End-Of-Life Care Part II

Grief is not something that goes away on its own. If grief is not dealt with properly it can result in psychological problems for the sufferer as well as for the patient. A "positive coping style may be characterized by a spirit of inner strength. A negative coping style may be identified by helplessness or hopelessness, which may lead to more negative outcomes in dealing with life circumstances" (Guido 2010: 138). Grief that is not appropriately channeled can assert itself in unexpected ways: a husband may take out his anger at the loss of his mother on his wife, for example. Positive grief resolution can help the survivors have a more realistic and resilient outlook when confronted with future life events. Ideally, they can learn to honor the person who has passed without being overly regretful about what they cannot change. Grief that is dealt with in an unproductive fashion can do permanent, psychological damage and renders the individual incapable of 'moving forward' and making positive changes. A professional grief counselor may be required to help patients deal with such losses.

Topic 2: Cumulative Loss

My most memorable patient who passed away was a woman dying from lung cancer. She was not a heavy smoker when she was young, and had quit many years ago. She was healthy, fit, and active for her age. Her diagnosis was somewhat unexpected, which made it much more poignant. I felt very sad for her because she was only sixty-four and had wanted to enjoy many more years with her grandchildren. She had also nursed her husband through a terminal illness, and it seemed very unfair that she had no one to give her the same kind of care she had given him. Talking with her adult children was helpful for me as well as for them. It helped humanize her, even her last hours. "Families in the process of losing a loved one to death will often use storytelling as another means of coping" (Guido 2010: 139). I did not actively seek out support from colleagues at the time: I was relatively inexperienced so I did not want to seem 'weak' or 'selfish' in talking about my own grief, when the patient's family was experiencing such a terrible loss.

Topic 3: Unique Needs

The nurse has a unique perspective upon the prospect of a patient facing death. The nurse has the biological knowledge of a patient's condition and can give the family realistic guidance about the likely trajectory of the illness. The nurse is also trained to diagnose the family's unique social and psychological needs when facing death, as well as the needs of the patient. The nurse can place the patient's needs in a higher context of human spiritual values. "The more that a nurse is involved with end-of-life care, the more growth there will be in levels of experience and comfort in dealing with such issues" (Guido 2010:141). The nurse brings a wealth of experience and compassion combined with an objective view of the situation. However, the needs of every family will vary, depending on their religious traditions, ethnicity, and personal composition. Through talking with and observing the family the nurse must make his or her own unique diagnosis of the family's needs as death approaches. No family is the same.

Topic 4: Near Death Awareness

The most common and memorable sign I have seen in all patients near death is that they talk about seeing loved ones who have passed on waiting for them on the other side. At first I was surprised by this, but I have learned to expect and to honor this event. Patients near death express little interest in eating and often grip or play with the covers of the blanket where they lay. During this time the nurse's role switches from one who maintains wellness and life to that of a counselor and a supporter. Patients often want to talk about their life experiences, to have their life journeys validated by someone else. Particularly if the patient has no surviving relatives to give him or her sustenance, the nurse may need to step in to fulfill this role. Nurses may also need to intervene to affirm the dignity of their patients and provide comfort to patients in their last hours, if the patient's loved ones are emotionally incapable of doing so (Guido 2010: 140-141).

Topic 5: Self-Care

"Professional caregivers, such as nurses, may become overwhelmed by the experience of death that patients and families are facing as well. There may be situations where the patient is the same age as the nurse, or as the nurse's child, and it may cause deep psychological or emotional pain as the situation seems to be very close to the nurse's heart" (Guido 2010: 140). Having someone to talk to during difficult emotional periods throughout the nursing process is important. These may include colleagues or professional support groups for nurses. Engaging in effective self-care, like eating and sleeping properly, exercising, and taking time to do enjoyable things is important. It is easy to feel guilty going out and having a good time after dealing with someone who is at the end of life. Nurses must be able to give themselves psychological permission to 'have a life' as well as to save lives.