Working with Terminal Patients As a nurse, the odds are you will work with terminal patients at some point in your career, regardless of what area of nurse you opt to work in. What to Say First of all, terminal patients almost always know that their condition is terminal, so you don’t need to avoid the subject if they bring it up. For many terminal patients, they lack someone to talk with, as family members may find it difficult to discuss. Patients may turn to their nurse to express some feelings, or concerns, and it’s a good idea to be receptive to their talk, you may be their only viable source for an open discussion. As for family members, you may also be a sounding block for them at times, although it may become necessary to recommend a counselor that specializes in similar cases. Related: Medical Mistakes in the United States Caring for Terminal Patients Terminal patients should be kept as comfortable as possible. In most cases medications are not limited, as the patient’s comfort is top priority. If patients are under the care of hospice, nursing staff can see to it that all needed medications are delivered to the patient. If the patient is hospitalized, or in a nursing facility, medication should be readily available as well. When a patient first learns their condition is terminal, there are usually a series of emotions they encounter, which is normal, and should be anticipated.
Disbelief- when the patient first hears their diagnosis, it may be that they simply cannot comprehend what is being said to them. This is especially true if the patient has not been extremely ill. Devastating news takes time to process, and nothing is more devastating than a terminal diagnosis. Patients may question the diagnosis, perhaps it's wrong, or they will beat the odds and not become another statistic. It generally takes about 3-5 days to comprehend very negative news. It is actually not uncommon to hear a patient make statements such as, a mistake was made, it cannot be true. Without false encouragement, advise the patient they could seek a second opinion. Anger- it’s natural for the patient and their family to experience a stage of anger. Why is this happening to them, what did they do wrong? They may try to blame circumstances, or even another person
for the condition they are in. everyone wants an answer, a reason as to why they are ill. Unfortunately, in some cases, the patient just may need to assign blame for their condition, it is part of the anger process. This usually passes fairly quick, but until it passes tensions may run high, anger is not an emotion that can be turned on and off. Sadness and depression- these emotions often follow the acceptance of the diagnosis. Some sadness and depression is to be expected, however if it overtakes the patient’s life, they may need a therapist, and possibly medication to help them cope. Eventually the news and all of the emotions will dwindle and the patient will most likely come to accept the diagnosis.
You may deal with families as much or more than the patient themselves. If the patient is not communicating on their own, family members may be the point of communication. Be honest about the patient’s condition, it’s not a good idea to mislead or offer false hope. Listening is usually the best alternative in a situation where a patient is making end of life decisions. Assuring family members that the patient's care and comfort are the main consideration and that everything is being done to care for the patient, can put loved one’s minds at ease. Social workers and clergy can often provide comfort during the difficult times, making a suggestion of what you feel may benefit the patient and their family is a good idea, some people may be reluctant to accept help, others may embrace it. Related:
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End of life care can be emotionally draining, so if you are working in this capacity, make sure you take care of yourself, and allow an outlet so that you are not completely surrounded by sadness. Depending on how long you care for the patient, losing them can be like losing a friend, and you may share in the family’s grief. After the patient passes, a suggestion for grief counseling for family members may be very beneficial, and don’t forget to allow some outlet time for yourself.
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