I was just reading something on Facebook and it started me thinking about this question. What if a patient asks you if they are dying or what if a family member asks you this? How do you answer?
When I was a student nurse and then when I first started my career we were told that only the doctor answers this question or talks about death with a patient. Nurses were not allowed to answer truthfully. So, how do you handle this? Well, you kind of hem and haw and come up with something. I guess you could say that you don’t know. How can the nurse not know? You might be as honest as you can be and say that you can’t answer that question. I guess that answers the question without really saying yes, or does it?
This is a difficult question both for the family and patient and the nurse. No one wants to deal with this. The one thing you should remember is that the patient, especially, already knows that he is dying. If you answer with a lie or partial truth, how do you think that the patient is going to feel. Will he ever trust you again with anything? Probably not. I know I wouldn’t.
The other thing that this does is to prevent the patient from talking about his death and life. I have had patients tell me that they so wanted someone to talk to, but they couldn’t talk to anyone. The family is too fragile to talk to and the nurse is not available to discuss this. The patient feels all alone when he needs to talk about this and get the support he needs. He is probably scared to death, but has to deal with this by himself. Is this right?
Things have changed regarding this rule since then. Thank God. Nurses are able to answer more honestly without the fear of retaliation. It is still a difficult thing to do, but at least the option is there. Some nurses still are not comfortable to talk with patients or family about death, but they no longer have to lie when asked if they are dying.
I have worked in mental health much of my career and feel that I am comfortable talking with people about most everything. I particularly like working with depressed people and doing grief therapy with people that have lost or are losing loved ones. However, when it came to my own family, I kind of dropped the ball.
My sister had liver disease for many years and kept getting worse and worse. It finally came time to talk about a liver transplant. She did have the transplant about two years ago. Only recently has it become more and more apparent that she was getting near the end without it. I think about what it must have been like for her living with this and not having anyone to talk about it with. Her husband and children were dealing with the possibility of losing her and were so busy trying to find options for her and telling her it would be ok that they could not focus and how she was really feeling and what she was going through.
Where was I? I could work with others that were dealing with this, but not with her. Why not? Maybe I am human? I am not sure. Even now I do not bring it up with her. It is time to, I think. I am sure that she still thinks about it and probably about issues related to the transplant. I need to step up and allow her to talk about this if she wants to. I definitely do not want her to feel alone with all of this.
I am sure that the elderly think about the end of life, too. When you are young it doesn’t enter you mind much of the time. However, when you get older you have a lot of time to think about the subject of death. Again, the children and family do not bring this up with their parents, as they are trying to deal with the possible loss of their elderly parents. So, the elderly, too, are alone to deal with the end of their life.
Nurses need to allow patients to express their feelings about dying. No one should be left alone with these feelings. Nurses, in turn, need support to do this. They need to find ways to cope with a lot of things. Suffering and death is a fact of life in nursing. They see death and suffering every day at work. They, too, need to talk to someone about what this.
After I retired I wanted to start my own business, but I had no idea how to do this. I found a company called Wealthy Affiliates that teaches you step by step how to do this. I am not sure how to relate this to the subject I was discussing, except to say that probably the most important aspect that they give you is support. Someone is always available to answer questions you may have about what you are doing as well as to just give you the support and encouragement you need to move on at times. We all need this and they are very good at this.
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