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Your Role in Caring for Someone at the End of Life
You should remember two important concepts when caring for someone who is terminally ill.
The first thing you must do when caring for someone who is at the end of life is to accept the person and the choices he or she makes about how to live and how to die. You must accept the person’s religious beliefs, the values of his or her cultural and ethnic background, and the person’s wishes about what to do and whom to see. You must accept the person without judging his or her decisions. Your job is to listen, encourage, and support the decisions he or she makes.
If you find that it is impossible for you to support a dying person because you feel strongly that the person’s decisions or beliefs are wrong, you must tell your supervisor about it. Sometimes it is necessary for the supervisor to transfer your responsibilities for the dying person to another caregiver. A terminally ill person will probably know when a caregiver disagrees with his or her choices, and this can cause the person to feel afraid, abandoned, or defensive. In this case, it is best for someone else to care for the person if possible.
Relief of suffering through effective care
Good care can relieve much of the pain and discomfort that a person may experience during a terminal illness. You should always be checking to determine whether the person is uncomfortable and finding ways to improve the comfort level. Some things you can do include:
• Position pillows comfortably
• Moisten lips and mouth
• Rub lotions on the skin
• Position body comfortably
• Provide good oral care
• Watch for skin breakdown; give skin care
Pain is not the only symptom that should be relieved. Nausea, constipation, anxiety, depression, difficulty breathing, and other symptoms should be reported to the nurse or case manager so they can be treated with medications and other therapies.
When a person is dying, the need and the desire for food and water decrease. You should not force food or fluids on someone who doesn’t want it. Remember that competent adults have the right to refuse any treatment, including food and water. Often, a terminally ill person will have a craving for a particular food, but when it is brought to him or her, he or she will take only one or two bites and say he or she is finished. The best thing to do is get the patient the food he or she wants if at all possible, but don’t force him or her to eat it. One bite may satisfy the craving.
A dying person may not want to drink anything, but the lips, mouth, and throat might get dry. You can relieve this discomfort with small sips of liquid, ice chips, hard candy, and oral hygiene. You should not force someone to drink more than he or she wants.
Don’t be worried about “starving” someone to death if the person is dying from a terminal illness. The illness is causing death; death is not caused by the decrease in food and water. If the person is allowing the natural processes of death to occur, he or she will want only enough food and water to be comfortable. Giving food and water only when it is wanted can allow chemical processes to occur in the body that actually decrease pain and discomfort. Forcing food and water on a dying person can greatly increase pain
and suffering and cause a more difficult death.