Nurse Base

When the patient first learns of his terminal illness, he'll refuse to accept the diagnosis. He may experience physical symptoms similar to a stress reaction — shock, fainting, pallor, sweating, tachycardia, nausea, and GI disorders. During this stage, be honest with the patient but not blunt or callous. Maintain communication with him so he can discuss his feelings when he accepts the reality of death — but don't force him to confront this reality.

When the patient stops denying his impending death, he may show deep resentment toward those who will live on after he dies — including you, the hospital staff, and his own family. Although you may instinctively draw back from the patient or even resent this behavior, remember that he's dying and has a right to be angry. After you accept his anger, you can help him find different ways to express it and can help his family to understand it.

Although the patient acknowledges his impending death, he attempts to bargain with God or fate for more time. He will probably strike this bargain secretly. If he does confide in you, don't urge him to keep his promises.

In this stage, the patient may first experience regrets about his past and then grieve about his current condition. He may withdraw from his friends, family, doctor, and from you. He may suffer from anorexia, increased fatigue, or self-neglect. You may find him sitting alone, in tears. Accept the patient's sorrow, and if he talks to you, listen. Provide comfort by touch, as appropriate. Resist the temptation to make optimistic remarks or cheerful small talk.

In this last stage, the patient accepts the inevitability and imminence of his death, without emotion. The patient may simply desire the quiet company of a family member or friend. If, for some reason, a family member or friend can't be present, stay with the patient to satisfy his final need. Remember, however, that many patients die before reaching this stage.