Introduction

Important Issues in the
   Care of the Dying

Your “Job” in the Death and
   Dying Process

Hierarchy of the Dying
   Person’s Needs

Living with Spiritual Distress

Overview on Death from a
   Traditional Jewish Perspective

The Role of Culture and Diversity

Signs of Impending Death

Resources

Action Ideas That Work

“Real” Intersection of Systems

Helping Individuals Face Important
   Decisions at the End of Life

Questions That are Good    Conversation Starters

Common Questions and Answers

Advance Care Planning

Advance Health Care Directive

Living Will

Durable Power of Attorney for
    Health Affairs

Hospice Care

Helping Survivors Deal With Grief

Questions and Answers About
    Health Care Directives

Handouts

References

Important Issues in the Care of the Dying

In the care of the dying, it helps to believe a definition of hope that moves beyond cure. Hope for the dying becomes hope to experience a dignified death, surrounded by the support and comfort of loved ones, with as little suffering as possible. You can help dying individuals experience this type of death by focusing on these important issues:

1. Help the individual control pain and physical symptoms. Pain is one of the things most feared by patients with a life-threatening illness, and it comes in many forms, including physical, emotional, and spiritual.
2. Involve people important to the patient. Individuals fear that they will face death alone. Those without a social support system often experience increased depression, sadness, anxiety, fear and loneliness. For those with emotional pain, simply being near them, and reminding them that you care, may be the best treatment of all.
3. Bring about acceptance of the situation by the dying individual. This doesn’t mean that you ask the person to give up all hope, but rather that they be realistic about their limits and possibilities as they approach the end of life.
4. Help individuals understand their medical condition. Most patients and their loved ones do not know the right questions to ask doctors, and do not fully understand what the doctors have said. You can “fill in the gaps” by explaining confusing medical terms, and even making sure they understand common medical terms such as do not resuscitate and CPR.
5. Guide individuals through discussions of what death means to them. People fear pain, anxiety, and emotional suffering. Some are concerned about receiving unwanted treatments, and are frightened of being abandoned. Others believe that life is sacred and must be preserved at any and all cost. Yet, many do not want to give voice to these concerns and philosophies. It is difficult to discern what an indiviual is thinking – some may be stoic, others upset. One may cry, while another may seem complacent. It is important for you to sit back and listen to what is, and is not, being said. With patient listening, you will be able to begin helping individuals discuss what is important to them, and not what they think others want to hear
6. Support the individual’s spiritual beliefs. For these times, flexibility is the key for congregational nurses. Some individuals may express their spirituality by telling stories about how they view their lives. Others may do so by talking about relationships that have been important to them. Some may want to pray. Others may want to listen to music, to be read to, or to simply hold hands in silence. Individuals may or may not be comfortable discussing the nature of existence and the possibility of afterlife.