Comfort care for the dying person

Caring for a dying client can be challenging, and your own personal feelings about death can affect the care you provide. If you have fears about death and have not yet come to terms with the idea of dying, you may be unconsciously reducing the quality of care you provide.

For instance, you may avoid spending a lot of time in the room of a dying client because you’re afraid they might want to discuss death.

Also, you might check in on them less frequently than other clients because you don’t want to become attached to your client. These are normal fears, especially for a new nursing assistant.

It can be helpful to share your concerns with the nurse as well as to discuss it with a clergy member or a mental health counselor in order to explore your own feelings and beliefs about death.

A person can die suddenly. However, sometimes, there are warning signs that death is near and that it will occur in the next minutes, hours, or days.

So, being able to recognize signs and symptoms that death is near will help you know what type of care your clients need.

Signs of impending death include abnormal vital signs due to a slowing down of blood circulation and include decreased blood pressure and a rapid and weak pulse.

The skin can appear pale; cyanotic, meaning blue; cool or warm; and mottled. Next, they could have irregular, shallow breaths, called Cheyne-Stokes respiration.

They could also have heavy and noisy breathing, called a death rattle, which is caused by saliva building up in the back of the throat.

As death approaches, the digestive system will also slow down, and the person can experience nausea, vomiting, abdominal distention, or fecal impaction or incontinence.

They may also refuse food or water, leading to dry mouth. The urine output also decreases, and the person may have urinary incontinence.

As the nervous system becomes affected, they may also lose their muscle tone, and this makes it difficult for them to reposition themselves without assistance.

They can also lose their ability to speak, and they can have blurry vision. Hearing is usually not affected until the moment of death.

During their final moments, the person may be alert or become unconscious and enter a coma. Family and friends may also notice these signs and become worried.

In this instance, you have to reassure them that these signs are normal when death is approaching.

Now, a person is considered dead when there’s irreversible cessation of the heart beat, respiration, and brain activity. Death needs to be legally confirmed by a physician or nurse authorized to pronounce the person’s death.

To ensure that every person will die with dignity, the Dying Person’s Bill of Rights has been established. During the dying process, everyone should be treated as a living human being until death occurs.

The dying person has a right to remain hopeful and be cared for by those who give them hope. They have the right to share their personal thoughts and opinions about death and to express their religious and spiritual beliefs without being judged.

They have the right to participate in decisions concerning their care, to have their questions and concerns answered honestly, to have their pain managed, and to receive care regardless of their prognosis.

They have the right to have their family members participate in their care, to not die alone, and to die in peace and dignity. Finally, they can expect that their body will be respected after they have passed.

Alright, now when caring for a dying person, it’s important to use a holistic approach, making sure you meet both their physical and emotional needs.

Starting with physical needs: You should keep their linens clean and providing skin care can prevent skin breakdown related to urinary or fecal incontinence.

Regular position changes are needed to prevent pressure ulcers and promote comfort. Pillows or rolled blankets can be used to maintain body alignment.

Next, providing ice chips and regular oral hygiene are essential as the client stops drinking fluids or becomes comatose; check with the nurse to see if a lip balm is ordered for the client.

They can also have dry eyes because they’re not blinking as often, and mucus may develop in their eyelids. Using a moist washcloth, clean their eyes gently.

You can also ask the nurse to apply a special eye ointment. If you notice that the person is in pain, notify the nurse, so medication can be administered to relieve the pain.

For clients that have difficulty breathing, remember that they will be more comfortable with their head elevated.

Another important aspect is to ensure that the dying client’s room is clean: empty emesis basins, control the odors, clean dirty urinals and bedpans promptly, and check that the wastebaskets are emptied regularly.

If necessary, you can also use an air freshener to eliminate bad odors. Also, ensure that your client feels warm or provide them with an extra blanket if necessary.

A dying client might have difficulty speaking so ask simple questions that can be answered with a simple yes or no, or with a head nod.