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Providing Comfort at home at the End of Life

You are probably reading this because someone close to you is dying. You're wondering what will happen. You want to know how to give comfort, what to say, what to do and what to expect. I am sure that you have a lot of uncertainties and questions as believe it or not, you are already dealing with grief. It is quite normal to feel this way when you are about to lose someone you love.

Durban North Nursing and organizations such as Hospice are valuable support systems that can assist to provide Comfort care or palliative care as it is often known.  This is the essential part of medical care at the end of life to the person and their family that helps or soothes a person who is dying. Our goal is to work with the family and the person to prevent or relieve suffering as much as possible while respecting the dying person's wishes.

In the beginning, it may seem frightening caring for a loved one who may be nearing the end and has wished to remain at home, but the reward of having them in a safe and familiar environment and receiving love and support will bring the family great peace in the end.  People often say that they feel a certain sense of achievement after their loved one passes on, having had been able to care for them at home.

There are many ways to make a person who is dying more comfortable. Physical discomfort can come from a variety of problems. For each of these problems there are things that you, your family or other caregivers involved can do, depending on the cause.  Very often it is not severe pain that is the cause yet something that can be easily remedied such as body stiffness from lying in bed too long, tension, feeling the cold or digestive problems.
Pain Management    

Watching someone you love die is hard enough, but thinking that person is also in pain makes it worse. Pain is one of the most important things to control as struggling with severe pain can be draining on the person and the family. Pain can affect mood-being in pain can make someone seem angry or short-tempered. Not everyone who is dying experiences pain, but there are things you can do to help someone who does. When someone is dying, we should focus on relieving the pain without worrying about possible long-term problems of drug dependence or abuse so don't be afraid of giving as much pain medicine as is prescribed by the doctor.                  
Pain is easier to prevent than to relieve, and overwhelming pain is hard to manage.

Try to make sure that the level of pain does not "get ahead" of pain-relieving medicines. If the pain is not controlled, you need to speak to your doctor about adjusting the dosage or seeking treatment alternatives.  Certain medications may be effective for one person but not for another.

Pain treatments:
Pain medications are often referred to as analgesia.
Over the counter oral medicines:  Drugs such as Paracetamol, Ibuprofen, Aspirin, Codeine and various anti-inflammatory drugs tend to be overlooked when managing pain in the dying patient. 
One often assumes that non-prescription medicines are not strong enough and very often doctors are approached for stronger alternatives which are usually more costly and have greater possibility of side effects.  We recommend trying these options first, always under the advice of your doctor or pharmacist as surprisingly enough, the milder medicines if used on a strict regular regime, can be more effective for preventative pain management than taking the very strong drugs only when pain is experienced.

Prescription medicines:
Deep persistent pain which cannot be resolved using over the counter drugs, may at some stage need to prescribed by your Doctor.  This does not mean that you cannot take milder analgesia between the doses but this should always be checked with your doctor or Hospice Sister first.  Many drugs have interactions and can cause further discomfort if used with other medications.                                            
For some cancer patients, it is common for one to be referred to hospice for admission for a few days, where doctors can manage the pain before they return home.                                                                          
Sometimes the hospice may suggest intravenous medicines which can be self-controlled using an injection /infusion pump.  As some kinds of cancer are very painful, it may at times even be necessary for the hospice sister to visit you at home to administer an injection such as Morphine or Pethidene.                                                                          

Analgesia may also come in the form of a tablet or capsule such as Tramal, Stopayne, Stilpane or may be a syrup such as Morphine. Dosages of morphine syrup may need to be increased as time goes on as the body soon becomes used to the effect.  People often are terrified when Morphine is suggested as some believe that it speeds up the death process when in fact if used properly as prescribed, it is amazingly effective.  It does have its side effects and does not agree with every person but it is certainly worth trying if it has been suggested by your doctor or hospice sister.

Another common form of analgesia is a skin transdermal patch which in most cases is effective for up to 72 hours.  These patches give slow uninterrupted release of the medication into the body.  They are particularly useful and effective if the person has difficulty swallowing or is nauseous yet has severe pain. One is not usually started on the patch unless other types of scheduled analgesia have been tried first.  They are also relatively expensive and can have severe side effects for some.  If you are using the patch and experience breathing problems, remove the patch immediately and contact your doctor.                                                             
Other Treatments for Pain
There are many things that you too can do to reduce the pain level in your loved one. Stress and tension can cause a great amount of discomfort and at times can contribute to severe pain.  Try and keep the nursing environment calm, peaceful and without too much disruption.                                                                  

Visitors: Although some people mean well, we have all had a visitor who can be irritating and persistent.  It is a very good idea to set limits so that there is adequate time to rest and complete nursing activities.  By setting this rule, you will not offend those well intending visitors who really just want to help in some way. We always recommend having a set visiting time where some days no visitors are allowed at all unless you are close family or have a special appointment.                                                                                                                  

2016. All rights reserved. DURBAN NORTH NURSING PTY LTD . Updated 21 Jan 2016   tel. 27 31 5632856  0800- 1600