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Taking care of patients at the end of life can be overwhelming. As a nurse, there are 5 things you need to know about interacting with a dying patient that can help.
To begin, when a patient receives a terminal diagnosis, there are a lot of emotions that bubble to the surface. Patients may feel anxious, scared, or even lonely.
Sometimes, they feel like their doctors and family have given up on them and this can make interactions more difficult.
However, you can support your patients at the end of life by understanding these basic tips.
Tips for Interacting With a Dying Patient
- Listen more. Talk less.
- Be present.
- Don’t ignore them.
- Be honest and share information.
- Don’t marginalize their feelings.
Why Are Interactions So Complicated?
First, let’s start with the fact that nobody wants to talk about death?
Secondly, as a nurse, you probably didn’t spend a lot of time learning about end-of-life conversations in nursing school.
And, you probably spent even less time interacting with dying patients.
Perhaps you’ve never had a patient die during your shift.
I was a nurse for 5 years before I had a patient die and I can still recall it like it was yesterday.
Honestly, I was a nervous wreck and even a little scared.
However, after many years of working as a hospice nurse and caring for patients with terminal illnesses, I’ve learned some skills that have made these interactions less intimidating.
Essential Advice for Interacting With a Dying Patient
1. Know Thyself
Seriously, before you can be there for your patients and their families, you need to understand your own feelings about death.
For instance, do you have fear and anxieties of your own related to death and dying?
If you’ve never seen a patient die, you might be afraid and uncomfortable talking to your patient as they approach death.
Additionally, if you work in a hospital setting, you might not have time to process the death of your patient because you have other patients to care for.
It’s situations like this that can lead to burnout and compassion fatigue so look for the signs that you need to take a break.
You should also take time for self-care activities when your patient dies.
Is It “Ok” For Nurses To Cry?
Let me start by saying this is my personal opinion and you can choose to disagree and it’s cool if you do!
Absolutely, YES!
When I first became a nurse (forever ago), I was trained that you shouldn’t cry because that adds stress to the patient and family. Furthermore, crying was considered to be unprofessional. And, to be frank, some people still believe this.
The First Time I Cried
Once, while working as an inpatient oncology nurse, I had a long-term patient that never got well enough to go home. They had many rounds of chemo and became one of the patients that I looked forward to seeing during my shifts.
Inevitably, one day I came into work and received the report they were not going to make it past the morning (hospice nurses kinda know). Honestly, I was heartbroken!
To make matters worse, I’m a crier.
So, my morning went something like this. I sat at the nurses’ station for about 45 minutes stalling because I couldn’t stand the idea of facing their family. I found orders and charts to check and calls to make.
Finally, my charge nurse said, “you have to go down there sometime!”
Keep in mind that I had cared for a lot of dying patients so I was an expert and considered myself extremely professional!
As I started down the hall, I started crying my eyeballs out! Yep, just like a big ole baby, and I couldn’t get it together. This was the first time I’d ever cried in front of a patient’s family.
The family and I embraced and they thanked me for treating the patient like a person and not just their disease.
The families’ next request is the one that really shocked me. They asked me to stay with the patient for post-mortem care because they knew that I would treat their loved one’s dead body with the same respect as I had in life.
I’m not saying cry every time. I certainly don’t, but my point is, sometimes you might cry and it’s ok.
Remember you’re human too, so don’t be so hard on yourself.
2. Do Activities With Your Patient
First, just because your patient is nearing the end of life or has a life-limiting illness, it doesn’t mean they’re already dead! So don’t treat them like they’re dead.
They are still very human (and alive) and don’t forget it!
12 Easy Activities To Try When Interacting with a Dying Patient
- Talk about memories
- Listen and be present in the moment
- Talk about pets
- Hold their hand
- Sing a song
- Go through photos (old and new)
- Talk about their prior profession
- Share a laugh
- Offer reassurance
- Ask about what’s important to them
- Compliment them (i.e. I always look forward to seeing you)
- Create art or do something expressive like coloring
“Don’t die until you’re dead!
— Rachel Wolchin
3. Show Up and Be Present!
Believe it or not, how you show up matters!
Perhaps you already know this but at a time when nurse burnout is at record highs, you might not even notice when your inner gremlin starts to creep out.
If you’ve had a rough day (which most are), take a few deep breaths before you enter the patient’s room or home. This is not the time to share how busy you are or how much your family hates your job and wants you to quit!
Your baggage is not their problem! They have enough on their mind, and this is your opportunity to educate them and share this beautiful time of transition.
Physical Ways to Demonstrate Presence
If you are a new nurse or new to end-of-life care, it might be more natural to spend most of your time talking to the family and caregivers. After all, you can only do so much in a visit, right?
In my experience, I’ve found that even though your patient may not say it, they may experience some degree of loneliness at the end of life.
Try these Simple Ways of Being Present
- When the patient is talking, sit next to them and make eye contact.
- Just LISTEN and don’t try to fill every second with small talk.
- Touch their hand and lean in.
- Watch a few minutes of their favorite television show with them.
- Freshen up their space don’t just ignore it (empty the trash, get rid of old tissues, straighten their blanket, fluff the pillow).
Recommended Article: How to Survive Your First Year As a Hospice Nurse
4. Share Information and Be Compassionate
Sometimes during the visit, your patient might have tough questions about dying.
For instance, they might ask you how much time they have?
Once, I had a patient ask me if I thought they would be able to come off hospice because they were doing better now that they stopped chemo and started hospice.
(Honestly, broke my heart!)
To start, your role is, to be honest, and share information with compassion and in a way, they can understand.
Techniques you can use:
- Verify what the patient already knows
- Avoid jargon and medical slang
- It’s ok to use the words die, death, and dying
- You don’t have to give too many details (I get this is a nurse thing because you want them to be prepared, right?)
- Confirm their understanding of what you said
For instance, you could say: “I know that you’ve received a lot of information, what are your thoughts?” Or, “how do you feel about it?”
Keep your focus on the patient and use your listening skills to connect with them.
Most importantly, follow the patient’s lead-if they aren’t up to talking it’s ok to sit quietly.
5. Don’t Marginalize Their Feelings
While this might seem obvious, sometimes it can be uncomfortable when patients make negative comments.
For instance, if your patient says, “This isn’t living, I thought I’d be dead by now. I wish someone would just take me out of my misery.”
In response, you might be tempted to say something like “it’s going to be ok” or “I know how you feel.” (DON’T)
No matter how you might feel, don’t blow off their feelings or ignore their comments.
The truth is, this is a perfect time acknowledge their feelings and to listen.
Here’s what you can say instead: “It sounds like you are having a hard time. What’s on your mind?” or I’m here to listen, let’s talk about what going on?”
Also, indulge them when they daydream. If they haven’t eaten in a while (i.e. feeding tube) let them talk about that perfect steak or burger if they want to.
Sometimes, I’ve “planned” full meals with a patient because they were daydreaming about the traditional Thanksgiving they weren’t able to have because of their illness.
Like I said earlier, they are not dead yet so don’t treat them like they are!
Conclusion
In summary, interacting with a dying patient can be stressful and emotional at times. However, if you get in tune with your own feelings and listen to them, you will be fine.
Allow yourself to get into the moment and be truly present. Caring for people at the end-of-life is an honor so listen, listen, and listen.
The gift you get from them will be far greater than you are able to give.
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