Fear of Abandonment During the Dying Process
Dying patients often fear abandonment. This fear may increase when they are actively dying, and it may portray itself as increased anxiety. Most patients do not want to die alone. This is a time when all hospice interdisciplinary team members need to visit and role blend as they strive to comfort the patient and family. The spiritual professional, psychosocial professional, nurse, CNA/HHA, volunteers, family, and friends can all decrease this fear, through continued, simple presence.
When the patient fears abandonment and even when the patient has not verbalized these fears, team members’ visits should be increased, not only for assessment, but also for support to the patient and family. When the patient is actively dying, a bedside vigil should be instituted. The use of an “11th hour” volunteer (those volunteers who are available 24 hours a day, 7 days a week and specially trained for care at the time of death) are used in many hospices and in any care setting.
Some family members are not comfortable in the role of providing presence at the bedside during the imminent stages. They may not be comfortable being in the room, or they may find they are unable to cope with the magnitude of the situation. While it is our responsibility to educate them regarding the dying process and provide reassurance, we must also “accept them where they are” and give them permission not to be present at the bedside if they so choose. Often, the caregiver wants to stay at the bedside, but is “afraid to do anything” or “does not know what to do.” Families may find bedside vigils easier if they are allowed to help with tasks and the physical care of the patient. Hospice team members can provide instruction verbally and through role modeling and example. As the hospice caregiver holds the hand of the patient, sings to the patient, plays music for the patient, or prays with the patient, the family member may be more comfortable in that role as well. An additional way to provide support to the family members at this time is to listen to their story — the story of their life with the loved one.
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