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Dealing with Death
Providing Care to Those in the Last Stages of Life

Clint Maun, CSP

While tending to dying patients is probably not the most upbeat aspect of healthcare, it is an issue almost all professionals in the field face. While many staff members caring for dying patients may experience a sense of helplessness as well as physical and mental exhaustion, it's important not to lose sight of the ultimate goal-providing the best care to those in the last stages of life. The material below will take a look at how we view death and how we can better care for those who are experiencing this transition.

Bringing Death to Life
Perhaps the first step is to look at how we, as a society, view death. It's probably fair to say that death has been "in the closet"-an almost forbidden topic. When it is necessary to talk about death, we often disguise it with euphemisms such as "passed on," "expired" or "left this world."

In healthcare settings, when a patient dies, much is done to cover up the death and get it out of view as quickly as possible-a sheet is covered over the deceased, curtains are drawn, oftentimes, loved ones are not able to see the body and say goodbye. As strange as it may sound, we could be doing a great service to friends, family and those in the last stages of life by more openly recognizing death.

According to a study by Katherine Phillips at the Royal Star and Garter Home in Richmond, people in residential care and nursing homes might like to talk more about death and dying. Some residents who were interviewed said that they did wish to talk about aspects of death and dying with staff. However, any specific conversation around these issues rarely happened between residents and staff in the study.

Communication Is Key
Communication is a basic human need and perhaps because it comes so naturally to us, it's easy to lose sight of its importance. Being prepared to listen to the hopes and fears surrounding death can help the patients facing this transition.

There are several items you should make a conscious effort to undergo:
  • Be up front and clear with dying patients. Simply asking them how they feel about the subject is a good starting point. Be sure to write and record that the topic has been raised, so the same question is not repeatedly asked.
  • Don't press too hard. Be prepared to drop the subject if your resident does not want to talk. The fact that you have mentioned the topic will make it easier for them to raise it at a later date, if they wish to do so.
  • Share a joke or anecdote. No rule states that you must be somber all the time when around dying patients. Humor can be a great way to relieve tension and raise spirits-just use good judgment and maintain a professional demeanor.
  • Be aware of what you say. Sometimes words can slip out of our mouths without us even being aware of what we've said. This is particularly true when one is confronted with situations such as death. Sometimes blocking techniques are used on patients to distance meaningful discussion. Comments like, "Don't talk like that" or "You have plenty of life in you yet" can deny the opportunity for people to express their feelings. Make a true effort to open yourself up-be mindful of the barriers that could close discussion.
  • Always make the effort. If your resident is confused or cannot communicate, it is still worth raising the issue. You may not get clear answers, but you can still show that they will be supported by caring staff until the end.

Simple caring and compassion are the main ingredients of what is needed to ease the pain of dying. If everyone took a few minutes out of their day to spend with a different resident, tensions and fears about death may be greatly reduced. It's important to remember that while the underlying disease cannot be cured, enhancement of life can still be achieved, which ultimately promotes a culture of well-being throughout old age.

Questions to Consider

When a patient dies, much attention is focused on the needs of the deceased and loved ones. While this is well-deserved, the needs of the staff must also be addressed. Here are some items to ask yourself and prepare the facility for:

Do new staff members have someone working with them who can help them cope with the first deaths they experience in the facility?

Is bereavement counseling or similar help available to staff?

When a resident is close to death, is information passed to members of staff who are off-duty who would like to be kept informed?

Are administrative, catering and domestic staff given the opportunity to relate to dying residents if they wish to?

Are all relevant staff given time, and helped with transport if necessary, to attend residents' funerals?

In addition, to answering the questions above, your facility should make sure that all staff participate in death education that covers the stages of dying, problems facing the dying, and staff related issues.