What do you say to and do for your frightened patient?

[This Won't Hurt Much]

I had a patient say today, "I'm scared." I couldn't get her to elaborate more, and her family mentioned that she has said this to them in the past as well when I filled them in later on our brief "conversation". Since she wouldn't and maybe couldn't tell me if she was afraid of dying, afraid she wouldn't make it to Heaven, or afraid of the dying process, etc..., I can only go with some feedback from the family. Seems like dying itself is exactly what she's afraid of the most.

I found myself unprepared with how to help her or how to handle this other than to hold her hand, smooth her hair, and gently ask her what exactly scared her. She did ask me if she was getting better, but all of this was very difficult for me to know how to best handle, too. I think she pretty much knows that she isn't and won't get better, but I think she is having a hard time coming to terms with her rapidly advancing and soon-to-be imminent death. She keeps telling her family that she needs to go back home and leave there (meaning inpatient hospice), and I feel that she'd be more at peace if she was able to "escape" the inpatient setting so that this prognosis and this harsh reality wouldn't be so "in your face" for her. Unfortunately and although she has a loving and supportive family, she doesn't have the available care that she would need to spend her remaining days outpatient. I don't believe she has the time she would need to come to terms with things before she dies, so if she could have some emotional respite somehow, I'd like to be able to help provide this for her.

I got some good feedback at work today, but I'd love to hear how each of you might have handled this with her yourself. Hearing her say, "I'm scared," just broke my heart. What do you do for the patient who's just plain afraid?

[nitenite]

The best you can do is be there and maybe she'll open up more before the end. It's hard

[jrowmom]

Wow. That's intense. I have utmost respect to you and other hospice workers. I am not a hospice nurse but what about a clergy member or spiritual advisor of some sort visiting her...even if she is not religious or especially if she is not religious. I would be scared too.

[tewdles, RN]

I use therapeutic communication to try to discover what she is afraid of...the dying process or death itself.

Many people have peace with dying but are afraid of the process...pain, breathing, etc...reassure them that you are good at managing symptoms. Providing an opportunity for them to ask difficult questions, listening with unconditional regard, and giving them honest and straightforward information about dying is effective for many if not most hospice patients.