Category: Dying Process

Articles on the dying process covering the transitioning stage and the active stage of dying including the last hours of life.

Review of Gone from My Sight by Barbara Karnes, RN

Gone From My Sight The Dying Experience By Barbara Karnes
As an experienced hospice nurse with years of experience, I have come across numerous resources that aim to guide families and caregivers through the process of dying. One such resource that stands out is "Gone from my sight: The Dying Experience" by Barbara Karnes, RN. This booklet, often referred to as the "Little Blue Book," has been a staple for hospice providers for over three decades, and for good reason.
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Understanding Terminal Illness Progression: Observable Signs and Symptoms

how people die trajectory
When a loved one receives a terminal diagnosis, it's natural to wonder about the journey ahead. Terminal illnesses follow a unique path, and understanding the signs and symptoms at various stages can help you provide the best care and support. This article aims to guide you through the general progression of terminal illnesses, focusing on observable signs and symptoms as the patient approaches the end of life. The progression of a terminal illness can vary depending on the type of illness, the person’s age, health, and treatment options. However, there are some common signs and symptoms that indicate that the illness is advancing, and the person is approaching the end of life. These signs and symptoms can help you and your loved one prepare for what is to come and make the most of the remaining time together.
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Understanding Changes in Palliative Performance Scale in the Last Six Months of Life

Palliative Performance Scale Ppsv2
In the journey towards end-of-life care, understanding the Palliative Performance Scale (PPSv2) and its downward changes in the last six months can provide valuable insights for hospice caregivers, patients, and families. This article aims to break down these changes' month by month, offering guidance on what to expect during this crucial period.
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The Last Breath of Life

Daughter Kissing Her Dying Mothers Forehead
As a caregiver or family member, witnessing the final hour of a loved one's life can be a challenging and emotional experience. It's important to be prepared and understand what to expect during this time. While each person's journey is unique, there are some common physical changes that may occur in the last hour of life. Here's a guide to help you navigate this sensitive time:
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Significant Signs a Terminally Ill Patient may be Close to Dying

Signs of imminent death
There are typical visible/audible signs that a person may have less than two weeks to live. There are times when we are so close to someone, we may miss the forest for the trees. Please allow me to go over some significant signs that a person with a terminal illness may have two weeks or less to live. If there is sudden onset, within the past 24-hours, any of the following signs and symptoms, please do an evaluation for end-of-life determination as soon as possible (family members seeing these signs should reach out to their hospice provider's 24x7 number):
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Managing Terminal Restlessness

Exhausted Patient From Restlessness
Losing a loved one is an incredibly challenging experience, and witnessing changes in their behavior and well-being can be distressing. As a hospice nurse, I've supported many families and caregivers through this grim time. One common symptom that may arise towards the end of life is restlessness. In this article, I will explain the different types of restlessness and offer guidance on how to manage them. Understanding these distinctions can provide valuable insights into your loved one's condition and help you navigate the final stages of their life with compassion and care.
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The Death Rattle

Death Rattle
As a caregiver, witnessing a loved one nearing the end of life can be a challenging and emotional experience. One symptom that you may encounter during this time is known as the death rattle. Understanding what the death rattle is, how to recognize it, and how to manage its symptoms can help you provide comfort and support to your loved one in their final days. In this guide, we'll explore the death rattle, its significance, and practical tips for managing it.
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Mottling of Skin Near Death

Mottling At End Of Life Lower Calves
As a caregiver or family member, it can be challenging to witness the changes that occur as a loved one approaches the end of their life. One such change that may occur is mottled skin, also known as livedo reticularis. Understanding what mottled skin is and its significance in the dying process can help you provide the best care and support to your loved one during this time.
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Understanding Functional Decline in the Natural Dying Process

In this article, we delve into the critical topic of functional decline in individuals nearing the end of life. Understanding these changes is invaluable for hospice nurses, caregivers, and family members as they provide compassionate care during this delicate phase. We will explore various examples of functional decline and emphasize the importance of documenting these changes to aid in care provision and decision-making.
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Trigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Signs of imminent death
Hospice visits by a nurse should always include a discussion with the caregiver and family members or facility staff about any changes since the last nursing visit. This interviewing process is extremely important because vital signs do not always provide clear indications when a patient is two weeks or less away from death. If we hear or read certain words or phrases in the notes, we should be on high alert for the possibility that the patient is either transitioning towards actively dying or is otherwise close to transitioning.
Read MoreTrigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Understanding and Addressing a Terminally Ill Patient’s Fear of Impending Doom

Yet Another Holding Hands Picture
I understand how challenging it can be for terminally ill patients to cope with their fear of impending death. It is crucial for both healthcare providers and family members to take these feelings seriously and respond with compassion and understanding. In this article, we will explore the importance of acknowledging a patient's fear of impending doom and discuss actions that families can take to provide peace and comfort during this grim time.
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The Actively Dying Phase of The Dying Process

Signs Indicating Death Is Imminent
A non-healthcare professional who has never witnessed death before, it can be unsettling to be present with someone who is nearing the end of their life. However, there are certain signs and observations that you can make using your own senses that may indicate that the person you are with may pass away within seconds, minutes, or hours. Understanding these signs can help you provide support and comfort to both the individual and their loved ones during this grim time.
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Breathing Patterns Before End of Life: Critical Clues for the Last Hours!

Breathing Patterns
This article is intended for family members, caregivers, as well as nurses new and old. As an experienced hospice nurse, I've learned that when a family member or caregiver tells me their loved one is or has "goldfish breathing" or "fish out of water breathing" or "taking guppy breaths" that the patient is now at the end of their life.
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The Transitioning Phase of The Dying Process

Signs of imminent death
Losing a loved one is an incredibly challenging and emotional experience. If you find yourself in the presence of someone who is in the transitioning phase of the dying process, it can be helpful to know what signs to look for. Although every individual's experience may vary, there are some common observations that may indicate someone is in the transitioning phase. Here's a guide to help you recognize these signs and provide support during this grim time.
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Is Dying Painful?

I Am Not Afraid Of Death
Other than "when will I die," one of the most frequent questions asked by patients and loved ones is a variation of "will I die in pain?" How much will I suffer along the way? One of the reasons the euthanasia movement gains any traction is the myth that dying is suffering and dying is painful is a powerful myth.
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