Dr Erica Borgstrom is a medical anthropologist whose teaching and research focuses on death and dying, with a particular emphasis on end of life care. She has worked on former module K260 (Death and Dying) and will be working on the forthcoming K220 module (Death, Dying and Bereavement) in the Faculty of Wellbeing, Education and Language Studies.
For nurses, in training and in practice, the experience of dealing with death is a reality and part of their working life.Dr Borgstrom considers seven essentials to bear in mind when supporting someone who is dying. They are adapted from the Government publication Five Priorities for Care of the Dying Person to recognise the valuable work nurses do when supporting someone at the end of their life.
Dr Borgstrom says:
Caring for someone who is dying can be difficult, whether it be on a busy ward or in the person’s home.
Here are her seven reminders to help you if you do this vital work:
1. Recognition and action
If you think someone is dying, let others in the multidisciplinary team know. Recognising that someone is dying is not always easy, but it is often a crucial first step to ensure they receive optimum end of life care. As a nurse, you may have more hands-on interaction and communication with the person than other members of the team, giving you experience to base your claim on. So, speak up within teams and encourage a team approach in identifying and supporting dying people.
2. Review, review, review
Now’s the time to review any care plans that are in place. Have things like symptom control, food and drink, and routine monitoring been discussed? What are you doing to support the person psychologically, socially, and spiritually? Are there any preferences that need to be further explored? Creating and regularly reviewing individualised care plans can help maximise the person’s comfort and wellbeing towards the end of life. And having clear plans in place can help support nurses and other team members be more confident in the care they provide.
3. Words matter
How we talk can impact how people feel. If you haven’t done so already, find out how much the person and those close to them want to know about their condition. If they would want to know that they are dying, communicate this information and further information about how they will be cared for sensitively and in way that respects the individual. Remember that euphemisms can be difficult for some people to understand; and for others, where appropriate, a bit of humour may even help. Sensitive communication also goes for communicating within your team.
4. Listen, even if there is silence
Research about communication indicates that people feel valued when they feel like they have been listened to. Give yourself time to pay attention to what someone is saying rather than thinking about what you need to say or what question you want to ask next. Through listening, you may find out what is important to the person as they are dying, giving you an opportunity to acknowledge this and support them where you can.
5. Involve people in decision-making
This includes the dying person and those close to them. Explore with people, where possible, their preferences about care and treatment. Use their involvement as part of reviewing the care plan.
6. Find out who else might need support
This could be family, friends, or even other patients who are witnessing that someone is dying. Explore with them how the situation is for them and what support they may need. You may not be able to support them yourself, but you could be the link between them and someone who can. Even small practical support, such as helping sort out hospital car parking, can relieve some of the tension people can feel during these situations.
7. Look after yourself
Whether you regularly care for dying people or if this is a rare event for you as a nurse, it can affect you personally. Make use of the professional support available to you: supervision, any reflective groups, peer-support, and extra training. Doing this on an on-going basis can help reduce burn-out. Similarly, in order for you to be able to care for others, you’ll need to care for yourself. Even taking a short break and eating a snack can help!
On the face of it, these seven tips seem manageable. But we all know that under pressure it can be hard to feel like it’s possible.
Because of this, here are also three tips for managers, Trusts, and service providers to support nurses who care for dying people:
- Offer training in end-of-life care, and offer it regularly: high staff turn-around often means that there is inadequate knowledge or confidence
- Demand for end-of life-care is on the rise, make sure you are structurally prepared for this (i.e. more resources, identifying areas to develop)
- Staff welfare is paramount to service provision: build this in to your strategy for delivering high quality care.
Read about the OU’s Nursing and Healthcare Practice courses.