Vague uneasy feeling of discomfort or dread generated by
perceptions of a real or imagined threat to one’s existence
• Worry about the impact of one’s death on significant others
• Powerlessness over issues related to dying
• Fear of loss of physical and mental abilities when dying
• Total loss of control over aspects of one’s own death
• Worry about being the cause of others’ suffering or grief
• Fear of leaving family alone after death
• Fear of developing a terminal illness
• DEATH ANXIETY
• Anticipating the impact of
death on others
• Anticipating suffering
• Experiencing the dying process
• Uncertainty about life after
• Uncertainty about the
existence of a higher power
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Emotional status
The patient will
• Identify time alone and time needed with others.
• Communicate important thoughts and feelings to family members.
• Obtain the level of spiritual support desired.
• Use available support systems.
• Perform self-care activities to tolerance level.
• Express feelings of comfort and peacefulness.
SUGGESTED NOC OUTCOMES
Acceptance: Health Status; Anxiety Level; Depression Level; Dignified
Life Closure; Fear Self-Control; Hope
INTERVENTIONS AND RATIONALES
Determine: Assess how much support the patient desires. Patients
may want a higher degree of independence in dealing with death
than the caregiver wants to allow.
Assess patient’s spiritual needs. Often as death approaches, individuals
begin thinking more about the needs of the spirit.
Determine which comfort measures the family believes will enhance
feelings of well-being. Dying patients have the right to decide how
much physical, emotional, and spiritual care they wish to have.
Perform: Administer medication to relieve pain and provide comfort
as required. Medicating at an appropriate level does much to relieve
pain and often helps the dying person maintain greater feeling of
Turn and reposition patient at least every 2 hr. Turning and repositioning
prevent skin breakdown, improve lung expansion, and prevent
atelectasis. Establish a turning schedule for the dependent
patient. Post schedule at bedside and monitor frequency.
Provide simple physical gestures of support such as holding hands with
the patient and encouraging family members to do the same. Patient
may want to experience less touching when he or she begins to let go.
Provide comfort measures including bath, massage, regulation of
environmental temperature, and mouth care according to patient’s
preferences. These measures promote relaxation and feelings of well
Inform: Teach family members ways of discerning unobtrusively what
the patient’s desires for comfort and peace are at this time because some
patients prefer not to be bothered unless they specifically request comfort
measures. Being sensitive to patient needs promotes individualized care.
Teach caregivers to assist patient with self-care activities in a way
that maximizes patient’s rights to choose. This enables caregivers to
participate in patient’s care while supporting patient’s independence.
Attend: Help family identify, discuss, and resolve issues related to
patient’s dying. Provide emotional support and encouragement to
help. Clear communication promotes family integrity.
Demonstrate to patient willingness to discuss the spiritual aspects
of death and dying to foster an open discussion. Keep conversation
focused on patient’s spiritual values and the role they play coping
with dying. Meeting the patient’s spiritual needs conveys respect for
the importance of all aspects of care.
If patient is confused, provide reassurance by telling him or her
who is in the room. This information may help to reduce anxiety.
Manage: Refer to hospice for end-of-life care if this has not already
been done. Communicate to the hospice nurse where the patient is
at present in coping with the terminal illness. Continuity of care is
crucial during times of stress.
Refer to a member of the clergy or a spiritual counselor, according
to the patient’s preference, to show respect for the patient’s
beliefs and provide spiritual care.
SUGGESTED NIC INTERVENTIONS
Active Listening; Anticipatory Guidance; Family Involvement Promotion;
Pain Management; Spiritual Support; Touch
Duggleby, W., & Berry, P. (2005, August). Transitions and shifting goals of
care for palliative patients and their families. Clinical Journal of Oncology
Nursing, 9(4), 425–448.