emotional care of the dying patient

emotional care of the dying patient

the compassionate, consistent support offered to help the terminally ill patient and the family cope with impending death. See also hospice, stages of dying.
method The professional person providing emotional support for the terminally ill encourages the expression of personal feelings, anxieties, and experiences regarding death and empathizes with the patient and the family. To prevent conflicting statements, it is essential to know what the physician, other professionals, and family members tell the patient about the outcome. Effective support in terminal illness involves a nonjudgmental approach to the patient's relatives and significant others, an understanding of their problems, and efforts to assist them in the grieving process. The patient needs relief from pain, tender care, and continued attention through all the stages of dying. A patient may not progress through all of these stages or may progress through them in a different order. When the patient denies the prognosis and refuses to follow directions, the nursing staff does not interfere with or support the denial mechanism but spends time with the sick person and encourages self-care. During the stage of anger, often manifested by refusal of care and food and by abusive language and negative criticism of the staff, the patient is not allowed to indulge in physically harmful behavior but is encouraged to verbalize his or her anger. In the period in which the patient tries to make bargains, such as "If I could live until..." it should be recognized that time is needed to accept death and that the person may appreciate discussing the importance of various events and people in earlier life. When depression, marked by apathy, insomnia, inability to concentrate, poor appetite, and weariness, sets in, efforts to cheer the patient or interrupt crying are inappropriate. The patient may want only the most beloved person to be present. In the final stage of acceptance the patient usually experiences less pain and discomfort, seems peaceful and lacking in emotional affect, and appreciates care from people who are close and familiar.
interventions The nurse has the major role in providing emotional care for the hospitalized terminally ill patient and may help the family arrange for hospice care or home care when it is possible and desirable. The nurse may teach methods of care required at home, may assist the family in realizing the patient's need to live as normally and as long as possible, and may refer the family to the social service department and to community resources for assistance.
outcome criteria Sensitive emotional support appropriate to the stages of dying may help the person to move more rapidly to acceptance. The family usually goes through similar stages; therefore, support and counseling by an experienced person may greatly enhance the quality of life of the patient and family.