Dying Process Death and Dying,

Dying Process

Death and dying, while frightening to much of contemporary society, are quite nature -- parts of the cycle of life. Dying should not be feared, nor should it be filled with pain and consternation. Yet, the cultural paradigms surround the issue of death and dying change considerably by culture, chronology, and even geographic location. Based on the last century or so in the United States, contemporary society has institutionalized, marketed, packaged, and managed the end of life. Death and dying have lost all semblances of spirituality and reverence, instead becoming a mind-numbing set of products to market and industries to support. Author and grief counselor Elisabeth Kubler-Ross similarly asks, "are we becoming less human or more human" in terms of how we treat the dying? (Kubler-Ross, 2005).

Nurses, in particular, have a number of challenges in effectively managing the pain of terminally ill patients. Doing so requires a great deal of empathy combined with a strategic approach to the subject. In fact, research shows that ongoing assessments of pain is crucial under the terminal circumstance and can be assessed by the nurse in a variety of ways. Unfortunately, in many cases, nurses either overdo pain medication requests since the "patient is terminal," or mismanage dosage which alleviates little pain and only causes further issues (Miller, et.al., 2001).

For this issue to be solved properly, the nurse first needs to determine if the pain is nociceptive (somantic or visceral pain) or neuropathic (continuous dyesthesias, lancinating, or paroxysmal). Nociceptive pain is usually the result of actual or potential tissue damage and represents itself as aching, throbbing, or stabbing pain. Visceral pain, on the other hand, is gnawing, cramping, aching from internal organs. Duration and an accurate assessment of type of pain or combination of pain is thus important due to pharmacological resources that respond to differing types of pain centers (St. Marie, 2009).

For example, there are new NSAIDs that have less gastrointestinal effects, but do not handle deep tissue or bone pain. Deep tissue and bone pain typically need corticosteroids added to actually alleviate discomfort. Bisphosphonates may also be used when pain is not controlled by NSAIDs. When dealing with neuropathic pain, either continuous and constant burning sensations or sharp, stabbing and shooting pain, tricyclic antidepressants are often used, as well as local anesthetics depending on the severity and location. Most all of these do, however, have side-effects, and part of the nurse management paradigm is ensuring that the pain is managed but discomfort from other effects not magnified (McCaffrey and Pasero, 2000).