Psychological and emotional changes are significant in end-of-life situations. The patient who is aware may be grieving his or her own passing and could be facing extreme fear of the unknown or fear of pain. Others may gently slip into a coma prior to death.
Many people rely on clergy to bring gentle religious meaning to this time and find it to be a very spiritual experience. Some patients are not religiously or culturally based and find peace in nature or reincarnation.
A patient may benefit from gentle support and open-ended questions such as, "How do you think things are going?" According to Grossoehme, patients often have the ability to sense when their bodies actively begin to die and express these feelings in statements such as, "I don't think I'll make it until my birthday..." Rather than offering words that deny their statements, invite them into empowerment by asking questions like; "How would you like to spend your time until then?" Most patients will become quieter and many will hallucinate and see people in the room that others may not see. Validate their feelings and listen to them. Sometimes they will offer words of wisdom in the midst of confusion.
There will come a point when many will begin to separate spiritually and need peace and quiet. Others may prefer to not be touched at all and may become super sensitive to any stimulation. Family members should trust their judgment and allow themselves to feel and grieve. Feeling helpless is often a part of pre-grief and after loss. Many communities offer grief support groups that address these feelings and offer listening support.
Contributed by LeNae Peavey-Onstad, chaplain and Manager of Pastoral Services for Jordan Valley Medical Center and Pioneer Valley Hospital in Utah.