Comfort Measures for End of Life Care

A Compassionate Guide

If the death of a loved one is approaching, it is important for the health care team and family to be aware of the changes that are happening to the person. Family members and loves may feel a mix of emotions that include fear, anxiety, sadness, anger, helplessness and more. Some people ‘handle’ death better than others. End of life is a journey that requires stamina, courage and strength from family members and loved ones.

Communication is crucial. It can be helpful to develop a system of relaying information to family/extended/family or friends to save the energy of immediate family. The most important thing to consider is the respect and dignity of the dying person. What are their end of life wishes? How can you keep them comfortable and dignified? ALWAYS involve the dying person in any conversations, discussions and decisions.

Once an end of life diagnosis is made, the process of dying may take hours, days weeks or months. The medical team may not provide you with an exact timeline because it is a natural process. Focus on trying to keep everything as normal as possible.

Physical Comfort Measures

1. Pain Management:

   • Assess pain regularly by observing body language and facial expressions. Ask the person to rate there pain on a scale out 10 to evaluate the effectiveness of pain management strategies.

   • Administer prescribed pain medications regularly as prescribed.

   • Use non-pharmacological methods like massage, warm compresses, or cold packs.

   • Use pillows, fans, bedding, pillows and cushions for support and comfort.

   • It is important to let the health care team know this information, so that a plan can be made for comfort and pain management. This may include medications, body positioning, mouth care, skin care, turning and positioning

2. Breathing Comfort:

   • Use a humidifier to keep air moist and easier to breathe.

   • Elevate the head of the bed to help with breathing.

3. Hydration and Nutrition:

   • Breathing through the mouth may occur which causes the lips and mouth to become dry or cracked. Encourage proper mouth care that a person can tolerate includes brushing the teeth, rinsing or swabbing the mouth.

   • Apply lubricant to the lips.

   • Offer small sips of fluid or ice chips as ordered. small sips of water, ice chips, or moist swabs if the patient can no longer swallow well.

   • Provide soft, easy-to-digest foods if they can still eat.

4. Skin Care:

   • Keeping the skin clean and dry is of utmost importance. Lotion may also be applied where the skin is dry or may feel itchy and for comfort.

   • Skin assessment and inspection is important ongoing through care provision such as bathing, toiletting, movement, ambulation, bed changes

   • Bedsore or pressure sores are a breakdown in the tissue of the skin especially over bony prominences but can occur anywhere. They can also become open, painful wounds, so it is better to prevent them.

   • Frequent turning and positioning of a person while they sit or lay is critical for comfort, skin assessment and prevent of pressure sores. A damp cool cloth may provide comfort to the forehead or face.

   • Change linens and pillow cases if soiled, wet or sweaty-should be changed regularly and frequently. Ensure there are no crumbs or wrinkles in the bedding.

   • Apply moisturizing lotions to prevent dryness and irritation.

Emotional and Psychological Comfort

1. Presence and Reassurance:

   • Always include and involve the person in conversations and deciosn making

   • Know that they can hear conversations that occur

   • Spend time with the patient, providing a calming presence.

   • Speak softly and offer words of reassurance and love.

2. Personalized Care:

   • Play favourite music or sounds that they find soothing.

   • Read to them from books or poetry they love.

3. Memory and Legacy:

   • Help to create a memory book or record their life stories.

   • Encourage visits from friends and family if the individual desires.

Environmental Comfort

1. Safety:

   • Ensure an occupational therapist is involved to assess the environment, bed, and equipment for safety and comfort measures including air flow mattress, bedrail, transfer and toiletting equipment is prescribed.

   • There is a higher risk of falls, skins tears and bruising can occur. It is important to ensure proper equipment is being used and that mobility issues are reported to the health care team.

2. Comfortable Surroundings:

   • Ensure the room is at a comfortable temperature and well-ventilated.

   • Decorate the space with familiar and comforting items, such as photos and personal belongings.

3. Lighting:

   1. Use soft, gentle lighting to create a peaceful ambiance.

4. Allow natural light during the day if it is soothing for the person.

   Spiritual Comfort

1. Respect Beliefs:

   • Respect and facilitate any spiritual or religious practices important to the person.

   • Arrange visits from spiritual leaders or clergy if desired.

2. Create Moments of Peace:

   • Engage in practices like meditation, prayer, or quiet reflection according to the person's wishes.

   • Offer comforting words and read spiritual support, resources and readings if appropriate.

Little Things that Matter

1. Personal Hygiene:

   • Assist with gentle bathing, oral care, and grooming to help the person feel clean and dignified.

   • Ensure clothing is soft, clean, and comfortable.

2. Sensory Comfort:

   • Continue to keep things as normal as possible with familiar scents and aromas such as baking, open windows and anything familar and desired.

   • Provide gentle hand or foot massages.

3. Maintain Routine:

   • Keep a regular routine to provide a sense of normalcy and security.

   • Be mindful of the patient’s preferences and routines they find comforting.

These comfort measures are vital in ensuring that the end-of-life journey is as peaceful and dignified as possible. Adapting these approaches to the individual needs and preferences of the patient can significantly enhance their quality of life in their final days.

Issues to be Considered:

• Continue to monitor pattern and regularity of bowel movements and urine output. Ensure you report to the healthcare team.

• As death nears, the area of the brain that controls body temperature may fail. A person may feel hot one moment and run a temp (report any temp over 37) or chilled the next. Check the temp frequently and report any changes to the health care team. Use fans or blankets as tolerated and needed.

Important Review:

• Ensure the person keeps living life as normal as possible and enjoying the people, things and places that bring them comfort and joy.

• Take a team approach and always involve the person on any communication, discussions and decisions.

• Know the contact information for the medical team -have it handy for everyone involved.

• Ensure end of life plan is discussed with the person including Do Not Resuscitate (DNR) and proper measures are in place based on the person's desires.

  
  These comfort measures are vital in ensuring that the end-of-life journey is as peaceful and dignified as possible. Adapting these approaches to the individual needs and preferences of the person can significantly enhance their quality of life of a person. As you navigate this journey, ensure you seek support from healthcare professionals and trusted resources to help guide you.