The scope of modern nursing practice is multifocal, and spans the entire span of human experience, including; birth, infancy, childhood, adolescence, adulthood, old age, and death. Death, and dying are unique aspects of nursing practice in that they represent the ending of physiological maintenance, and care, but the beginning of a unique aspect of spiritual and psychosocial care for the patient, patient’s family and love ones, and the nurse him/herself. The finality, and totality of death increases the stressors on the patient, family and friends, and the nurse, and can contribute to the anguish of those aforementioned individuals who may be already in a volatile state. While encouraging the patient, family and friends to express their feelings, the nurse must realize that the difficulty of the situation may lead to the nurse him/herself being the target of anger, and the nurse should be empathetic to the experiences that are occurring, and not react on a personal level (Lewis, Bucher, Heitkemper, Harding, Kwong & Roberts, 2017). Due to my extensive history of loss within my direct family circle at a young age, I innately empathize with the family members of dying patients. It is because of my many experiences with loss that I understand that each individuals grieving process is unique, not only from individual to individual, but from one experience with death to the next. Although the uniqueness of each individual’s experience of grief is compounded by the cultural, ethnic, and economic differences among groups of people and results in an infinite spectrum of experience, finding ground common ground is still comforting, and reassuring to those who are entrenched in the throes of grief.
Experience and Beliefs Related to Death and Dying
My first experience with death came when On December 14, 1989 when my sister and I were was roused from sleep by my mother entering our room in tears, and unable unable to form a cogent sentence through her crippling lament. When I finally could discern the words that crept from between the tears, what they revealed left me in horrified disbelief. My father, a man who through the course of my life had been an unbreakable pillar of strength, a limitless volume of wisdom, a orator of keen insight, a bastion of boundless energy, a volcanic element of tumult, a wordsmith with rapier wit, a purveyor of scientific inquisition, and a harlequin of ridiculous joviality had committed suicide in his office with a rifle earlier that morning. My family was shattered, spiritually, emotionally, and economically. We all were angry, unspeakably so. Angry with my father for leaving us, angry with ourselves for not seeing any of the warning signs, and angry with God for not intervening on our behalf, and preventing him from taking his life. This would not be the only time that death struck while I was still a teen. Within six months of my father‘s death my grandfather, and uncle had passed as well. Two of my best friends, Giovanni, and Arlen would pass of overdose and murder respectively, before I was 20. Within five years of deaths of Giovanni and Arlen, my younger sister, Vanessa would pass tragically in a car accident at 23 years of age. As much as losing a large portion of my family and friends in such a short period of time affected me, the loss of my sister has had the most enduring impact on my mother, my brother, and myself.
Of the people who passed away during that ten-year span, the only one well I knew was dying was my grandfather, as he had been diagnosed with stage four prostate cancer which has metastasized to his bones in 1988. We made many pilgrimages, my mother, sister, brother, and I to his home in Riverside. We would help reposition him in bed, bathe him, play giant cards (he had lost most of his vision from cataracts and couldn’t see the smaller playing cards any longer) and listen to his stories between doses of morphine (which made him incoherent, drowsy, but allowed him to drift off to sleep), as he slowly wasted away over the course of those two years. We were in the hospital with him when he passed, and I will never forget not having the strength to see him before he took his last breath. I understand that as a child it was completely reasonable for me to be frightened, but I’ve never been able to completely reconcile my guilt, as I was the last person he asked to see before he died, but I could just not muster the fortitude to say goodbye and was still in a state of shock from my uncle, and father‘s deaths earlier that year.
The Nurses Role in Postmortem Care
The nurse has many roles after a patient has been pronounced dead, yet these functions should be done with extreme care as to not insult the cultural, ethnic, or religious beliefs of the family, and in accordance with state law. Generally the nurse’s duties immediately upon the pronouncement of a patient’s death would be to: … close the patient’s eyes, replace dentures, wash the body as needed (placing pads under the perineum to absorb urine and feces), and remove tubes and dressings (if appropriate). The patient’s body is straighten, leaving a pillow to support the head and prevent pooling of blood and discoloration of the face. (Lewis, et al., 2017)
The following are a general guidelines and the nurse should adhere to the cultural, religious, and ethnic traditions of the deceased and their love ones if it all possible. The nurse should take effort to become informed of the individual terminal patient’s religious, cultural ethnic, and spiritual beliefs so that adherence to these principles unfurls smoothly. Although during my LVN rotations I had a patient pass away, I was not in clinic on the day she passed, and therefore have not experienced the duties of postmortem nursing care first hand.
Personal Faith and Death
Personally, I not only have experienced the death of many family members, and close friends, but I’ve been very close to death on more than one occasion, and have never been overwhelmingly terrified of the experience. For example, when I experienced septic shock, just before I fell into unconsciousness, the last Overwhelming feeling I could remember was not the fear of death but, the fear of causing my daughter, mother, brother, girlfriend, and niece the grief that I had experienced with the loss of my friends and family, whom I’d loved so deeply. The knowledge that we would be rejoined once again was comforting, even upon witnessing the impending darkness before I awoke again to see them surrounding my hospital bed.
The Nurse’s Role in the Dying Experience
The nurse’s role in the care of a dying patient is expansive and encompasses emotional, spiritual, and physical care of the patient and their family, and loved ones. The nurse should encourage the dying patient, and their family to make decisions about the end of the patient’s life with as much forethought as possible, using the nurse’s unique position to foster conversations about the desires and preferences of the dying patient well in advance of the patient’s eventual demise (ANA Center for Ethics and Human Rights, 2016). The nurse will encounter patients of many different ethnic, and religious traditions of disparate origin over the course of their practice. To many patients comfort, hope are found in the idea that their souls will persist indefinitely after death, be reunited with their passed love ones, and/or find peace, and it is within the role of the nurse as a spiritual caretaker to foster participation in these personal spiritual practices, and cultural traditions (Potter, Perry, Stockert & Hall, 2017). In the context of providing care for an end of life patient, assessment, and treatment shift from interventions meant to maintain functionality, to interventions intended to alleviate pain and provide comfort. Although a premium is placed on a alleviating pain with medications and easing shortness of breath with oxygenation, end of life nursing interventions supersede the mere administration of analgesics, and oxygen. Due to vulnerable state of the dying patient psychosocial care such as: encouraging the expression of feelings, allowing time to internalize the realization of the situation, fostering an atmosphere of hope through spiritual practice, maintaining a presence to prevent the fear of loneliness, encouraging and assisting patients to identify positive aspects of their lives, and communicating, empathizing and paying attention to subtle nonverbal cues to encourage a candid, and trusting relationship with the attending nurse Earl invaluable features of end-of-life nursing (Lewis, et al., 2017).
Over the course of my life, experiencing death in many different ways, and at many different times, I’ve come to understand that the pain of loss never truly leaves. With the passage of time, support of loved ones, the love of God, and the knowledge that through Christ death is not the end, but the beginning, the burden of death lessens over time. For it is clearly stated in John 20:31(New King James Version), “but these are written that you may believe that Jesus is the Christ, the Son of God, and that believing you may have life in His name.”
- ANA Center for Ethics and Human Rights. (2016). Nurse’s Role and Responsibilities in Providing Care and Support at the End of life. Retrieved from https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf
- Lewis, S. M., Bucher, L., Heitkemper, M. M. L., Harding, M., Kwong, J., & Roberts, D. (2017). Medical surgical nursing: assessment and management of clinical problems. St. Louis: Elsevier.
- Potter, P. A., Perry, A. G., Hall, A., & Stockert, P. A. (2017). Fundamentals of nursing. St. Louis, MO: Mosby Elsevier.