people maintain denial up to the point of impending death. The next stage is anger. This is a period of hostility and questioning Why me? The third stage is bargaining. At this point, people revert to a culturally reinforced concept that good behavior is rewarded. Patients are often heard stating Id do anything if I could just turn this thing around. Once the patient realizes that bargaining is futile, they quickly enter the stage of depression. In addition to grieving because of his or her personal loss, it is at this point that the patient becomes concerned about his or her family and putting affairs in order. The final stage comes when the patient accepts death as reality and is prepared for it. It is usually at this time that the patients family requires more support than the patient.
Despite the fact that each of us expects to die and expects all others to die, there is no easy way to discuss death. To the strong and healthy, death is a frightening thought. The fact that sooner or later everyone dies does not make death easier. There are no procedure books that tell health care providers how to do death. The how to will only come from the individual health care provider who understands that patients are people. More than any other time in life, the dying patient needs to be treated as an individual person, not a thing, a number, or a disease.
An element of uncertainty and helplessness is almost always present when death occurs. Assessment and respect for the patients individual and cultural value system are of key importance in planning the care of the dying. As health care personnel, we often approach a dying patient with some feelings of uncertainty, helplessness and anxiety. We feel helpless in being unable to perform tasks that will keep the patient alive; uncertain that we are doing all we can do to either make the patient as comfortable as possible or to postpone or prevent death altogether. We feel anxious about how to communicate effectively with patients, their family, and even among ourselves. This is a normal response since any discussion about death carries a high emotional risk for the patient as well as the health care provider. Nevertheless, communicating can provide both strength and comfort to all if done with sensitivity and dignity, and it is sensitivity and dignity that is the essence of all health care services.