On Death and Dying

A couple of articles of note, both longish, but definitely worth reading. For nurses, in any setting, providing care around death and dying is probably the most profound and meaningful thing we can do — and I have seen nurses do it exceedingly well, with sensitivity and empathy. Excerpts:

The Last Hours of Living: Practical Advice for Clinicians

Clinical competence, willingness to educate and calm, and empathic reassurance are critical to helping patients and families in the last hours of living. For most dying patients, predictable physiologic changes occur. Management principles are the same at home or in a healthcare institution. However, death in an institution requires accommodations that include ensuring privacy, cultural observances, and communication that may not be customary.

In anticipation of the event, it helps to inform the family and other professionals about what to do and what to expect, including matters such as when rigor mortis sets in, and how to call the funeral home, say goodbye, and move the body. Care does not end until the clinician has helped the family with their grief reactions and helped those with complicated grief to get care. Care at the end of life is an important responsibility for every health professional, and there is a body of knowledge to guide care.

Life Review in Critical Care: Possibilities at the End of Life

When any form of life review is undertaken, a life is examined, and questions such as the following are asked: Who am I? How did I do? How did I live my life? Thus, an important difference between reminiscence and review must be addressed. Life review is “not a random sharing of pleasurable past events, but rather a structured process containing a component of self-evaluation.”  Life review can be used with both patients and patients’ families; the outcomes include increased life satisfaction and accomplishment, promotion of peaceful feelings, and a state of integrity. Furthermore, Garland and Garland contend that life review has a distinct purpose in end-of-life care by upholding the unique value of each person’s life. These themes are consistent with Erikson’s theories of development: the final task is ego integrity versus ego despair. Ego integrity involves acceptance of the course of one’s life, acceptance of one’s place in history, absence of death-anxiety, and satisfaction with life. In contrast, ego despair echoes in the words of the poet Robert Frost: “. . . nothing to look backward to with pride, and nothing to look forward to with hope, so now and never any different.”

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  1. #1 by JennJilks on Thursday 25 February 2010 - 1438

    You never fail to find good info. I am speaking at the NSM Palliative Care Conference in June, I intend reading the latter article in full. I will point out the former for the part of my audience that includes Primary Care Staff.

    I really felt that the care in this stage of life is sadly lacking by those who do not understand that their responsibilities must outweigh their personal issues.

    Thanks for pointing them out! Well done.

  2. #2 by Emes on Friday 28 May 2010 - 1112

    Thank you for your well written piece. Many of us unfortunately have read horror stories about the funeral business. Regrettably there are companies selling cremation urns online which are not much more reputable. While they spend lavish amounts of money on web sites dripping with sympathy – many of these companies are nothing more than a site that drop ships product. Beware of sellers that do not have a physical address or the names of the principals of the company on the site – what are they hiding from? I had an issue with a company called Perfect Memorials ( Perfectmemorials.com ) and there was no one from the company that would talk to me. While I could call to order an urn – I could not speak to an owner or manager over the phone – they insisted that we only communicate via email. An evasive tactic if I ever saw one! Perfect Memorials is really a company that invested heavily in the web – but puts very little into the human contact part of the funeral/memorial industry. I would be careful of Perfectmemorials.com and others like them.

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