SIGNS & SYMPTOMS CLOSE TO TIME OF DEATH OBSERVATIONS OF HOSPICE NURSES
MONTHS NOT WEEKS
WEEKS NOT MONTHS
DAYS NOT WEEKS
NEXT FEW DAYS
TODAY OR TOMORROW
PSYCHOLOGICAL SIGNS & SYMPTOMS
Anxiety re: unfinished business, distancing, expression of anger / feelings Information-seeking, e.g., How am I doing? What can I expect?, speaks of death
Apprehension, fear, peacefulness
Maintains control, sense of humor, anger
Peacefulness, fear of being alone
Peacefulness, fear of being alone
EMOTIONS
Wants to die, acceptance, saying goodbyes, family wondering ( asking ) ‘how long’ in order to pace themselves
Information-seeking, denial, will to live, refers to future, concern re: taking medications
Wants to die, intuitive, “I’m dying,” reassuring others
FACING REALITY
Acceptance, goodbyes
SOCIAL MARKERS INTERACTIONS
Withdrawal, especially from close family
Inability or unwillingness to express self
Normal
Withdrawal, outside interests
Withdrawal
Closure of affairs, decisions re: Rx, e.g., food, hydration, deciding who to see
Stops unnecessary medications & treatments
Decision-making, very definite wishes
Putting affairs in order
Unable to make decisions
SPIRITUAL MARKERS
Final funeral arrangements, dreams of dead / spiritual figures
Dreams of dead / spiritual figures
May see people who are dead
Plans funeral
FAMILY MARKERS
Information-seeking: “how long,” report changes, anxiety about being able to see death through, give patient permission to die
Family report patient’s acceptance / denial / anger
Instinct, statements by significant other / family re: dying
Ready for patient to die ( may feel guilt ), burnout
Give patient permission to die / let go
39 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024 Adapted from “Markers noted by Home Hospice Nurses Related to Time Remaining in the Dying Process,” Master’s Thesis of Carol McCrann McShane RN, MS, Creighton University Lincoln NE, 1991. Used with Permission
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