Nursing care of the dying patient
- Fundamental
In the last hours and days, nursing protects comfort, recognises the signs that death is near and supports the patient and the family.
What it is
As death approaches, the goal of care shifts from cure to comfort and dignity. Nursing recognises the signs of the final phase, adapts care to the patient's wishes (for example an advance directive), keeps symptoms controlled, cares for the skin and mouth, creates a calm setting and prepares the family for what they will see. Palliative care is given by an interdisciplinary team, and nursing is the continuous presence at the bedside.
Key points
- Palliative care relieves the physical, psychological, social and spiritual suffering of patients and families facing a life-threatening illness.
- It starts at diagnosis and continues to the end of life; it is not only for the last hours.
- WHO estimates that only about 14% of the people who need palliative care receive it.
- Cheyne-Stokes breathing: cycles of breaths that build up and fade with pauses; common at the end of life.
Components
- Physical comfort: symptom control, positioning, skin, mouth and elimination.
- Communication: goals of care, the patient's wishes and advance directives recorded in the chart.
- Family support: clear information, presence and time to say goodbye.
- Spiritual and cultural support: a chaplain or spiritual guide if the patient or family wish.
What it is for
- Relieve suffering and keep dignity in the last hours.
- Avoid interventions that no longer help and that the patient does not want.
- Prepare the family to reduce fear and support healthier grief.
Step by step
- Confirm the goals of care and any advance directive or do-not-resuscitate order — they guide what is and is not done.
- Assess comfort often (pain, breathlessness, agitation, secretions), using behaviour if the patient cannot speak — distress may go unspoken.
- Reposition gently, protect bony prominences and keep the skin clean and dry — prevents injury and discomfort.
- Moisten the mouth and lips often — mouth breathing and little intake dry them out.
- Lower the light, the noise and unnecessary alarms — a calm setting reduces agitation.
- Explain to the family the expected changes in breathing, skin and consciousness — this lowers fear.
- Invite the family to stay, talk to and touch the patient as their customs allow — presence is part of care.
- Record findings, comfort measures and what was discussed with the family — keeps the team's care continuous.
In nursing practice
- Many patients in the final phase stop eating and drinking; forcing food can add discomfort.
- Families fear that the patient will die alone or suffer: anticipating these fears and answering them calmly helps.
- A farewell list you can suggest to the family: ask forgiveness, forgive, say thank you, say «I love you» and say goodbye.
- When death comes, follow the institution's procedure for care after death.
Common mistakes
- Continuing routine vital signs and procedures that no longer help the patient.
- Talking about the patient in front of them as if they were absent: always treat them as someone who can hear.
- Using medical jargon or giving an exhausted family a lot of information at once; repeat it in simple words.
- Rushing the family or leaving no room for their rituals and farewell.
Test yourself
Think of the answer, then tap the question to see it.
Which signs suggest that death is near?
Cool, mottled skin, a rapid or irregular pulse, irregular or noisy breathing, more drowsiness or confusion and less urine.
Why are routine vital signs usually stopped in the final phase?
Because they no longer benefit the patient; care focuses on comfort.
When does palliative care begin?
At the diagnosis of a life-threatening illness, and it continues to the end of life.
What can nursing do to reduce the family's fear?
Explain the expected changes in simple words, repeat the information, invite them to stay and answer their fears calmly.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Fundamentals, 17.5 Nursing Care During the Final Hours of Life (Open RN, Wisconsin Technical College System (LibreTexts), 2021); Nursing Fundamentals, 17.4 Palliative Care Management (Open RN, Wisconsin Technical College System (LibreTexts), 2021); Palliative care (fact sheet) (World Health Organization, 2020).
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Representative model, for educational purposes only.