Dying

From the moment we are born the only predictable event in life is that one day we will die. Dying is thus an inevitable part of life, yet it remains surrounded in mystery to a large extent, provoking fear and anxiety in most individuals, particularly in Western society. However, when explored, it is not usually the thought of death that creates anxiety but the where, the when, the why and the how. Other issues of concern often include: what will happen to my body; how will those left behind manage, financially and emotionally; and who will help them through this difficult time? It is also not unusual for dying clients to feel guilty about the distress they perceive they are causing to their loved ones.

Addressing such issues with clients and their relatives can be daunting for even the most seasoned health care professional, let alone the novice. Consequently, whilst this chapter aims to offer guidance for those with little or no experience of death and dying, the reader is reminded that it is important for us all to recognize and acknowledge our limitations and not be afraid to seek assistance if we are unsure or worried about any particular aspects of care delivery.

Factors affecting dying may be:
• physical arising from the nature of the terminal illness or cause of death such as pain, nausea, breathlessness
• psychological such as fear and anxiety about death itself or the effects on those left to grieve
• sociocultural including personal beliefs about death and attitude towards death and dying
• environmental, for example preferred place of death, quiet/noisy, private/open
• politico-economic such as lack of finances for funeral, outstanding debts.

This chapter outlines some of the principles and practices surrounding care of the dying and the performance of last offices. The need for respect of clients’ and relatives’ beliefs, values, culture and customs when initiating and carrying out these final acts of nursing care is emphasized throughout. The chapter includes sections on common terminology; communicating with dying clients; the signs of approaching death; informing relatives; confirmation of death; the equipment required to perform last offices; and the procedure for cleansing, dressing and positioning of the deceased, paying due regard to issues surrounding infection control,
labelling of the body and care of the deceased’s property and valuables. The reader is reminded of the need to refer to local policy and procedures throughout but particularly in relation to infection management and removal of the body from the clinical area. The chapter concludes with references and direction to enable further reading.