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How do nurses know when someone is about to die?

Updated: Aug 25, 2023

Frequently, individuals express apprehension regarding the circumstances surrounding their own or their loved ones' impending passing. Questions arise about the anticipated experience during the final moments of life. Although each person's encounter with death is unique, most individuals with terminal illnesses find tranquility and comfort in their final moments. They do not endure suffering, anxiety, or distress as they approach death. How do nurses know when someone is about to die?


While the manner in which each person approaches death varies, certain aspects are commonly observed. Although those in the dying process might not be fully conscious of these developments, understanding them can offer valuable insight to caregivers. This guide is intended to aid caregivers in navigating this phase.


If your loved one is under home care rather than hospice care, consult a healthcare professional to comprehend the immediate post-death expectations.


Recognizing Approaching Death

Every person's journey toward death is distinctive, much like their individuality and relationships. Below are some frequently observed occurrences:

• Reduced appetite and thirst, or a complete lack thereof.

• Withdrawal from the external world.

• Increased sleep or semi-conscious states.

• Alterations in breathing patterns.

• Moments of restlessness and agitation.

• Cooling of hands and feet.

While witnessing these transformations in a loved one can be emotionally challenging, they generally do not imply discomfort or distress on the part of the individual. Such changes are intrinsic to the natural progression of dying, and the healthcare team is dedicated to ensuring the utmost comfort for both the patient and their loved ones.


Changes in Appetite and Thirst

Individuals in the dying process typically require less sustenance, as their bodies require less energy from food. Witnessing a loved one's diminished interest in eating and drinking can be difficult to accept, yet it's a natural outcome of the body's slowdown. The most supportive approach is allowing the person to consume food and drink according to their own inclination, even if it's just a teaspoon or nothing at all. Occasionally, individuals might cease eating several days or even weeks before passing. If eating difficulties arise, healthcare professionals can provide guidance.


Withdrawal from the World

Approaching death often brings about detachment from the immediate environment. Conversations may lessen, and activities that were once routine might cease, like reading a newspaper. Sometimes, individuals appear more animated and conversational when interacting with less familiar individuals. This behavior signifies their comfort with close caregivers but reflects their limited energy for sustained social interaction.


Increased Sleep or Semi-Conscious States

Dying individuals may experience increased drowsiness and extended periods of sleep. Even if they appear asleep, they might still derive solace from familiar sounds, like a loved one's voice or familiar music. Comfort can be provided through ongoing communication, gentle touch, and verbal acknowledgment upon entering or leaving their presence. This phase can facilitate granting permission to let go and say final goodbyes. Such states can persist for a couple of days to longer periods, varying for each individual.


Alterations in Breathing

Breathing patterns commonly shift significantly during the final days and hours of life. Breathing might become laborious or adopt a rhythmic pattern, oscillating between rapid and slow intervals, or even pausing for extended periods. Audible, rattling breath sounds may arise due to throat fluid buildup. While this sound might be distressing for caregivers, it generally doesn't cause discomfort to the individual. Elevating the head and turning it sideways can aid fluid drainage. These breathing changes may occur minutes before passing or continue for up to 24 hours.


Restlessness and Agitation

Occasionally, restlessness or agitation surfaces shortly before death. Healthcare providers ensure appropriate medication to alleviate pain, anxiety, or fear in such instances.


Temperature Changes in Extremities

In the final hours, the extremities may grow cool to the touch and exhibit paleness or bluish tint, signaling a slowdown in circulation. Providing blankets or warm socks can offer comfort.


Duration of the Dying Process

Dying is a unique, natural progression, making it challenging to predict the duration of an individual's final moments. Witnessing various signs can evoke uncertainty, but it's important to acknowledge that we still lack a complete understanding of the physiological and mental dynamics during this stage. Providing support through presence, communication, and touch remains valuable.


How to Provide Comfort

Several approaches can enhance comfort during the final hours:

• Adjusting pillows or positions for comfort.

• Employing warm or cold pads to alleviate localized discomfort.

• Offering calming hand-holding or gentle hand massages.

• Providing a reassuring presence, projecting calmness.

• Administering prescribed oral medications as needed.

For in-home care, specialist community nurses, district nurses, and GPs can guide caregivers in optimizing comfort.


Presence during Passing

Deciding whether friends and family should be present during the individual's passing is a personal choice. While some desire to be present, there's no definitive answer. Due to the uncertainty of timing, facilitating presence can be challenging. Hospice staff can assist in accommodating those wishing to be present.


Immediate Post-Death Protocol

Anticipating a loved one's death doesn't fully prepare for the emotions experienced when it occurs. Reactions may vary from shock to sadness or relief. It's beneficial to identify a supportive person to contact at this juncture. Certain formalities must be addressed after death. Initially, death verification is essential.


Confirming Death

If the individual passes at home, contacting the GP or out-of-hours service within hours is crucial for a doctor's confirmation. Hospitals or hospices arrange verification, with nurses verifying expected deaths. This entails assessing pupil response, breathing, and heart sounds. A doctor provides a "Medical Cause of Death Certificate," necessary for registration.


Caring for the Deceased

Hospice or hospital settings allow time with the deceased, inviting family and friends if desired. Private moments of farewell or companionship with staff can be comforting. Subsequently, the body is moved to a mortuary if available or collected by a funeral director.


Planning for the End

Despite foreknowledge of death, shock is a common response. Developing a clear post-death plan, considering support and child care, can help mitigate confusion. Have a clear plan in place and speak to us to assist in the best way to move forward for your individual situation. This way it will be able to followed almost like on autopilot when the time arrives, and helps to alleviate confusion and stress.


For further detailed information, head to our webpage titled "what to do when someone dies" which may be of further help




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