Three Things Every Nurse Needs to Know to Provide Excellent Care for the Dying

Three things every nurse needs to know

Three things every nurse needs to know

Putting Death on the Table: By Kath Murray

On Feb 1st I gave myself an assignment when I sent the “Putting Death on the Table” one page ad to CLPNA for the CARE magazine.  My assignment, to write about the THREE THINGS THAT EVERY NURSE NEEDS TO KNOW TO PROVIDE EXCELLENT CARE FOR THE DYING!  This sounds like a great assignment, but imagine having to formulate the content!  Imagine inflicting this painful assignment on oneself!

Over the past month I have pondered this assignment daily.  During this time I identified at least a dozen things that one absolutely needs to know, value, or do, in order to provide excellent care for the dying!  I struggled to articulate the ideas, and struggled even more to prioritize the ideas.

Then tonight a woman expressed gratitude for the “Essentials in Hospice Palliative Care” text.  She described how the information helped her to understand what was happening as her friend died, and how she was better able to support and companion her friend through to death because she felt comfortable with the process.  She expressed a profound sense of gratitude for the experience, how companioning her friend through to death was life changing.  As she spoke I remembered the most important things for us to know in order to provide excellent care for the dying.   Years ago, as a brand new hospice nurse I identified three things that we need to provide excellent care….  Stop.  Look and listen.  When we are invited – cross the street.

We need to stop.  Put our agenda on hold.  Get our issues out of the way.  Quit worrying about the multitude of other things going on.  Take a deep breath.  Imagine clearing your brain of all the business and fussing.  Take a broom and sweep the path clear, allow the fresh air to blow in through open windows.  Breathe in the fresh salt air.

Look and Listen.  Look at the person, the family/loved ones/companions.  Assess what is happening.   What are the needs – needs that are spoken and those unspoken?  Listen to the concerns, fears, and questions. Assess not only the physical needs, but the psychosocial needs, the practical needs, the issues of loss and grief.  Assess how best to provide care, how to share information, and how to support informed decision making.

And then, sometimes, if we have stopped, looked and listened, we are invited to cross the street with the dying.  We journey with them for a ways.  We provide a safe place, a sacred place.  At some point, they continue on their journey, and when they are gone, we turn back.  Our lives, like the woman I spoke with tonight, are changed.

Sir Edmund Hilary said “We summited Mt Everest because of the people at base camp.  We could not have summited without their support.”  So it is with other journeys in life.  We cannot climb some peaks in life without the support of loved ones to share the load, help us navigate new land, and help us learn new skills.  Then, secure in their safety net, fortified by their strength, and inspired by those we love or trust, we rest, regroup, gather strength, and move onward.

A woman once said to me, “Dying ain’t for wimps”.  And another, “You only die once”.  And still another, “You don’t get to do it again”.

While we wait at base camp, we might hear requests for information about common issues and needs, comfort, and communication.  You might hear, “It’s not being dead, it is the dying I fear”.   You might receive questions about timelines,   “How long do I have?”  Or preferences, “I don’t want to die in pain.”  Or limits, “I have had enough.  I am tired.  No more tests. I want to die.”

The ground upon which we walk is sacred ground.  If we listen to the needs, the questions, and the concerns, we will have sacred opportunities to companion, be with, share information, education, and support informed decision making. As nurses our role includes being educators and being advocates.

When we listen, our role becomes that of advocate to communicate and ensures patients preferences and desires are met.  As nurses, we then, not only value the patient’s voice, but we value our own voice as well.

If we STOP LOOK and LISTEN, we will be privileged to hear needs, wishes, dreams and fears.  As nurses, it is our rather sacred privilege to provide a safe base camp, and to help patients prepare for the next step of their journey.

2 thoughts on “Three Things Every Nurse Needs to Know to Provide Excellent Care for the Dying

  1. Stop. Look and listen. When we are invited – cross the street.
    Three things a nurse needs to know to provide care, and what other care providers also attend to so naturally. They know the one they are ‘being there for’… they are our greatest source of taking a lead from along with the patient particularly, if they are not able to articulate or able to ‘be in control’ of what they want, need or desire. Knowing that the table can turn and the nurse/ health care provider is the one to step in a take the lead when the caregiver is struggling to ‘be there’ for the one they are caring for. It is okay for them to ‘just be there’ as this is powerful medicine for the one dying and we are the providers of other needs they cannot meet within our skills and personal abilities.

    Yes, our biases and personal belief systems can influence our approach to care but it is best to reflect on this and how it may impact negatively or positively, or derail the path the dying individual is on that is giving them what they sense they need to do from their own biases, spiritual beliefs, and grief stages their come and go into.

    I have never worked in Hospice but over twenty years in nursing I have gleaned this understanding through personal and professional experience in various areas in my work. I have attended various Hospice related courses/seminars that help to strengthen the concept of nursing ‘differently’ then in acute care where we are always just ‘flying by the seat of our pants’ because of the pace of the work environment or inadequate staffing support ratios. I am very cognizant of still remaining with a mindset to apply when a moment/situation I come across calls me for a ‘deeper’ nurse connection with my patient. I just close the curtains around us and ‘just be there’ and take the lead by what I see, hear or sense is the need in ‘the moment’. I value this as care provider and this is what brought me into nursing in the first place. I never want to lose that ability to ‘take the moment’ but I constantly experience the conflict of ‘time’ to do this.

    I thank you for this article as it prompted me to share my reflections in response to the words you shared.

    Carrie

  2. I question precisely why you called this specific article, “Three Things Every Nurse Needs to Know to Provide Excellent
    Care for the Dying | Kath’s Blog”. In any case I really enjoyed it!Thanks a lot,Barbra

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