7 Questions About Near Death Awareness

  1. The phenomenon of near death experience (NDE) has been widely explored in research; the patient experiences a sudden event, either dies and is resuscitated or death is imminent. Afterwards, they are able to describe what it was like leaving their body and then returning with resuscitation. But how comfortable are you supporting a terminally ill patient as they prepare for death? Let’s ask seven questions to increase your comfort level in supporting a patient experiencing near death awareness.

    7 Questions About Near Death Awareness

    What is near death awareness (NDA)?

    In terminally ill individuals, the phenomenon of near death awareness is a part of the dying process and prepares the individual for death. What often appears to be confusion and hallucinations may actually be a form of symbolic communication as a person approaches death. The experience of NDA varies based on cultural background and life experiences, however, several common experiences have been reported. These include talking with someone who is deceased, preparing for travel, describing what is seen in another realm, knowing when death will occur. Experiences of NDA are usually comforting to both the patient and loved ones. I would like to share a few of my experiences with dying patients.

    "Mrs. H is the first hospice patient I was assigned to that transitioned through the dying process. On my last visit prior to her death, I told Mrs. H I would be back on the following day. Mrs. H replied, "I won't be here, I am going to paradise tonight". The next day, the on-call nurse told me Mrs. H passed overnight."

    "I visited Mr. S, age 101, after the patient had a significant decline overnight. The patient was no longer eating or drinking and remained lethargic. Mr. S's father passed away when Mr. S was only 8 years old. The patient's family was tearful when they described a conversation Mr. S was having with his father in the early morning hours."

    How is near death awareness different from near death experience?

    A near-death experience (NDE) is an experience some people report after clinical death and resuscitation, near death or an acute situation where death is likely or expected. Near death, awareness is preparation for death in a terminally ill person.

    Is the patient experiencing NDA or just hallucinations?

    Studies have shown distinctions between NDAs and symptoms of delirium. NDA tends to be spiritually transformative, while hallucinations tend to be insignificant. NDA experiences reported are typically clear, well organized and rich in detail. These experiences are frequently calming and comforting to the patient rather than distressing. As nurses, it is important for us to to be aware of what NDA may look like so we can support the patient and family.

    "A patient once described seeing a figure in the corner of the room motioning for the patient to "come". The patient said, "I kept trying to go, but they told me I had more work to do".

    "In the days leading up to my grandmother's death, she often made a waving gesture. My father asked her what she was waving at and she described waiting on the train go, it was time for the last trip"

    What do I tell the loved ones when they ask me what a NDA experience means?

    There is no guide for what experiences mean. The term "individualized care" is used frequently and healthcare and NDA experiences are just that..... Unique to that person. Often, family and loved ones can decipher meanings, but sometimes the meaning may not be known. NDA experiences are woven with that person's life experiences (relationships, friends, conflicts, disappointments, hardships, successes, regrets, gratitude, what they have learned, how have they contributed). It is a way they can say "goodbye" to all aspects of their life. Our role is to simply be present, listen and acknowledge the experience. Just allow the person to share their experience with you. You can support the family in exploring meaning by gently asking the dying person:

    • Who do you see?
    • What are you seeing?
    • How does this make you feel?
    • What do you need from me?

    What are common tasks need completing before the patient's death?

    Dying individuals look at the entire fabric of their life and usually in great detail. Forgiveness becomes forefront and forgiving becomes important to complete unfinished business. This could be forgiving others, repairing relationships or even forgiving themselves. What they find in preparing to say good may surprise them and can be a final gift to loved ones.

    What if I don't understand the patient's beliefs in what occurs in the afterlife?

    Remember, our job is to actively listen allowing them to share their experience, provide support and acknowledge the experience.

    What are signs of an NDA experience?

    • State they have talked to people who have already died
    • Speak to people you cannot see
    • Seeing spiritual beings
    • Describe a journey or trip they will be taking as a metaphor for their death
    • Describe another realm that is peaceful, beautiful etc.
    • Talk about exactly when they will die
    • Reach for unseen objects, hold or manipulate unseen objects

    NDA experiences can be a final gift to loved ones, but also to you as you support the patient's death. It is often "instinct" to explain or argue away the experience, but this instinct can be replaced with your presence and active listening.

    Have you had interaction with a patient experiencing near-death awareness?
    What was your experience?

    Additional Resources:
    Palliative Care Network of Wisconsin, Fast facts and concepts-near-death awareness, #118 Fast Fact #118 NEAR DEATH AWARENESS

    National Communication Association (2007), How should I talk to a loved one who's dying. How Should I Talk With a Loved One Who's Dying? | National Communication Association
    Last edit by tnbutterfly on Sep 11
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    About J.Adderton, BSN, MSN Pro

    J. Adderton is a nurse with 22 years of experience. J. Adderton worked in home health/hospice and earned her master's degree in nursing. Also, worked as Director of Education at a large home health and hospice company for 8 years prior to accepting a position teaching in an ADN program.

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  3. by   Mudpinesredneck
    Very insightful article! Personally, it blows my mind all the different things people see!

    I've heard that DMT is only released during sleep and at death

    If that is true, it makes me wonder just how much that plays a role in our transformation from life to death

    And if the latter is true, that may explain why we see different things.

    Personally, I'm one to even question what human consciousness and this world is. I have yet to find an answer
  4. by   Kaisu
    In the days before she died, my mother described scenes with loved ones that had passed before. She would look up toward the corner of the room where the ceiling and the wall met and say things like "Oh look, they are getting ready for a party." She told me that she would be attending my son's wedding with her brother, who had passed before her. Mother died a month before my son got married.
    I really believe the veil that separates this life from what comes after lifts for those preparing to leave. It was full of mystery, yet a profound and beautiful thing.
  5. by   J.Adderton
    It would be interesting to explore available research on the release of DMT at birth.
  6. by   J.Adderton
    Wow, thanks for sharing your story.
  7. by   Solange90
    Thank`s a lot
  8. by   Have Nurse
    I enjoyed this read. Thank you. While my mother was dying she said to me: "Russ" (her dead brother), was here last night." She sailed out at 11:08 the next morning. It's been nearly 16 years. I still miss her....
  9. by   ClaraRedheart
    My great grandmother, sick with brain cancer, got up and got dressed to the nines one Sunday morning and told her daughter, when she was asked what she was doing "My honey is coming to pick me up for church today" (speaking of her husband who passed a few years prior). She went to be with the Lord that day. They got to worship at the feet of Jesus, together.
  10. by   Mudpinesredneck
    I never even thought of that J. Adderton
    That'd be some interesting stuff.

    Wahh wahh what is this weird place? Oh well. Looks nice and bright. I'll stay