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.”