This is the way I explain it to my pt's. as long as it is rhythmic each time they breath out, it is usually not pain. I usually tell them it is coming from the throat constricting, and usually with some ativan, it may decrease, but it is normal and nothing to be alarmed about. It alway helps if you mention everything that could happen before it does, it takes the panic out and instead of them going "oh no, what is that"? it is, "oh, that is what she was talking about" it is scary enough for the families going through this, but they need to know what to expect. Always try to keep them ahead of what is going to happen next. Most of the time when I do the pronouncment, they tell me it happened just like I said it would and they are comforted.
I even demonstrate the breathing they may see or hear and although it is different, it is normal for them. The secretions is what is the most distressing for most of the families, but if it is explained what it is and how it will sound, they deal with it better. It's all about education.
Of course there have been times the pt has done something that is totally out of the norm and even distressing for me, but on the outside, I stay calm, explain it is normal, even when the inside of me is saying, holy crap, this is not normal. lol ie. a lung cancer pt copious secretions, nothing seemed to help, in taking his last breath, he sat straight up and brown/black stuff came shooting out of his mouth all over the place. I just calmly asked for some towels, reassured this was normal, and cleaned him up, but inside I was a little freaked out. In 10 years in Hospice, I havent seen it like that again. I have had secretions come out, but not like it did that night.