Many nurses work in areas of healthcare where they do not encounter terminally ill patients regularly. Others work in hospices, critical care and emergency departments where death is relatively common.
Often new nurses experience death initially while completing clinical rotations or during their early days as professional nurses. Being with a dying patient and their loved ones can be overwhelming. Talking about dying remains relatively taboo for most Americans. Fortunately, there are ways to facilitate nurse preparation, improve nurse comfort levels and enhance nursing expertise for nurses inexperienced with providing terminal care.
Recognizing that death provokes strong feelings universally is a first step in becoming able to be comfortable when caring for dying patients.
The nurse’s presence, simply being, is in itself an enormous part of the dying experience for patients and their loved ones. Dying is inevitable, the quality of the nurse’s presence can be the most comforting aspect of nursing care given.
Though curing can not always occur, healing is always possible. Nurses strive to help patients heal from physical, emotional and spiritual distress. They support loved ones as they try to come to terms with old unhealthy patterns of relating. Being with dying patients is nursing stripped away to its century’s old basic goals of comforting and promoting patient dignity.
Nurses unfamiliar with simply being present, may initially feel helpless, anxious, and want to avoid caring for dying patients. Nurses, like physicians, desire to see patients well and healed. When that is impossible, and the main task is simply being present, it can feel terrifying. The nurse may feel inadequate. Compassionate detachment may seem like a lofty goal when faced with intense suffering of the patient and / or family.
Death is not usually a dramatic Hollywood style ending, where the person utters some final words of love, closes their eyes and quickly dies. In the real world, death can be quite ugly. Sounds, odors, sights and raw emotions add to the challenges of caring for terminally ill or critically injured people.
Nurses caring for dying patients are inevitably faced with their own beliefs about the meaning of life, spirituality, and finding meaning in their own lives. Nurses may relive personal experiences of loss of their own loved ones to death, when caring for patients in their final days of life. This can be very stressful for the nurse.
Unfortunately, nursing education related to death and dying is often theoretical or encountered by chance if a student is caring for a dying patient during clinicals.
Here are some methods which facilitate comfort and competency for nursing students and nurses unfamiliar with caring for dying patients:
Experienced and inexperienced nurses need to partner in providing care to terminally ill patients. This affords the inexperienced nurse a role model and opportunities simply to experience what dying looks like. The inexperienced nurse gets a chance to be with death without the pressure of having to be responsible for meeting the needs of the dying patient and their loved ones.
- Increase awareness about the needs of dying patients through role playing and in depth discussions. Possible scenarios to be played out may include: being with a patient who has just learned that he or she is terminally ill; controlling pain and dyspnea, family education and support; advanced directives, unexpected death and discontinuing life support.
- Keeping a journal related to personal emotions and thoughts about death and living can provide values clarification for nurses.
- Debriefing and utilizing nurse supports such as pastoral care, nurse support groups, and self care techniques benefit nurses and expedite their transition from inexperienced to competent, confident, and skillful presence when caring for the terminally ill.
Nurses caring for dying patients need to become as compassionate with themselves and co workers as they are with their patients.
Skilled nurses find ways to balance caring for others with self care. They are resilient and able to offer dying patients and their loved ones outstanding nursing care.
No one is an expert nurse initially when taking care of seriously ill patients. With time, preparation and team work nurses are able to provide compassionate , expert care when there is “ nothing more that can be done” The nurse will find that there is much that he or she can do simply by being.