Comfort care for the dying person
Definitions & Key takeaways
Comfort care for a dying person can be challenging, but as a healthcare provider, you must learn what to do in such a situation. Comfort care for a dying person is about making them as comfortable as possible in their final days or weeks. This might include providing a comfortable place to rest, gentle touch and massage, soothing music, soft lighting, and nutritious food and drink.
It's also important to provide emotional support to the dying person and their loved ones. This might include talking with them about their life and what they're looking forward to, sharing memories, or simply lending an ear. It can be difficult for everyone involved, but providing comfort care can make it a little bit easier.
Intro 0:00–0:54
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.
Signs of Impending Death 0:54–2:40
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.
The Dying Person’s Bill of Rights 2:40–3:28
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.
Physical Needs 3:28–5:36
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.
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.
They may also have diminished vision so make sure that the room is well lit, and when entering the room, don’t forget to introduce yourself.
Finally, people who are dying are still capable of hearing even though they might not react. Try to minimize noises by reminding the client’s family as well as members of the healthcare team to talk quietly.
Explain procedures as usual and let the person know that you’re there to help them. Also, talk to them and encourage family and friends to do so; however, remind them not to discuss topics that can upset the client.
When caring for a dying person, it’s also important to meet their emotional needs. Many people have fears regarding death.
Emotional Needs 5:36–7:33
For instance, they may have a fear of dying on their own, that death will be painful, that their loved ones will be unprotected, or that they will lose their dignity.
Sometimes, people feel better when they express their fears, or they want to talk about significant moments in their life.
Make sure to spend time with them and be a good listener. You don’t have to say anything in response: just encourage them to share their thoughts and concerns and let them know that you are there to listen.
On the other hand, many dying clients prefer to remain silent and may become agitated if you attempt to start a conversation.
Observe closely for signs to decide whether your client wants to talk. However, even if your client doesn't want to talk, make sure they know you’re still there watching out for them.
Alright, another important aspect of caring for a dying person is to meet their spiritual needs. Religious and cultural beliefs can affect how a person responds to death.
Some religions and cultures accept death and feel comfortable discussing it, while others fear it or consider it a private matter.
They can also provide explanations regarding what happens after death. For instance, some people believe there's an afterlife where all dead people meet, while others believe in reincarnation, meaning that a person’s soul comes back to earth and lives inside another human being or inside an animal.
Many people that are dying find strength in their religion and wish to pray, meditate, or read religious texts. If you’re asked to assist in any of these, accept their request even though you may not share their beliefs.
You may also be asked to arrange a visit with a clergy member. During the visit, ensure privacy by remembering to close the room’s door.
Some people don’t belong to a specific religious group but can still be considered “spiritual,” which means that they believe that a higher power can provide them with strength and hope.
These people find peace reading poems or listening to music. Now, the family of a dying client also needs support.
Supporting Family and Friends 7:33–8:42
Remember not to take it personally or engage in their anger. Instead, be empathetic and acknowledge their feelings.
However, there are some tips you can use to provide comfort to the family. First, make sure that the healthcare team allows family members and friends to spend time with the dying person to talk and say their goodbyes.
But, if you notice your client is getting tired, you need to report to the nurse. Also, be sure that there are chairs for family members and friends to sit down and that they’re properly informed about the rest-rooms, coffee places, and where they can get something to eat.
Whenever you feel that the family is getting tired, offer to stay with the dying person while they take a short break. Remember that the most important thing for the family is knowing that their loved one is receiving the best care possible.
Reporting 8:42–9:28
Also, inform the nurse if the client has difficulty breathing. Next, let the nurse know if they request the support of a clergy member.
Also, inform the nurse if the client or a family member asks a question regarding their care that is not within your scope to answer.
Report to the nurse if you notice a conflict within the client’s family that may affect the emotional status of your client.
Recap9:28–10:03
It’s also important to be familiar with their rights as established by The Dying Person’s Bill of Rights to promote death with dignity.
Also, be sure that both their physical and emotional needs are met and do your best to comfort their family and friends.
Finally, report your observations to the nurse and remember to
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