Assessing the dying client

Remember that assessment of the activity of dying is only part of a holistic nursing assessment and should not be undertaken in isolation without reference to or consideration of the client’s other activities of living. The specific points to consider when assessing the dying client are:

• Physical
Is the client in any physical distress, for example nauseous, vomiting, dehydrated, breathless, constipated, unable to sleep, immobile, in pain?
Is everything possible being done to promote the client’s comfort?
Could anything else be done?
Do they have a ‘Do not resuscitate’ order and has this been discussed with the client and their next of kin?
Can any other members of the multidisciplinary team offer help or guidance?
Could any alternative therapies be of help?
Are there any physical effects on family/friends?
Is the client an actual or potential organ donor and are the family aware?
Do the client/family wish sustained treatment?
Remember, good symptom control is not just for clients but also for relatives, as they have to live with their memories.

• Psychological
Are the client/family aware of the diagnosis/prognosis?
What are the client/family’s beliefs about death and dying?
Are the client/relatives frightened, anxious, depressed?
Do they have any concerns that can be addressed by you or others, for example a Macmillan nurse, the palliative care team?
Is everything possible being done to promote the client’s autonomy, privacy and dignity?
Have they any outstanding or unfinished business they wish to address?
Do they require you to contact any outside agencies on their behalf?
What effect will the death have on family members?

• Sociocultural
Do you have full contact details of next of kin/religious leaders?
Do they wish to see a minister, priest or other religious leader?
Do the client/family wish anyone else to be contacted?
Do the client/family feel isolated?
Does the client wish restricted or unrestricted visiting?
Are family and significant others aware of the visiting agreement?
Are there any other specific spiritual, religious or cultural wishes to be addressed before, during or following death?
Do the client’s family wish to be participants or observers of care?
If they wish to participate how can this be facilitated?
Are there any barriers preventing their involvement that can be overcome, for example lack of skill or knowledge?
Do relatives wish to be informed immediately if their loved one dies and they are not present? This is particularly important if the death occurs during the night, if the relatives live a long distance away, or the next of kin is ill or disabled. Who should be informed of the death first?

• Environmental
Does the client wish to die in a clinical environment, hospice or at home?
Can this be facilitated?
What support mechanisms are required/available?
Is the environment of care conducive to the client/visitors?
Could it be improved?
Are there any concerns about necessary environmental changes that might be incurred for spouse/family following death?

• Politico-economic
Have the client/relatives any financial worries or concerns?
Could referral to other agencies help?
Are there any other health or support services available for the dying or bereaved?
Have they made a will? If not, how can this be facilitated, if desired?