How do I interact with terminally ill patients?

Nurses General Nursing

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(I am posting the same thread, because I wasn't able to get answers and tried to delete my previous one, but I am unable to do so. Sorry....)

Hello, I am a pre-medical student, who is writing a secondary personal statement for one of med schools..

They made us to read two essays written by third year students rotating, interns, or residents, and these essays are about their interaction with dying patients. They want me to write about what I learned by choosing one of these two essay.

Essay 1 writer thinks that the process of death is like an invisible tidal wave, which can take her patient's life abrutly and stealthily.

Essay 2 writer described her interaction with a dying patient, who was old enough to be her father, and wrote about her being compassionate and being emotionally invested to him. She was very emotional, cried and prayed with him and his family members, and insisted that she felt privileged to be a doctor caring for her patients.

I chose essay 2, because I could relate to my experience with a terminally ill patient whom I encountered at haven hospice, a palliative care center. I met a patient in her seventies and initially enjoyed conversation with her as she talked about her 50 years of life in my hometown and proud achievements like sending her 3 of 5 children to college. Then her joyful voice soon faded as she started to talk about not getting colonoscopy regularly. I didn't know how to provide solace cause terminally ill patients, they are very different than other patients.

During my 7 years of volunteering, I interacted with patients in dialysis, surgical center, ER, ER minor care, and OR, pediatric patients, and even homeless patients, I can give them encouraging comments, can be compassionate and empathetic to them, and reveal my willingness to help and etc. However, knowing that their conditions cannot be ameliorated, I was occupied with ambiguity and uncertainty on how to treat terminally-ill patients. To the patient in her 70s, if I expressed my compassion and empathized with her then I could only augment her sadness. On the other side, if I was optimistic and said positive things to her then my attitude could be deemed to be insensitive and uncaring. so All I could do was to hide my emotion and pretended that I was paying attention to her words while trying to come up with an answer to my uncertainty.

In essay 2, the author cries with her dying patient and families. My initial impression was that she could be compromising her professionalism by being emotionally invested to her patient and should stay aloof to not to sacrifice her clinical reasoning. The dying patient simultaneously treated her as a member of his medical team and as an one of his children and felt a need to protect her. :confused: (what a role change here!!) But since the essay prompt was about "What I learned" and a popular book "On Call" written by a compassionate internist did the same thing, I think that I must be openly compassionate and emotionally invested to terminally ill patients. But am I right?

If I am right, my essay is going to start with this terminally ill patient I described above and the uncertainty and ambiguity I encountered. Then I write about how this essay solved my uncertainty and how I am going to change myself as a volunteer. Does this sound good? :D

Addendum:

My position as a volunteer, I am aware that my general duty include offering a variety of services depending on patients' need, providing company or practical helps such as transportation. But what I want to discuss here is "Providing Company." How should I effectively bring emotional healing or at least relief? My presence could be already helping, but I certainly want to do more. I am also aware that I must choose my words carefully and should never be a counselor.

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Specializes in Hospital Education Coordinator.

yep. I imagine the assignment is to have you reflect on your own feelings about death and dying. Dying is a process. Rarely is it immediate. Would you be tempted to avoid the patient? Would you want to "assist" them in dying quickly? Are you opposed to terminally ill patients receiving expensive end-of-life care? What about elderly care? Do you have issues with elderly receiving expensive care or should they be cut off and be allowed to die sooner than otherwise? What would you do if a patient's religion is different and they want you to perform certain duties or rituals? Explore what has the potential to make you uncomfortable, then work out what you would do if the situation presented itself. Because I guarantee, the situation will occur someday. Good luck. I had a similar assignment in nursing school. My pet peeve is non-compliance and BOY! have I had to deal with a lot of non-compliant patients.

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You say you are a pre-med student - - why not ask your advisor what is expected of you?

I do not mean to be harsh, but what nurses see/expect/do may be different from what is expected of you.

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You say you are a pre-med student - - why not ask your advisor what is expected of you?

I do not mean to be harsh, but what nurses see/expect/do may be different from what is expected of you.

Unfortunately, my advisor isn't the most propitious person to ask, I would rather seek answers from professional nurses who have more extensive experience with dying patients than the writer of the essay I need to read. Judging from my discretion coming from rudimentary experience as a premed, I think nursing professional in general requires greater need for compassion, empathy, and attachment to their patients.

My position as a volunteer, I am aware that my general duty include offering a variety of services depending on patients' need, providing company or practical helps such as transportation. But what I want to discuss here is "Providing Company." How should I effectively bring emotional healing or at least relief? My presence could be already helping, but I certainly want to do more. One thing I am aware that I must choose my words carefully and should never be a counselor.

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what i will tell you (as a hospice nurse) is there are pts/situations, as in #1...

where dx and hospice care, come far too late in the process, and pt/family either remain in denial or do not have enough time to process and absorb the enormity of his/her death sentence.

then there are those pts who receive eol care for weeks or months.

this creates ample opportunity for much bonding, often resulting in crossing (emotional) boundaries and being too involved.

granted, there are also those pts who remain in denial, do not wish to talk about dying, and remain hopelessly optimistic.

still, in that time, relationships still develop, and the nurse/pt are left to deal with the consequences of not facing prognositic indicators of decline.

how you interact with your dying pt, is going to be contingent on what the pt is willing to share and confront.

it is up to the nurse/dr., to enable pt to die with relative peace.

that may mean talking about regrets, missed opportunities, and see if any given situation can be ameliorated.

it may mean a time to review life, and see if/what would be done differently.

it may mean a time of intimate conversation w/a loved one, where none had taken place before.

it may mean to jump out of an airplane, or be blonde for a few days.

it is so personal for each patient.

but keep in mind, it is ingrained in us, not to get emotionally involved.

does that mean we don't cry?

of course not.

but it does mean that you don't want to be available to this pt 24/7...

and flee off to see them whenever they call your home or cell number.

nor do you remain hopelessly optimistic with them, even as their extremities mottle and turn ten shades of pale.

we are responsible for ensuring they have been educated to depth possible, and whatever that involves.

there are sensitive means of delivering such messages, and it's never necessary to tell them to "buck up because you're dying".

(yes, i've heard this inflection being used.)

it is important that even when they are unable to face the truth, that we make them feel valued and respected...and heard.

dying is complicated, as is caring for this population.

it is seldom straightforward....many diverse dynamics involved.

contemplate your own death...and explore your feelings of here on earth, and if you believe in any afterlives.

how would you want to be treated? what would be important to you, before you die?

personally, instead of relating to essay #1 or #2, i think i'd opt for #1.5...

as it really is often, somewhere inbetween.

leslie

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Specializes in LTC, Psych, Hospice.

Well said, Leslie!

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No b.s.

If you cry- so be it.

It's their death, not yours (though it can be difficult for you, too).

If there is some little thing that they want, go all out to try and get it for them (within your ability and reason).

Soemtimes, silence is the biggest gift- just "be" with them.

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Specializes in ED.

First of all, kudos to you for caring about interacting with them. Although a difficult question to answer, at times, at least you know something about yourself. You care for them and what they are going thru.

As for me, I interact with them alot of times in a more acute setting. My opportunity to interact with them is brief. So, I make it count. I am honest with them. I listen to them. Truly listen. I use more than my ears. Figuretively, I place my self in that hospital bed. I try to answer questions for them before they ask. Are they in pain? Do they have to use the restroom? Are they thirsty?

It gets really basic...basically...when death arrives. Its true that all of life's ladder climbing means diddly-squat at the end and what they want is interaction...true interaction. Sometimes, they will try to live their lives vicariously thru yours. Be honest and real with them about who you are.. as a person, a father, a son, a friend, a doctor or nurse.

This topic goes on and on and you will find different answers from different people. The beauty of being human.

Being there for someone in need is highly fulfilling. The dying patient has alot to teach us. be ready.

Jake

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Specializes in Hospice / Ambulatory Clinic.

I'm not sure if this will be helpful or not but one of the most important part of my job is making them feel like I care. You can care but if you can not express that to your patient then....

But this is my experience as a nurse. I'm not sure if your medical school is looking for touchy freely caring or cold and aloof.

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Specializes in diabetic wound care/podiatry.

Treat them the way you would like to be treated... Speak in terminology that fits their background. Today I was working with a gentleman that was stage 4 or 5 AD, but I still spoke to him as if he was intact(within reason, I know the reality...) Compassion goes a long way, not only with your pt, but family and yourself......:up:

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Why not just listen to the patient? As them if they want to discuss their dying...many times someone who is dying feels isolated because no one - unless they are on hospice - wants to talk about dying. Another thing, why not ask them to reflect, if you feel this is approachable, on their life? What advice would they give to others about living, taking chances, regret? It's interesting you are struggling on how to interact with the dying and for me, the only time I am 100% comfortable with a patient is if they are over 60, dying or terminally ill...for me, there is no b.s. in most of the situations, the patients are who they are and you can really relate to them. It's difficult for me to describe in words....Elizabeth Kubler-Ross would be a good resource for you - her work that is. Good luck

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Everyday I take care of pt"s that have a terminal diagnosis( usually cancer 99.9 %) usually it's my job to transition them fro

Palliative to hospice, I do a little hospice too. It's a hard conversation, but necessary. Pt"s need to understand hospice and the benefit it can provide. Hospice is about living the best quality of life you can have. Unfortunately i deal with people who refuse and hold out hope and die on palliative care which is still ok. I cry, I hug them and their family members at times. It's a hard conversation, but if it makes someone's end of life more comforting for pt and surviving family members i don't hesitate.

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