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End of Life: Providing Comfort

Fear, anger and inadequacy are some common feelings we experience when we must deal with our own or a family member’s mortality.

An understanding of how to help comfort someone who is near the end of life can help us cope with these feelings, and allow us to provide more effective support and care for our loved ones.

The National Institute on Aging, in its literature about the end of life, discusses four main areas of comfort that should be addressed at the end of life. These four areas are mental/emotional, spiritual, practical and physical.

The provision of mental/emotional comfort will vary since everyone will have their own experience with death and there is no right or wrong way to think or feel about it. People are often afraid of talking about death and don’t know what to say to someone who is dying. They try to offer platitudes, which although are meant well, usually aren’t helpful.

Instead, let the individual know that you are willing to listen, and allow the dying person to guide the conversation. Some people may be willing to share their thoughts, while others may not be ready. Don’t be offended if the individual chooses someone else with whom to talk. Sometimes, sharing thoughts and feelings with family or friends can be more difficult than sharing them with a more “neutral” party, such as a medical professional.

Dying people may have specific fears or concerns, such as being alone at the time of death, or leaving others behind. Some fears and concerns (like the two mentioned previously), may be common among those who are dying, while others may be highly individualized. It is important not to assume that you know what someone’s fears are, or impose your own fears on the individual. These situations may lead to misunderstandings and tension instead of comfort. A dying individual will be comforted when his or her own fears and concerns are validated and attempts are made to address them, no matter how trivial they may seem to others. Meeting this need will allow the individual to relax and focus energy and attention on important relationships.

Other mental/emotional needs revolve around the environment. How many visitors does the individual feel comfortable with at one time? What about lighting and noise levels? Absolute quiet is not necessary — the noise of daily activity may be reassuring. Background music may or may not be appreciated.

Consideration of an individual’s personality can help guide routines and activities. Those who are dying but who are able to tolerate activity will appreciate being treated “normally,” and may have a need for time alone. Respecting the individual’s ability to make choices and retain autonomy for as long as possible also is an important factor in promoting well-being.

Recognition that some dying individuals experience a phenomenon called “nearing death awareness” can help minimize feelings of surprise and alarm by loved ones.  The dying individual may see or hear other loved ones who have previously died, or say/do things that don’t seem to make sense.  These experiences are real to a dying individual, and it is most helpful if loved ones are able to go with the flow.  Encouraging the individual to share more about their experiences can bring greater understanding about what is happening.

Understanding an individual’s spiritual needs will also contribute to their level of comfort The belief that one’s life has been meaningful provides a sense of peace to many people. This meaning can be reinforced by sharing memories, verbalizing the importance of your relationship with the dying person, discussion about personal beliefs and faith, and prayer. For people who are distant and unable to visit in person, these activities can be shared through letters, recordings and even Skype.

When speaking with the dying individual, asking open ended questions about beliefs, meaningful experiences, and regrets can help initiate a discussion of potentially sensitive topics. Sharing tears can be cleansing for everyone. Writing down information that is shared verbally may become a source of comfort to family members and friends after the individual’s death. To achieve a sense of closure, the individual may require assistance to make telephone calls or write letters to others to say thank you, offer an apology, ask for forgiveness, or say goodbye.

Hopefully, these tips will help you feel more empowered to provide comfort to those who are dying, so that you may put your love into action, and your remaining time spent together will be honest and meaningful. Next week’s column will cover the last two areas identified by the National Institute on Aging — practical comfort and physical comfort.

Karen Kaslow, RN, BSN