Dear friends ,
As I am dealing with terminating ill patiens since last 15 yrs. Though their terminal illness up to their deaths, I observed many things about there fealing regarding their life and deaths. They have many needs that are basically the same as those of other patients: spiritual, psychological, cultural, economic, and physical. What differs in these patients may be best expressed as the urgency to resolve the majority of these needs within a limited time frame. Death comes to everyone in different ways and at different times. For some patients, death is sudden following an acute illness. For others, death follows a lengthy illness. Death in chronic illness especaily with end stage reanl ds not only affects the individual patient; it also affects family and friends, staff, and even other patients some times it affects treating physican too. Because of this, it is essential that all healthcare providers understand the process of dying and its possible effects on people. Individual’s Perspective on Death Patient,s view death from their individual and cultural value perspectives. Many patient find the courage and strength to face death through their religious beliefs. These patients and their families often seek support from representatives of their religious faith. In many cases, patients who previously could not identify with a religious belief or the concept of a Supreme Being may indicate (verbally or nonverbally) a desire to speak with a spiritual representative. There will also be patients who, through the whole dying experience, will neither desire nor need spiritual support and assistance. In all these cases, it is the responsibility of the Physican to be attentive and perceptive to the patient’s needs and to provide whatever support personnel the patient may require. Cultural Influences An individual’s cultural system influences behavior patterns. When we speak of cultural systems, we refer to certain norms, values, and action patterns of specific groups of people to various aspects of life. Dying is an aspect of life, and it is often referred to as the final crisis of living. In all of our actions, culturally approved roles frequently encourage specific behavior responses. I observe that patients on end stage illness faces five stages of death, denial, anger, bargaining, depression, and acceptance. The first stage, denial, is one of nonacceptance. “No, it can’t be me! There must be a mistake!” It is not only important for the doctor to recognize the denial stage with its behavior responses, but also to realize that some 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, “I’d do anything if I could just turn this thing around.” Once patients realize that bargaining is futile, they quickly enter into the stage of depression. In addition to grieving because of their personal loss, it is at this point that patients become concerned about their family and “putting affairs in order.” The final stage comes when the patient finally accepts death and is prepared for it. It is usually at this time that the patient’s family requires more support than the patient. It is important to remember that one or more stages may be skipped, and that the last stage may never be reached. Support for the Dying Despite the fact that we all realize our mortality, 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 healthcare providers “how to do” death. The “how to” will only come from the individual doctor who understands that patients are people, and that, more than any other time in life, the dying patient needs to be treated as an individual person.