The Process of Dying as It Is
When one dies should they die in peace. Does this happen for all human life of course not. The process of dying is the same physically, but does not happen the same for all. To understand how death affects people as an individual look at factors that make the difference. The medical and physical that is given when dying is different for everyone. History shows that when people died the rituals were more to comfort the living, but we now understand death is not for the living, but for the individual who is dying, and for them to die with dignity.
Dying is inevitable. We are born dependent on another’s care, to only become dependent on others in the dying process to keep us safe and comfortable. The difference from birth to death is that we have lived, therefore becoming dependent on others, and not being able to handle life on our own terms is demoralizing. No matter how death comes, from illness, the aging process, or an accident, everyone has some sort of anxiety about how they are going to die.
There is a process to death. When given a terminal diagnosis it is up to the individual to have advanced directive, and a will for the wishes of the individual to hopefully be carried out. As a person giving care to someone who is at the end of life it is important to understanding the process of death, what happens during the last few days, the reason why death is apparent, and to know what the human body goes through.
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It is important to have this knowledge in order for a person to die with dignity.
History of Death
In the past a human died at a very young age due to unhealthy living conditions. They did not have immunizations, nor clean living conditions. People died from influenza, typhoid fever, tuberculosis, and digestive issues. Symptoms were treated by using cocaine as a fever reducer, and opium poppy derivatives as pain relievers. Most would pass away from their illness in their beds cared for by a family member. Due to not having advanced treatments like today most people suffered while also spreading the illness to others. When a person had consumption (known as Tuberculosis) they suffered with symptoms consisting of night sweats, and cough until they were consumed by illness. A person would suffer for up to three months before passing away.
Before one was pronounced dead, they would be watched closely for three days to make sure that they were not just sleeping. Dying was a part of everyday life in the 1800’s. Death had rituals as far as the way the living dressed, how the dead were dressed. The body of the dead would be kept in the pallor today known as living rooms for viewing, and paying respects. . Death was more focused on what society expected, and family wanted for their dearly departed. Not necessarily what the departed wanted during or after death.
In the late 19th century into the 20th century mortality rates decreased with advancements in medical treatments. Children started moving away from home leaving sick and elderly to be cared for at the end of life in nursing homes, and hospice institutions. With more treatments in hospitals and other facilities advancements in medicine thrived. With treatment and the ability to live a longer life an individual now can make it known their wishes at the end of life. They can donate organs, choose whether or not they would like to be resuscitated, some even have the option for self-euthanasia if a terminal illness will cause suffering. Protection for an individual’s rights and needs started with advanced directives which details the medical treatment, and end of life wishes a person have in order to have a plan if they are unable to express what they want during end of life. We now have more time to prepare for death when we are diagnosed with a terminal illness then in the past enabling us to make decisions for our medical care up until we die. We are now able to die with dignity.
Death Prognosis
A death prognosis is medical diagnosis given to a person due to failing health, whether it is cancer that is unable to be treated, or old age dying happens over time. Once a prognosis is given an individual will need guidance, and someone to be there for them. When a person has been given a timeframe of how much longer they have to live, even Before the physical symptoms of death begin, there are five mental, and emotional stages a person will experience. When it is explained a person has six months to live the first emotional driven thought process leads to Denial. It is a shock being told you are going to die.
They look for any treatment to cure their diagnosis. If at no prevail they realize there is not a treatment out there to prevent the prognosis anger will set in. Anger that this is happening to them, anger towards family, friends and doctors. This can lead to isolation as well. One will bargain with God or their higher power, asking for more time, or try to change things they might feel they do wrong to good in order to reverse their ultimate demise. When Depression sets one will feel they are at a loss. They are dependent on others to care for them without the ability to handle everyday common tasks on their own.
These stages don’t always happen in order, and will repeat themselves throughout the process. Hope should be encouraged, but not to the point to where someone believes they can be cured. Acceptance is a part of these stage, and is one that is sometimes not reached. A feeling that you are going to die no matter what is said or done begins, and a person will just give in either dying accepting their fate as this is what it is, or confident that they had a good life, and it is ok to go.
Anatomy and Physiology
Death can be from illness, or trauma. It can happen suddenly, or over a long period of time. No matter how death presents, we all go through the same processes from the day of diagnosis till the end comes, but not always in the same order. With the five mental stages a person will contend with, so starts the physical stages of death. The physical body starts with Pre-active dying. In pre-active dying a person will become restless, confused, and irritated. This is accompanied by increased sleeping time, a decrease in nutritional intake, and increased swelling. A person will express that they are dying, and will not be able to recover from wounds.
This mental unrest and physical deterioration can be from diminished organ function, possible infections, or dehydration. The pre-active stage can last for days, or even weeks until entering the active phase. . Due to deceased blood circulation in the body skin color can change to an ashy color, or cyanotic. Arms, legs, hands and feet will be cool to touch. This is the bodies way of keeping vital organs working by redirecting blood flow from extremities in order to keep the major organs functioning as well as possible. In order to keep the dying person comfortable blankets can be added for warmth, and turning every two hours in order to keep wounds from developing. There is less of a desire for food and water from a week to a few days before death occurs.
It is important not to force nutrition even though we might feel it is needed. Understanding that our bodies do not require nutrition due to the dying process and the inactivity requiring less energy. A natural process of the body is for the brain to release endorphins in order to relieve the stress and pain of the dying process. Endorphins do not relieve all pain this is why there is a need for analgesics, but they do assist in suppressing the feeling of hunger, and thirst. . Due to dehydration the ability to swallow becomes harder therefore if water or food is requested first only giving very small amounts in order to prevent aspiration. Without activity levels breathing becomes slower, and there could be a time spans in between each breath.
A dying person will take several short breaths with a long pause or apneic events before breathing again this is called Cheyne-stokes. Accumulation of secretions, and inability to cough will cause noisy breathing also referred to as a death rattle. Once the active dying stage begins a person will mostly be unable to arouse, if awake they could state they are seeing relatives who have passed away, maybe they are unable to feel parts of their body. In order to comfort a dying person, talk to them, even if unconscious they can still hear, but speak calmly and softly.
At this point yawning could take place as the body is trying to take in as much oxygen as possible. At the moment of death pupils will become dilated and fixed with no response to stimuli. Finally, the heart will stop beating, and breathing will stop. These are indications that the brain stem is no longer functioning. Once the physician has examined and is sure that a diagnosis of death has been made then they will pronounce a person deceased, and document time, date, and reason for death.
Socio-Economic Factors for the Dying Patient
Dying at home for most of us is preferred. Unfortunately, a lot of people will die in hospitals or facilities without family, either because there is no one still alive in a family or all contact has been lost. The less fortunate souls that don’t have financial resources will be on government assistance, not having the ability to afford hospice or hospital care, and will die in a community based or government funded skilled facility if not in a community-based hospital. For those with financial stability have opportunities with hiring care givers, and have more of an opportunity, and benefit from dying at home. Is it different from homelessness compared to the wealthy on how someone dies? The main issue between the two is education, and the ability to understand the illness.
A less educated person will find dying at home disconcerning feeling the need for more medical attention. The underprivileged are found to need more advocacy medically than the privileged. It boils down to being a part of delivering dignity with end of life care. No matter how rich or poor a person is all deserver the care, respect, and compassion from others to die with dignity. We are given the options to be resuscitated or not, to be kept comfortable when the pain is too hard to bare, or to pick and choose how assistance is given to us as far as bathing, toileting, brushing teeth.
Every human being has the right to die with dignity, in having choices, not alone, scared, and in pain. Lower social economical care does not allow for early diagnosis. Appropriate treatments needed, or palliative care. We as a society are separated in the dying as we are in living due to economic standings. The medical care received is based on what can be afforded. Yet the actual process of dying is the same for everyone. Let’s say there are two people in a hospital with the same exact prognosis and diagnosis. One’s life could be prolonged with treatments, and the care they get. The other person right down the hall of lower standings would die sooner because they are not covered to receive the same treatment as the other is getting, and will not get the same care due to financial stability.
Working in the medical field this is happened upon on a daily bases, and hard for anyone on the medical team to understand. Yet the nurse does his or her best to give as much as they can in order for both patients to die in comfort, with respect, and dignity.
Medical Management
Most care given to a dying person is done by a nurse. The physician is responsible for delivering the news of a terminal illness, and submits medical orders for treatments, but the nurse is there to administer the orders as well as support the dying. The most important as far as caring for a person who is dying is the ability for the nurse to communicate with the family and client.
If not already in place the nurse should be able to discuss Advanced directives, and living will if needed. A nurse should make sure they are able to recognize, report, and manage all abnormal symptoms, and signs of pain. He or She must be able to administer medication as ordered, and report to the physician if current medication dosages are not alleviating pain, and contact the physician for new orders.
If due to restrictions there is nothing more that can be ordered the nurse can try other forms of holistic comfort for instance talking, listening to music, warm blankets, reading a book, or physically repositioning the patient can help with keeping them comfortable. Assisting the patient as needed for personal and hygiene care, but allowing them to do what they can for themselves will help with the feeling of being a burden on others. Making sure they have access to spiritual care is most important for them to be at peace in dying.
Make room and time for the family and client to preform rituals. When there is family that does not understand what is happening it is imperative the nurse knows how to explain what is going on physically with their loved one. The nurse has the ability to help family get through death with honest explanation. This way they as well can be in a place to give what is needed as far as wishes, and for them to begin the grieving process. Councilor’s, social workers, and spiritual leaders may need to be brought in for family support.
The ability for the nurse to keep emotions away is very hard. A nurse that gets to emotionally involved hinders their ability to support the dying and family members. They will be able to walk away after death knowing they did everything possible to give the person and family dignity when dying. The nurse will need to administer medications while instructing the family on what is going on with the body, as well as help them calm down, and letting them know the doctor will be called.
Within 24 hours of death the family will call for the nurse every time the client stops breathing, gasps for air, or the death rattle begins. The nurse should be able to stand by the family explaining why it is happening, and asking family to talk to the dying client in soft caring tones, as the person dying can still hear and it helps to sooth them for the dying process. With End of life care maintaining a therapeutic relationship is very important, and not crossing personal boundaries is the only way to give the best nursing care to a dying patient and the family.
It is with care and compassion for each individual the nurse is able to give honest, complete, non-discriminatory medical care to all humans without becoming overly emotionally involved. As Florence nightingale created a nursing environment for the sick and dying that was clean, comforting, while caring for clients with passion and commitment, so now do nurses every day. It is a strong sense of wanting to do whatever can be done for even the most unfortunate human in the world. It goes beyond caring for a sick family member. it is with education, critical thinking, and a heart for caring that a nurse can say we did everything possible, they are in a better place, then life goes on. With all of the knowledge a nurse has they can put into action everything it takes to give everyone possible dignity in dying.
The Process of Dying as It Is. (2021, Dec 11). Retrieved from https://paperap.com/the-process-of-dying-as-it-is/
