7 Questions About Near Death Awareness

J.Adderton, BSN, MSN

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