Providing Comfort Care: The Ultimate Guide For Nurses

by | Jan 25, 2024 | Critical Care | 0 comments

Comfort care is an essential skill for compassionate healthcare providers! Walking the final steps of a patient’s journey requires special skills and a heart full of empathy. In this guide, we’ll explore how to provide comfort care for patients who are actively dying. Together, let’s ensure their transition is as peaceful and dignified as possible.

comfort care ultimate guide for nurses

What is Comfort Care?

Comfort care in nursing is a holistic approach focused on providing relief from the symptoms and stress of a serious illness for terminally ill patients, prioritizing their comfort and quality of life in their final days. This care involves managing physical discomfort, emotional and psychological support, and ensuring a dignified and peaceful end-of-life experience.

This type of care often involves managing physical symptoms such as pain, breathlessness, or nausea, but it’s also much more than that. It’s about creating a serene, respectful environment where the patient feels emotionally supported, and at peace.

Rather than repeated detailed assessments, coordinating scans and labs, and creating care plans with curative goals, we pivot to a more holistic approach with different goals. Success in comfort care is not a normalized lab value, a clear scan, or meeting a physical therapy milestone. It’s simply ensuring that the final months, weeks, days, or hours are as comfortable as possible. This means that people are thinking as clearly as they can, given ample time to rest, are comfortable and as pain-free as possible when awake, and can engage in activities and relationships that give them meaning.

The Role of Hospice in End-of-Life Care

What is hospice? Hospice represents a model of compassionate and high-quality care designed for individuals facing a life-limiting illness. The attention is focused on quality rather than length of life.

The hospice team is included when the patient has stopped responding to all the possible treatments for their illness and has 6 or fewer months of life expectancy (certified by two doctors). No life-prolonging medications are used at this point.  

Hospice care offers comprehensive comfort for patients and support for their family members. These benefits include medical care, pain management, and emotional and spiritual support tailored to the patient’s needs and wishes.

It’s delivered in locations chosen by the patient; typically their residence, nursing homes, retirement homes, specialized hospice care clinics, and occasionally in hospitals.

Hospice services have been linked to improved symptom relief, greater fulfillment of patient end-of-life preferences, and a higher overall assessment of the quality of end-of-life care when compared to standard care, according to research.

Additionally, hospice care is eligible for reimbursement from Medicare and other care plans when certain conditions are met. These conditions include the patient having a terminal illness with a life expectancy of six months or less, and being covered by Medicare Part A insurance.

This is available for all ages, from babies to the elderly.

Being in the presence of people who are dying can be a bit of a jarring experience, especially if you are taking part in those initial comfort care conversations. As a new nurse, these situations scared me more than codes because it felt deeply important to get it right.

I was often at a loss for words and desperately did not want to offend someone, but I was unaware of what those things could be. You’re in luck! You can learn from my mistakes. We’ll go through some good things to say when caring for patients who are on comfort care, and some not-so-great things to say.

The important thing to remember is that your words will not take away their pain or fix the problem. The problem is much bigger than you, so do not feel pressured to say the perfect thing to make them feel better. It’s just not possible. Once we release the grip of those expectations, we can be present in a more authentic way, which is what they really want.

Also, remember that as a nurse, you are in a position of power: what you say matters. They will consistently ask for your professional opinion on clinical needs and considerations, often deferring to your judgment. The line between objective clinical reality with cold-hard facts, and deeper meaning about what is right or best for that person, can quickly become blurred. Please maintain an awareness of the natural power dynamic in the nurse-patient/family relationship, as it gives your words extra weight.

(I like to view the opinions of friends and others as a normal blanket. It’s there, but you can easily forget or ignore it. The opinion or perspective of the nurse who cares for the patient is like a 25lb weighted blanket. You can really feel it.)

Things to Avoid Saying to Patients on Comfort Care

People are not perfect and sometimes we’ll inadvertently say insensitive things. Let’s go through some things to avoid.

Do not compare their situation to something similar you or someone you know went through. This makes it about you. We tend to want to do that in an attempt to relate to the other person, but it ultimately pulls focus from the situation at hand.

Do not point out the positive. This sounds counter-intuitive, but please bear with me. When someone is going through something gut-wrenchingly awful, like looking at their loved one or facing death themselves, seeing the positive implications of the situation requires the person to deny their painful emotions, which makes it worse. It also comes across as telling someone how they should feel instead of just being with someone in what they are actually feeling.

  • Don’t tell the daughter who lost her father, “Hey, so many people had terrible fathers. You should feel lucky you had such a great dad and are actually sad to lose him.”
  • Don’t tell the mother losing her son, “I’m so sorry you’re going through this, but you are so lucky you got to be a mother because I struggle with infertility and have no idea if I’ll have a child of my own.”
  • If a patient attempted suicide and ended up succumbing to complications and is now on comfort care, don’t tell their loved ones about your suicide attempt or one of someone you know.

Do not talk about where the person “goes” after death. This gets into very deeply held beliefs that vary widely from person to person. We also don’t know what happened during that person’s life that may influence where they believe the loved one will go after death.

If you have more traditional beliefs of a heaven and hell post-death and assume your patient and their family share that, and then say something along the lines of, “Well, at least they’re in a better place,” you don’t know if that’s actually true in reality. You don’t know if that person was abusive, hurtful, or did some awful things that would lead the family to believe he or she is not actually in a better place, and those comments would just lead to more complicated feelings.

Knowing with confidence what happens after death is a very personal belief that most people only casually ponder during their lives. However, these people are looking at death directly in the face right now, and sometime soon, one of them will be in that “place” – whatever it may look like.

Don’t focus on practical steps unless asked. Suggesting things like how to handle the estate, selling property, etc., is not appropriate in the immediate period after death. Practical details are less intimidating than emotional availability, so people can fixate on those steps and speak about little else outside of them. Nurses can focus on the clinical details and neglect being emotionally available and present. Notice if your topics of discussion are limited to the practical care of the patient or coordination of care.

Helpful Things to Say to Comfort Care Patients and Families

Remember: Your non-judgemental presence is much more powerful than any perfect words you might say.

Ask about their lives. You can find out about their occupation, interests, hobbies, and more, and then ask specific questions.

  • I saw he served in the military. What branch?
  • You have two cats? What are their names? How many cats have you owned during your life?
  • How many kids do you have? Where did you raise them?

These questions can enable the patient/family to reflect on meaningful memories and share important things about their life/loved one that we, as the healthcare provider in that moment, don’t know about them.

Reflect back to them what they’re saying. Reflective listening is a powerful tool to provide emotional support that enables you to demonstrate that you’re listening and that you care. It is not a chance for you to prove what you know. For example, let’s say someone tells you the story of how their dad collapsed at home and they performed CPR until paramedics arrived, and now he’s on comfort care.

Do not start talking about the times you have performed CPR. “You had to do CPR? It’s pretty crazy, isn’t it? You can feel the ribs cracking under your hands. I’ve done it so many times before. It’s pretty brutal.”

Instead, reflect back the big emotions of the story in simple terms. “Wow, that sounds like a really traumatic event to have to give your own father CPR. I’m so sorry you had to experience that.”

As hard as it might be in the moment, resist some of the first-reaction responses to relate it to your previous experience or what first came to mind. Ask yourself, “What would be most comforting and helpful to this person in this moment?” This is emotional maturity at its best nurses!

Here’s a list of compassionate and supportive things you can say to patients receiving comfort care:

  1. “I’m here for you. You’re not alone in this.”
  2. “Tell me about your favorite memories or things that bring you joy.” (The more specific you can be in this prompting, the better. If you already know the basics about them, you can use those to better craft your question.)
  3. “It’s okay to share your feelings about what you’re going through.”
  4. “How can I make you more comfortable right now?”
  5. “I’m here to listen if you want to talk about anything.”
  6. “You’ve been so strong; it’s okay to rest and let others care for you now.”
  7. “Is there anything specific that would bring you comfort at this moment?”
  8. “I’m here to support you in any way you need.”
  9. “Would you like me to read something to you, or play some music you enjoy?”
  10. “Your feelings are valid and it’s okay to express them in whatever way you need.”
  11. “Let’s focus on making today as comfortable and peaceful for you as possible.”
  12. “You are important to me and I care deeply about your well-being.”
  13. “If you want, we can reminisce about the good times a bit. What are some good memories you have?”
  14. “I’m here to help you through this, every step of the way.”

These statements aim to provide emotional support, validate the patient’s feelings, and emphasize your presence and willingness to assist them in any way possible.

Understanding the Physiological Stages of Dying

While some meet death in a very quick manner, like a sudden, massive heart attack, accident, or aneurysm rupture, many people will experience end of life in stages. It is like the body preparing to shut down.

An imperfect comparison is like a woman having a c-section vs. going through the five stages of labor before a vaginal delivery. When a woman goes through labor, her body experiences different stages to prepare to give birth to the baby and expel the placenta. When there is a planned c-section, the baby is removed from the uterus through the abdomen during a surgical procedure. Therefore, the body does not go through these stages.

So, when we’re talking about the physiological stages of dying, these are for patients with a terminal illness who will succumb to that over a period of time, and not after a sudden event.

  1. Pallor and Coolness: Skin may become pale and cool to the touch as circulation slows.
  2. Decreased Consciousness: The patient may become less responsive and may drift into unconsciousness.
  3. Changes in Breathing Patterns: Irregular, shallow breathing is common. “Cheyne-Stokes” breathing, characterized by periods of deep breathing followed by apnea, may occur.
  4. Decreased Urine Output: As circulation diminishes, urine production slows.
  5. Restlessness and Agitation: Some patients may experience restlessness due to metabolic imbalances.

It is important to note when these stages unfold and not work against them. We wouldn’t want to give a diuretic to increase urine output, repeatedly wake someone who is sleeping more and more, or put someone on a ventilator for changes in breathing patterns. We only address the aspects of these stages that are causing distress. For example, if the agitation or restlessness is distressing, we can give medications to help the patient feel calmer.

How to Recognize End-of-Life Signs or Signs of Active Dying

Being attuned to the terminal phase signs allows the medical team to offer tailored support and comfort, ensuring a dignified and respectful transition for patients in their last 24 hours before death. 

If a patient is on comfort care and their death is expected, nurses are often running this care, and speaking with a physician on the phone for orders to address any changing needs. These are often hospice nurses working directly in a patient’s home or hospice facility. However, acute care nurses may provide hospice and comfort care measures on inpatient units, especially if the patient’s death is imminent and moving them is not feasible or would cause additional distress.

The end-of-life signs include:

  • Reduced Food and Fluid Intake: As the body shuts down, the dying person may lose their appetite and thirst, consuming very little to no food or fluids.
  • Decreased Urine Output and Bowel Movements: There’s often a noticeable decrease in the frequency and volume of urine and bowel movements.
  • Changes in Breathing Patterns: Irregular breathing, such as Cheyne-Stokes respiration (a cycle of rapid breathing followed by no breathing) can occur. There may also be periods of apnea (temporary cessation of breathing).
  • Altered Consciousness: The person may become less responsive, slip into a coma, or experience periods of confusion or delirium.
  • Physical Changes: These can include a drop in body temperature, with the hands and feet becoming cool to the touch, and changes in skin color, such as mottling.
  • Decreased Mobility and Weakness: The person may become bed-bound and show very little physical movement.
  • Changes in Pulse and Blood Pressure: The pulse may become weak and irregular, and blood pressure often drops.

Towards the end, we don’t take vital signs unless asked by the family. Again, we do not intervene in these assessment changes unless it is causing distress. Education is key in active dying so that we are not causing additional distress to the patient.

For example, family members may want the patient to eat more because they’re concerned she’s not eating enough and subsequently wake her up so she can eat. However, the patient may be moving into active dying, and waking her up to attempt to eat, especially if she refuses most food, is probably causing her body more stress than simply letting her rest.

A quick note: In someone’s final days on comfort care, they may see things in the room others cannot see. They may say they see deceased loved ones in the room. This is not a distressing situation; rather, it provides comfort. This ebook describes the process very well, beginning on page 18.

Nurse-isms for End of Life Care

If you want to become a hospice nurse or regularly provide comfort care, you must familiarize yourself with the following common symptoms.

  • Death Rattle: This term refers to the specific sound often heard when a dying person cannot clear secretions from the throat or lungs. This gurgling or rattling noise can indicate that death is near, usually within hours or days.
  • Mottling: This term describes the blotchy, red-purplish marbling of the skin, usually seen on the feet, hands, and arms, as circulation diminishes.
  • Cheyne-Stokes Breathing: While not exactly slang, this term is commonly used among nurses to describe a pattern of irregular breathing, characterized by alternating periods of rapid breathing and apnea (no breathing), often seen in the final hours of life.
  • Sunsetting Eyes: This term describes the appearance of a patient’s eyes when partially open, and only the whites are visible, resembling the setting sun. It’s often observed in patients who are in a coma or near death.
  • Rallying refers to a phenomenon where a terminally ill patient suddenly appears to improve or becomes more alert and coherent, which can occur shortly before death.

These are common occurrences in the dying patient, but not everyone experiences them all. It is helpful to be familiar with it so that you are not caught off guard.

Supporting the Comfort Care Patient in the Final Days

During the 48 hours before death, various potential manifestations of distinct changes can occur. Furthermore, the last 3 minutes before death are considered crucial due to the acute nature of this brief timeframe because the physiological and emotional changes become more immediate and intense.

Recognizing the physiological signs of impending death in a comfort care patient is important for healthcare providers, especially in delivering compassionate and appropriate end-of-life care. When death is minutes away, the following signs are often observed:

  1. Agonal Breathing: Also known as “death rattle,” this refers to a specific type of breathing pattern characterized by a loud, labored, and often gurgling sound. It indicates a decrease in the body’s ability to effectively circulate oxygen and can signal that death is imminent.
  2. Very Very Slow Pulse Progressing to No Pulse or Heartbeat: Often, the heart rate will slowly decrease and eventually stop altogether. As the heart stops functioning, blood circulation comes to a halt.
  3. Unresponsiveness: The patient becomes completely unresponsive to external stimuli, including touch or sound. Please note, that does not mean they cannot hear you.
  4. Changes in Skin Color and Temperature: Skin may become pale, dusky, or mottled, especially in the extremities. Body temperature drops as circulation decreases, and extremities may feel cold to the touch.
  5. Fixed and Dilated Pupils: Pupils may become fixed and dilated, no longer responding to light, indicating a significant decrease in brain function.
  6. Loss of Control Over Body Functions: As the body’s systems shut down, there may be a loss of control over bodily functions, including urinary and bowel continence. This can also happen immediately after death.
  7. Profound Relaxation of Muscles: The muscles in the body may relax completely, resulting in a slack jaw and a lack of any tension or resistance in the limbs.
  8. Absence of Reflexes: Basic reflexes, such as the gag reflex or corneal reflex, may be absent.
  9. Decrease or Absence of Breath Sounds: As the respiratory system shuts down, there may be an absence of breath sounds when listening with a stethoscope.
  10. Cyanosis: The appearance of a bluish coloration, particularly around the lips and nail beds, due to decreased oxygenation of the blood.

It’s important to remember that each individual’s experience of dying is unique, and not all these signs may be present. Healthcare providers and caregivers should continue to provide comfort care and emotional support to the patient and their family during this time.

Recognizing and addressing these symptoms is essential for providing anticipatory care in the last days of life to enhance the patient’s comfort and quality of life.

Common Medications for Comfort Care

Patients on comfort care can receive various medications to ease the most common issues that can cause distress. Let’s go through a few! Please note that many of these mention an IV route. However, if you are caring for a comfort care patient in their home, they likely do not have IV access. If you are caring for a comfort care patient in the hospital, they are more likely to have IV access.

  1. Morphine
    • Brand Name: MS Contin, Roxanol
    • Purpose: Pain relief and dyspnea management
    • Route: Oral, Intravenous (IV), Subcutaneous
    • Dose: Varies depending on the patient’s condition and prior opioid use; often titrated for effect.
  2. Lorazepam
    • Brand Name: Ativan
    • Purpose: Anxiety relief, agitation control, and as a sedative
    • Route: Oral, IV, Sublingual
    • Dose: Typically 0.5 mg to 2 mg as needed; dose adjusted based on patient response and need.
  3. Haloperidol
    • Brand Name: Haldol
    • Purpose: Management of agitation or delirium
    • Route: Oral, IV, Intramuscular (IM)
    • Dose: Usually starting at 0.5 mg to 5 mg; titrated based on the patient’s symptoms and response.
  4. Hydromorphone
    • Brand Name: Dilaudid
    • Purpose: Pain relief, particularly in patients who cannot tolerate morphine
    • Route: Oral, IV, IM, Subcutaneous
    • Dose: Starting doses can vary; often used in lower doses than morphine (e.g., 0.2-1 mg IV).
  5. Fentanyl
    • Brand Name: Duragesic, Sublimaze
    • Purpose: Pain relief, especially in patients with renal impairment
    • Route: Transdermal, IV, Sublingual, Buccal
    • Dose: Transdermal doses vary (e.g., 12.5 mcg/hr patch); IV doses are typically in micrograms (starting at 25 mcg/dose), titrated to effect.
  6. Metoclopramide
    • Brand Name: Reglan
    • Purpose: Nausea and vomiting management, gastroparesis
    • Route: Oral (disinigrating tablet), IV
    • Dose: Commonly 10 mg before meals and at bedtime; IV doses may vary.
  7. Ondansetron
    • Brand Name: Zofran
    • Purpose: Nausea and vomiting control
    • Route: Oral (pill or disintegrating tablet), IV
    • Dose: 4 mg to 8 mg
  8. Scopolamine
    • Brand Name: Transderm Scop
    • Purpose: Management of secretions, nausea, and motion sickness
    • Route: Transdermal patch
    • Dose: One patch (1.5 mg) applied behind the ear every 72 hours as needed.
  9. Paracetamol (Acetaminophen)
    • Brand Name: Tylenol
    • Purpose: Pain relief and fever reduction
    • Route: Oral, Rectal, IV
    • Dose: 500 mg to 1000 mg every 4-6 hours as needed; not to exceed 4000 mg in 24 hours.
  10. Gabapentin
    • Brand Name: Neurontin
    • Purpose: Neuropathic pain management
    • Route: Oral
    • Dose: Starting dose of 300 mg, titrated up to effectiveness; maximum doses can vary. This medication takes time to build up to a therapeutic level in the system to feel its effects.

Because patients are so dynamic and their needs differ quite a bit, there is not one set of meds that works for everyone. Some patients will have more pain and discomfort than others.

Emotional and Spiritual Support Strategies For Comfort Care Patients

Before these moments occur, it is helpful to know what the patient wants when the time finally comes. Do they want to be alone? Do they want family near? Are there specific people they want near and others they don’t? If it happens in the middle of the night, do they want you to wake up loved ones and have them come, or would they rather quietly exit? Do they want only family, or do they feel better having a nurse with them?

Consider assisting the patient and loved ones in facilitating these conversations.

In addition, there are other ways to support patients that go beyond physical clinical care. Let’s discuss a few.

Active Listening

Provide emotional comfort by actively listening to the patient’s thoughts and feelings without judgment. Listen to their fears, stories, concerns, needs, and more without an agenda to fix or provide advice. Having someone who is an objective third party who is not a close family member or friend to talk through experiences with is both validating and affirming. These are healing experiences!

Encouraging Reminiscence

Foster therapeutic closure by encouraging the patient to share meaningful memories and reflections on their life. Be engaged with what they are sharing with you. Ask to see photos and learn more. This sounds simple, but another person just being interested in what you have to say is deeply supportive.

Facilitating Family Connection

Support emotional connections by encouraging open communication and meaningful goodbyes with family and loved ones. You can empower patients to face hard conversations with your support. Maybe they didn’t feel like they’d be able to do it alone, but if you’re with them or give them a pep talk beforehand, maybe they will have the conversations they need to have to leave this world with more peace – and peace for others.

Providing Spiritual Care

Cater to spiritual needs by facilitating conversations with spiritual advisors or offering access to religious resources aligned with the patient’s faith. If you’re working in a hospital while caring for a comfort care patient, you can connect with your unit’s hospital chaplain, who would be able to facilitate these services.

Remember that chaplains are there to provide support and are trained to care for people in crisis. While many chaplains do come from a Christian faith background, they are there to provide non-judgemental support regardless of the patient’s faith or spiritual background. Their training involves:

  • Grief and bereavement counseling
  • Crisis intervention
  • Family support counseling

Many believe a hospital chaplain is the same as a pastor, but it’s not. They have additional training that is extremely valuable for comfort care patients and families.

Mindfulness and Meditation

Promote tranquility through mindfulness or meditation practices, such as breathing exercises or guided imagery. You can find these on YouTube for free or on meditation apps like Calm and Headspace.

Creating a Comfortable Environment

Enhance emotional well-being by ensuring the physical environment is personalized and comforting. This might mean having a favorite show on, music the patient enjoys, or an audiobook playing.

Supporting End-of-Life Decision-Making

Empower the patient in decision-making about care, treatment preferences, and end-of-life wishes. There are many things to consider that we’ve already outlined. It’s important they have their affairs in order, know who they want to be with them, and what they want things to look like. As their nurse, you are in a position to help facilitate these wishes as appropriate.

(Note: You can inform them about the various aspects of getting their affairs in order, but you cannot do that for them.)

Preparing for the Moment of Passing

When caring for a comfort care patient in their final moments, it’s paramount to approach the situation with a blend of professional expertise and compassionate sensitivity. The primary objective is to ensure the patient’s comfort and dignity during these precious last moments. As a nurse, you should meticulously manage pain and other distressing symptoms, utilizing the prescribed medications and interventions effectively. Regular assessments are crucial to identify any changes in the patient’s condition and to respond promptly, always prioritizing their comfort.

Communication plays a vital role in these situations. It’s important to maintain a calm and soothing presence, speaking gently to the patient even if they are non-responsive. Research suggests that hearing could be one of the last senses to fade, so your reassuring voice can be a source of comfort.

At the same time, be aware of the family’s needs. Offer them support and provide clear, compassionate explanations of what is happening and what they can expect. Allow them the space to be with their loved one, and respect their wishes regarding privacy and religious or spiritual practices. Notice how the family responds to your presence and support, and adjust accordingly. We don’t want to be overbearing, but we also don’t want to be too removed.

Maintaining the patient’s dignity is a critical aspect of end-of-life care. This includes keeping them clean, dry, and comfortable, and ensuring the room is peaceful and respectful. Dimming the lights, playing soft music, or opening a window for fresh air can make the environment more serene. Lastly, after the patient passes, demonstrate empathy and professionalism. Assist the family in their initial stages of grief, provide them with information on what to expect next, and ensure that the patient’s body is handled with respect and care.

In these moments, remember that you are not just a caregiver but also a crucial source of solace and strength for both the patient and their loved ones. The care you provide in these final moments is not only a testament to your professional commitment but also to the profound human connection at the heart of nursing.

Providing Post-Mortem Care

Clinically speaking, you must provide practical care for the patient after he or she passes. Let’s go through some practical steps, but please remember that these are informational only. Specific guidelines depend on your state and facility.

It is important to have a few details in place prior to providing this important care:

  • The funeral home selection of the family
  • If the family wants an autopsy, or if one is legally required
  • If the patient’s death requires a medical examiner to evaluate
  • If the patient was an organ donor

The funeral home will pick up the body from the hospital or their home to bring them to their facility to begin preparing for services. Time is a factor, so it’s helpful if the family has identified this before the death. It can be shocking to see your loved one pass and then attempt to Google local funeral homes and pick one.

If the patient was an organ donor, but had a lengthy illness, they likely can only donate tissue and eye. There is probably a checklist in your documentation to determine this.

When death is anticipated, and a patient has been in comfort care for some time, families often do not want an autopsy. Before beginning any post-mortem care, you must know if the patient is getting an autopsy because it will impact what you do and do not do. Also, you must know if the patient will be sent to a medical examiner.

The specifics are determined by state law, but generally, deaths that are unnatural or suspicious, without medical attendance, in custody, of unidentified people, of public health interest (infectious diseases), children, or when there is no attending physician, will require a medical examiner to be involved. In all my years as a nurse, I actually never had to send anyone to a medical examiner. Your documentation should include a checklist so you know for certain.

  1. Call the Time of Death: Making the death official is necessary. The laws surrounding this depend on where you are, but often it includes listening to the apical pulse for one minute and certifying there is no cardiac activity. The requirements for this are specific, so please make sure you know what they are! Include the time of death in your documentation.
  2. Family Notification: Inform the family in a clear but kind manner that the patient has died. Use language that communicates with certainty that the patient is gone. (I have observed situations in which vague language is used, and people do not appreciate that!)
  3. Notification and Documentation: Notify the attending physician of the patient’s passing as appropriate with your protocols.
  4. Privacy and Dignity: Close the door and draw the curtains around the bed to provide privacy. If the patient is in a shared room, consider moving them to a private area.
  5. Family Time: Ask the family if they wish to spend some time with the patient before post-mortem care or after. Give them space and privacy to grieve. Be available to provide support and answer any questions they might have.
  6. Provide Post-Mortem Care: This also depends on your hospital/facility. In general, you can wipe down the body with wipes or water and mild soap, removing any bodily fluids. Close the patient’s eyes and mouth; if necessary, use small rolled towels or gauze to keep them closed. You may need to gently hold the eyelids down for a little bit so they stay closed.
  7. Positioning the Body: Position the body lying flat, with a pillow under the head and the arms placed outside the blanket or sheet. This helps prevent discoloration and pooling of blood.
  8. Handling of Tubes and Lines: If the family has agreed and there are no legal or policy requirements for an autopsy, remove all tubes, catheters, and IV lines. However, always check with your facility’s policy and the physician’s orders.
  9. Dressing the Patient: Change the patient into a clean gown. If the family has provided special clothing, dress the patient in these clothes. Respect cultural and religious customs whenever possible.
  10. Identification: Place identification tags as per your facility’s policy. Usually, tags are placed on the ankle and attached to the outside of the body bag.
  11. Preparing for Transport: Gently transfer the patient into a body bag, respectfully handling. Ensure the body is covered appropriately. If you’re in a hospital, you can likely leave the patient on the bed until transfer details are decided.
  12. Coordination for Transfer: Notify the appropriate department (usually the morgue or funeral home services) to arrange for the body’s transport. If the funeral home will be there soon, you may be able to keep the patient in the room until they arrive. Otherwise, they need to be transported to the morgue to keep the body cool. This may entail bringing the patient down on the same bed, or transferring to a specific type of stretcher/gurney that can fit in the morgue.
  13. Complete Documentation: While there is not a lot to document after a patient passes, it is imperative to get it right. There are important details to record, so make sure you get those in the chart promptly according to your facility’s protocols.
  14. Self-care and Team Support: After performing post-mortem care, take a moment for yourself. This aspect of nursing can be emotionally taxing. It’s 100% reasonable to take a break after a death.

Remember, providing post-mortem care is not just about following steps; it’s about honoring the patient’s life and providing respect in death. Your compassionate care continues even after a patient’s final moments.

Aftercare and Grief Support for Families

Guiding families through the grieving process after the loss of a loved one is an essential part of compassionate care. Families experience grief in unique ways, and there’s no “one size fits all” approach. However, offering support, understanding, and resources can make a significant difference in their journey.

Resources and support systems available post-passing:

  • A frequently utilized tool in hospice care that offers considerable solace to family members is “Gone From My Sight: The Dying Experience.” This resource is readily available online if not currently available at your facility.
  • The National Hospice and Palliative Care Organization (NHPCO), has information about grieving and loss. 
  • The Hospice Foundation of America also has a grieving section
  • Specifically for grieving children and families, you can go to The Dougy Center.
  • Support Groups: These groups offer a safe space to connect with others who have shared similar experiences. Look for local groups through hospitals, hospices, religious organizations, and community centers. A wide range of online options is also available.
  • Therapy: Seeking professional help from a therapist or counselor can be invaluable in processing grief, developing healthy coping mechanisms, and managing the long-term impact of loss. 

Embracing the Final Journey: The Vital Role of Nurses in End-of-Life Care

Providing comfort care for dying patients is a sacred duty. Your compassionate presence and skilled care ensure the transition is as gentle as possible.

You are the embodiment of empathy and dignity in the final moments. Keep up the incredible work, and never underestimate your profound impact on your patients and their families during this tender time.

FAQs About Comfort Care, Death & Dying

Why does a dying person linger?

The first thought that usually crosses our minds is that the person may feel they have unfinished business, such as unresolved relationships, unsaid words, or unfulfilled goals, and sometimes, that is the case. However according to Psychology Today, the individual nearing the end of life is enveloped in their realm, guided by an innate intelligence of the dying process. Meaning that the lingering is related to them alone and is unrelated to their requirements from others, and one should respect their journey letting them go through it on their own terms.

Does a dying person smell weird?

The specific chemicals released during the dying process can vary among individuals, and factors such as overall health, medical conditions, and care received can influence the nature of the odor. During the dying process, the body undergoes various metabolic shifts, and one of the byproducts is the release of certain chemicals, including acetone. Acetone is a compound found in products like nail polish remover, and its presence can contribute to the unique odor observed in individuals approaching the end of life. In cases where an individual is in the final stages of bowel or stomach cancer, the associated odor can be notably intense.

What do you smell before you die?

The experience of a specific smell before death is subjective and can vary among individuals. However, a curious fact related to smell and death found in research is that losing the ability to detect specific smells proved to be a more accurate predictor of death than diagnoses of cancer, heart failure, or lung disease. However, researchers emphasize that the loss of smell is unlikely to be a direct cause of death but it is a possible harbinger for what is to come. 

What are the disadvantages of dying at home?

Dying at home may pose disadvantages, including a lack of medical resources in case of emergencies, potential social isolation because the support network available in a healthcare setting might be absent, emotional impact on family members, logistical challenges, and caregiver stress. Also, home care, while often preferred, can be expensive, especially if specialized equipment or additional staff are needed. Therefore, exploring insurance coverage, financial assistance programs, and community resources might be necessary.

Does comfort care mean the end of life?

While comfort care is often associated with end-of-life care, it is not exclusive to that stage. It is a broader term that can be implemented at any point during a serious illness, including during curative treatment or in life-prolonging treatments. According to specialists, when patients elect comfort care, they’re choosing aggressive measures for symptom control, and it is scientifically proven that when people feel better, they live longer. It doesn´t necessarily mean declining medical treatment. While end-of-life care specifically refers to the care provided in the final stages of life.

What is the death stare when dying?

The term “death stare” is colloquial and does not have a specific scientific definition. However, it is sometimes used to describe a fixed or intense gaze that some individuals may exhibit as they approach death. This gaze is often attributed to changes in consciousness or neurological function that can occur during the dying process.

How do dialysis patients die?

According to scientific evidence, the causes of death in patients with dialysis are cardiovascular disease (as a leading chronic illness cause), withdrawal from dialysis, infections, endocrine/nutritional/metabolic diseases, genitourinary diseases, and neoplasms. When a patient chooses to withdraw from dialysis, their end-of-life experiences and symptoms are very similar to others that were previously mentioned in this post (decreased level of consciousness, breathing changes and difficulties, etc.)

More Resources For Nurses

Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.

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