Quality of life at end of life

understanding palliative care and the grieving process

What is Palliative care?

  • Providing psychosocial care and symptom management
  • Promote dignity and self-esteem
  • Maintain comfort and a peaceful environment
  • Provide spiritual comfort & hope
  • Protect against abandonment & isolation
  • Assist with ethical decision making
  • Support family
  • Facilitate mourning (Potter & Perry, 2009)

Promoting Comfort to the terminally ill

Symptom management:

  • Alleviate Pain with prescribed pain medication, repositioning, and massage.
  • Prevent Skin breakdown by applying lotion and lip balm. Cover eyes with moist wash cloth, reposition every 1-2 hours, provide special mattress, and keep skin clean.
  • Allow frequent rest periods to alleviate fatigue
  • Relieve anxiety with anti-anxiety medications, encourage family to support client, hold clients hands, provide a massage, encourage music therapy, and set up clergy visits. (Kolsky, 2012)
  • Alleviate nausea with anti- nausea medications, encourage small portions of preferred foods, change to a liquid diet, and eliminate medications or food causing nausea.
  • Alleviate constipation with laxatives and encourage more fluid intake (Potter & Perry, 2009)
  • Prevent dehydration with ice chips, a moist cloth to clean the mouth, apply lip balm, and provide oral care every 2-4 hours.
  • Promote comfort for ineffective breathing patterns by using a vaporizer, open a window or use a fan, apply oxygen if prescribed, raise the head of the bed, reposition the client, and administer prescribed medication to dry secretions. (Kolsky, 2012)

Five Stages of Grief

  1. Denial- person refuses to acknowledge the loss of a loved one.
  2. Anger- person feels anger towards other people, the situation, or blames god.
  3. Bargaining- person tries to prevent the loss by making promises to others, god, or self.
  4. Depression- person may experience loneliness, sadness, or hopelessness. May become distant from people.
  5. Acceptance- person accepts the loss and tries to move forward. (Potter & Perry, 2009)


*The grieving process does not occur in any particular order. Everyone grieves differently. The stages of grieve can also overlap each other. (Potter & Perry, 2009)

How to help a grieving loved one

  • Listen with compassion/ empathy- acknowledge their situation, lean forward to show them your engaged and listening, be silent and let them talk, and offer your support.
  • Offer Practical assistance- clean their home, grocery shop for them, help with their pets, and engage in enjoyable activities with them.
  • Provide on going support- stay in touch (send a card or give them a call) and prepare them for special occasions.
  • Watch for warnings signs of major depression- withdrawal from friends and family, unkempt appearance, inability to enjoy life, suicide thoughts and behavior, and drug and alcohol abuse. (Smith & Segal, 2015)
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References

Kolsky, K. (2012) End of Life: Helping with Comfort and Care. Bethsada, MD: National Institute on Aging. https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/providing-comfort-end-life


Potter, P., Perry, A. (2009) Fundamentals of Nursing. St. louis, Missouri: Mosby, INC.


Smith, M., Segal, J. (2015) Supporting a Grieving Person. http://www.helpguide.org/articles/grief-loss/supporting-a-grieving-person.htm

Written by: Danielle Braley SN, Husson University

Date: 12/2/2015