relatives of the dying person face. Even professionals cannot answer this question unequivocally. Some scientists believe that talking about death with a person on the verge of death is useless and even harmful, especially when he has not yet experienced a state of shock. However, at present, psychologists are inclined to believe that this question cannot be posed in this way at all, because knowing the truth about one’s health is an inalienable human right, and it is the doctor’s duty to tell it to him.

Honesty with the dying person is the least that can be done to help him cope with his feelings and make his passing easier. Sooner or later a person will realize that he is dying, and when this happens, he will have to deal not only with his own death, but also with the deception of loved ones. In addition, those who deceived him will face torment of conscience, especially after he dies.

How can you help a dying patient? First of all, it is necessary to provide him with good care. It is worth considering allowing a person to spend his last days at home and meet death in a familiar environment and surrounded by loved ones. According to Kübler-Ross, “a spoonful of your favorite soup can be healthier than an injection in a hospital.” You should also try to ease his physical suffering with medications or other methods. However, with the help of medications you can only get rid of bodily pain. Therefore, open and honest communication with a terminally ill person is of great importance.

The dying person should be able to calmly talk with loved ones about his condition, and the accompanying feelings of fear, loneliness and grief. Walling off is a natural defensive reaction of those watching a loved one die, but even on the verge of death, a person is still human and deserves warmth and acceptance. If possible, such assistance should be provided not only to relatives, who often do not have the necessary training, but also to a professional psychologist and social worker. However, it is the participation of relatives that is key in alleviating the suffering of the patient.

What is needed to organize the stay of a seriously ill person at home?

Hospice institutions in Russia cannot provide full care to their patients. You can order a private nurse for the hospital or try to organize the stay of a seriously ill person at home. The medical team organizing the discharge and transportation of the patient will tell you what you need to purchase.

The list of necessary equipment will depend on the specific disease. But most often you need:

• anti-bedsore mattress;
• stands for infusion systems;
• a cabinet or cabinet with a lock for storing medicines;
• call button;
• lift;
• sanitary chair;
• disabled carriage.

In particularly severe cases, the patient requires a ventilator and a system for monitoring vital signs. It is more advisable to rent such medical equipment.

Principles of communication with the dying:

1. Be prepared to provide assistance to a dying person at any time.
2. Give him a chance to talk and listen to him.
3. Be patient and calmly react to his emotions - it is not anger that speaks in him, but fear.
4. Do not try to instill inappropriate optimism in a dying person if there is no hope of improvement in his condition.
5. Explain that his feelings are completely normal and you are ready to help him deal with them.

June 15, 2020

You might be interested:

• Financial assistance in connection with death
• The new law on palliative care came into force
• Center for Emergency Psychological Assistance of the Ministry of Emergency Situations

Preparing for a negative outcome

Unfortunately, serious illnesses sometimes end in death. You need to be mentally prepared, contact your doctor and ask to describe possible warning signs of death. You need to know the symptoms, which should promptly call an ambulance.

The most common signs that the disease has reached the terminal stage:

• periods of causeless anxiety are replaced by a sharp general improvement in the patient’s condition;
• constant drowsiness;
• complete loss of appetite;
• more frequent attacks of apnea;
• cold and pale extremities;
• frequent dreams about people who have already died;
• complaints of chills.

If you see that a seriously ill person has suddenly calmed down after an attack, do not fuss and do not try to leave your loved one alone. It’s better to just go up to the patient, take his hand and once again remind him of your love.

What are the predictors of death according to scientists?

How does a sick person die? Based on numerous observations of dying patients, scientists have drawn a number of conclusions:

1. Not all patients experience physiological changes. One in three people who die have no obvious symptoms of death.
2. 60–72 hours before death, most patients lose their reaction to verbal stimuli. They do not respond to a smile, do not respond to the guardian’s gestures and facial expressions. There is a change in voice.
3. Two days before death, there is increased relaxation of the neck muscles, i.e., it is difficult for the patient to keep his head in an elevated position.
4. Slow movement of the pupils; the patient also cannot close his eyelids tightly or squint his eyes.
5. You can also observe obvious disturbances in the functioning of the gastrointestinal tract, bleeding in its upper sections.

Signs of imminent death in a bedridden patient manifest themselves in different ways. According to the observations of doctors, it is possible to notice obvious manifestations of symptoms in a certain period of time, and at the same time determine the approximate date of death of a person.

Symptoms of clinical and biological death

Clinical death is a reversible process that appears suddenly or after a serious illness and requires urgent medical attention. Signs of clinical death that appear in the first minutes:

If a person is in a coma, attached to a ventilator, and the pupils are dilated due to the action of medications, then clinical death can only be determined by the results of an ECG.

If timely assistance is provided, within the first 5 minutes, you can bring a person back to life. If you provide artificial support for blood circulation and breathing later, you can return the heart rate, but the person will never regain consciousness. This is due to the fact that brain cells die earlier than the neurons responsible for the vital functions of the body.

A dying bedridden patient may not show signs before death, but clinical death will be recorded.

Biological or true death is the irreversible cessation of the functioning of the body. Biological death occurs after clinical death, so all primary symptoms are similar. Secondary symptoms appear within 24 hours:

• cooling and numbness of the body;
• drying of mucous membranes;
• the appearance of cadaveric spots;
• tissue decomposition.