Death is the only certainty, signifying a changing life and ultimately bringing it to an end. People react differently to dying and death. Some deny death as an attempt to buffer the thought of its inevitability. However, it is imminent and tends to change our plans, hopes and future goals. The indiscriminate nature of death often creates anxiety and frustration as we lose control of life.
For many of us, life can mean good health, family, relationships, lifestyle, prospects and a goal to aim for. However, this can significantly impact many patients at the end of life and how they live out the rest of it. For healthcare professionals (HCP), quality of life (QoL) is important and viewed as a link to dignity and, by extension, a dignified death. Every intervention, palliative treatment, care and support given to people who are dying is guided by the principles of QoL and dignity. We can argue that if these principles are achieved, patient's relatives and close friends might find bereavement more bearable, as they can focus on the positive aspects of care given to their loved one. Community nurses (CN) are well-trained and well-positioned to help the bereaved achieve this outcome. It is equally important for CNs to remind themselves of the meaning attached to the life of a dying patient. Each patient will interpret the meaning of life in different ways, even if the experience (e.g impending death) is similar.
Understanding the patient's perspective
To understand the patient's perspective, it is important to look at their meaning of life, which is better understood as a construct, flexible enough to vary with each person, tribe, culture, situation or history. Therefore, community nurses must ensure that they first understand each patient's meaning of life, after which, they can support them as they reconcile their life to their imminent non-existence. First, the advent of death literally ‘forces’ people to review priorities, coupled with periods of reflection and introspection. With effective communication, patients may share their inner thoughts and feelings with us. We need to listen for any regrets and missed opportunities or goals and acknowledge them. While acknowledgment makes patients feel heard, we can also help them focus on the more positive experiences or memories. The aim of such support is to achieve a positive meaning to life, which can be different for each person. Community nurses or any other professional supporting such patients must work with them to devise ways to fulfil their wishes in the remaining time they may have. For example, help with advance care planning helps focus patients on what is important to them and how they wish to be cared for until they die. Sadly, as the law stands in the UK, it also allows them to control how they wish to die.
It is critical that we build a trusting, honest relationship with patients if they are to divulge what really matters to them. Such relationships help avoid not just physical loneliness while in hospital, community or in the hospice setting, but also reduce psychological loneliness.
Furthermore, such interactions can also be had with family, close friends and colleagues, serving three main purposes: offering an opportunity to convey their deep-felt emotions toward the dying person; helping close any unresolved issues and saying good-bye; the dying patient may themselves want to say goodbye and convey their last wishes.
This may explain why relatives and friends are called in when staff realise that the patient is about to die, as many friends and families want to be by their bed side. The above three points give the greatest meaning to life in the final moments, to both the patient and their family (Tomás-Sábado et al, 2015). When this happens, it is also possible that the bereaved may find it easier to go through the process of bereavement.
Conclusion
Finally, HCP and informal carers’ own meaning of life is affected each time they connect emotionally with, and support people in palliative and end-of-life phases. Therefore, we need to constantly reflect on our meaning of life so that we too can revise our idea of its purpose. By doing so, we remain better able to support patients and those deemed important to them, at all times.