Counseling the Dying Patient

Death is certain to come. It is only a matter of time and how we face it. Ironically, it is part of life. There is no fearful human experience than going through the anguish of dying. Attitudes toward death are not completely positive or negative; rather, they are on a continuum. At one end of the continuum is the perception of death as humanity’s mortal enemy… at the other end is accepting and even welcoming death as a passage to a more blissful state of being. (Aiken, 2001, p. 5). Dr. Elisabeth Kubler-Ross, in her years of caring for the dying patients, described death as a wonderful experience.

In her book On Death and Dying, she cited five stages wherein terminally ill patients undergo during their final moments. The First Stage is Denial and Isolation. Due to the terrifying as well as stressful effects of dying both physically and emotionally, the patient usually refuses to accept the reality that his life will end soon. He thinks that there must have been some mistakes and that this is not happening to him. The patient still thinks that life is normal recalling more often happy memories with his loved ones. The Second Stage is Anger.

Realizing that the situation is no longer controllable and that he is helpless, the patient demonstrates emotional outburst of anger with himself and his surroundings. Feeling that there is no choice but to die, the patient experiences a sense of loss that is unbearable to him. The Third Stage is Bargaining. Realizing that death is imminent after all the medical measures have been done, the patient now tries to make a compromise in order to make his remaining days fruitful and memorable like making peace with God or settle grudges with the family, friends and other people he has hurt before.

If given more time, he promises to do good deeds and attend an important family event like his children’s graduations or birthdays. The Fourth Stage is Depression. Knowing that you are dying adds up to your misery after battling the deadly disease that ends up for nothing. The patient feels that all his efforts and struggles are all useless. Angry and incapable knowing that death is near, the patient develops these guilt feelings he thinks causing so much pain to him and his loved ones.

The Fifth Stage is Acceptance. This comes after the patient has explored all possibilities available and dealt with all the struggles and conflicts in his final moments that he now realized this is really happening. With less emotions, tired and weak, he comes to terms with reality that it is okay to die. The battle is over and he is ready. With these thoughts, he accepts death as part of life and that the world will continue even without him. Counseling the Dying Patient.

A number of health institutions are now integrating care for the dying patients. From the foregoing it is evident that the terminally ill patient has very special needs which can be fulfilled if we take the time to sit and listen and find out what they are. The most important communication, perhaps, is the fact that we let him know that we are ready and willing to share some of his concerns. (Ross, 1989, p. 240). This special therapy is known as Hospice that focuses mainly on caring rather than curing.

Specifically, it pays attention to the patient’s physical, emotional, social and spiritual aspects trying to ease pain and suffering that will prepare him and his family for death. This is provided wherever the dying patients are mostly in their homes but it is also available in nursing homes and hospitals for long-term inpatient care. Hospice care is a comprehensive interdisciplinary program of care designed to provide hope, care and comfort to terminally ill people and their families or loved ones in the familiarity of their own communities. (Hospice Hawaii, 2004, ¶2).

In home settings, two family members are assigned shared responsibilities of care giving. Hospice staff visits the home on a regular schedule to assess the patient and provide support for the whole family. They are on call 24 hours a day seven days a week. However, if there is some difficulty or symptoms that would require continued professional care a short-term inpatient solution could be provided. The team composing the hospice care includes doctors, registered nurses, social workers, chaplains/clergies, home health aides, and trained volunteers.

The team’s major responsibilities are: manages the patient’s pain and symptoms; assists the patient with the emotional and psychosocial and spiritual aspects of dying; provides needed medications, medical supplies, and equipment; coaches the family on how to care for the patient; delivers special services like speech and physical therapy when needed; makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and provides bereavement care and counseling to surviving family and friends.

(Caring Connections, 2006, ¶4). The patient’s physician continues to be in-charge of his medical care. The team formulates care plan designed to suit the needs of the patient for pain management and to control symptoms. Counseling the dying patient and his loved ones is an important service of hospice care. Bereavement support is offered to families for at least a year after death by way of visits, support groups, telephone calls, and literature on grieving. This approach is covered by health insurance and is given to those who are only willing to undergo. Dr.

Kubler-Ross in her own experiences with dying patients came to realize that death is simply a shedding of the physical body like the butterfly shedding its cocoon. It is a transition to a higher state of consciousness where you continue to perceive, to understand, to laugh, and to be able to grow. (EKR, 2006, ¶15). Reference Aiken, L. R. (2001). Dying, Death and Bereavement. Lawrence Erlbaum Associates, Inc. ; 4th edition. Mahwah, NJ. ISBN: 0805835040 Ross, E. K. (1989). On Death and Dying. Routledge; Reprint edition. London. ISBN 0-415-04015-9 Hospice Hawaii, AssistGuide, Inc. (2004).

Creating Comfort • Giving Hope • Connecting Lives. Retrieved October 20, 2006, from http://www. hospicehawaii. org/home/default. asp? PF= Caring Connections. ((2006). How Does Hospice Work? Home Advance Care Planning. National Hospice and Palliative Care Organization. Retrieved October 20, 2006, from http://www. caringinfo. org/i4a/pages/index. cfm? pageid=3467 EKR (Elisabeth Kubler-Ross) Foundation. (2006). Selected Quotes. Life, Death, Compassion. Retrieved October 20, 2006, from http://dying. about. com/gi/dynamic/offsite. htm? zi=1/XJ&sdn=dying&zu=http%3A%2F%2Fwww. ekrfoundation. org

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