Many people fear death. More people fear the dead. I was not any different. On the first day of our hospital placement as nursing students, we were taken to the morgue. I don’t know if it was a scare tactic or a genuine attempt at orientation. To this day, I still remember the pile of bodies on the floor, including children, and how it made me question my choice of career.
I also remember my first last office like it was yesterday. I remember taking off this patient's clothes while everything inside me was turning gooey. My whole body did not like the experience, and since then, I was keen to avoid finding myself in that situation. Until the pandemic happened. During COVID, I did more last office than I was ready for. If I’m being honest, this is when I got over my fear of the dead. Each passing day, we would loose one or two patients. Some would be on end-of-life care, while some would die unexpectedly.During this time, I also lost my dad. This gave me a chance to truly empathize with loved ones of patients who die or are on end-of-life care.
Through experience, I have come to learn that we should care for the dying and dead with the same enthusiasm and compassion we do all our other patients.End of life care should ensure that the patients and their families experience dignity, comfort, and support during this critical time. The main considerations for end of life care are:
Assessment and Planning: Comprehensive assessments are conducted to understand the patient's needs, preferences, and goals of care. This includes discussions about treatment options and advance care planning. Family must be involved in care planning.
Symptom Management: Effective management of physical symptoms, such as pain, nausea, and breathlessness, is crucial. Palliative care specialists often play a key role in this aspect. They will prescribe the medication but it is the nurse's duty to assess for discomfort and intervene.
Emotional and Psychological Support: Providing emotional support to patients and their families is essential. One way to do this is to communicate with patient's relatives efficiently. Explain to them what to expect and listen to them and address any concerns. If relatives opt to stay with the patient, offer them small measures of comfort such as comfortable chairs, blankets or cups of tea.
Spiritual Care: Addressing spiritual needs and providing support for patients' beliefs and values is an important part of holistic end of life care. Different people have different spiritual needs. For instance, Catholics may request a priest to come in and say prayers before a patient dies and after the patient dies.
Care in Different Settings: End of life care can take place in various settings, including hospitals, hospices, and at home, depending on the patient’s wishes and clinical needs.
After the patient dies, the dignity and respect you gave them should not die with them. For all we know the patient's soul and spirit could still be near by. Screen the bedside or close the door if its a room. Be gentle when handling the body and leave the patient as clean as possible, follow your hospital's protocol when doing this. You must also observe patient' and family wishes and any cultural and religious practice they want followed.
Communication with relatives is crucial at this stage. Earlier on in my career, I did not know how to give such news to relatives. I would rely on colleagues to do it for me. This is something I also learnt during the pandemic. If you are still in the stage of not knowing what to say, don't be hard on yourself. A rule of thumb is to be factual and professional but as humanly as possible. Over time, you will learn how to communicate with compassion and empathy. Allow the family to express their grief without inhibitions or judgement. Explain to them all the next steps you will take and what to do or who they need to contact to prepare for the funeral.
As with everything else, proper documentation is paramount in end of life and care after death.
Finally, caring for the dead and dying can have an emotional toll on the nurse. Sometimes we experience grief for patients we have cared for for long periods. Other times, a patient's death will remind us of our own grief. The worst of this times is when we become numb, when we feel dead inside and have no emotion whatsoever. It is important to recognize when this is happening. To take the time to care for ourselves and recharge.
We should always care for our patients with compassion until they are discharged. Whether it is to home, another hospital or unit, or the afterlife.
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