The CNA’s Role in Death and Dying
by Rynae Golke
As a CNA, your role in end-of-life care is arguably the most important of all. You are the most consistent caregiver many patients have; they rely on you for nearly all of their most intimate activities of daily living. These close working relationships often grow into even closer personal friendships.
In this blog, we’ll help you cope with the impact death and dying have on you as the caregiver, understand the dying person’s rights, outline your role during end-of-life, and provide you with key takeaways for successful contribution during this intimate patient experience.
Coping with your feelings
Death and dying can dramatically impact the caregiver. According to a study published in Geriatrics, as many as 20% of bereaved caregivers experience complicated grief or depression following the death of a patient. It’s important to take measures to cope with your own grief as you care for a patient experiencing end-of-life. Healthy caregivers are the best caregivers.
These measures can help:
- Learn as much as you can about the disease or condition impacting your patient. When you know what to expect, the risk of severe anxiety is reduced.
- Talk to somebody you trust about your feelings, taking special care to maintain the patient’s confidentiality.
- Take time to care for yourself. Get plenty of rest, drink water, and do things that make you happy when you’re not working.
- Know your limits. Although you may have developed a personal relationship with the patient, it’s important to check out – both mentally and emotionally – when you punch the time clock at the end of your shift. Give yourself permission to disconnect.
- Care for your spirit. Being at peace with “being” can help you come to terms with death and dying, too. Save time for prayer, meditation, or any activity that brings you inner peace.
Many caregivers find peace in knowing that they were able to provide dignity, comfort, and tender care to a patient and their family during their last days. Doing your very best work for the patients who need you most is sometimes the healthiest way to cope with the impending loss.
Understanding the rights of the dying
The dying person’s rights as written by Judy Tatelbaum in The Courage to Grieve are an important resource as you advocate for your patient. When you understand the patient’s rights, you are able to focus in on both providing and protecting those rights.
The dying person’s rights, paraphrased, include:
- The right to be treated like a living human being until the very end
- The right to be hopeful
- The right to be cared for by people who are hopeful
- The right to talk about their feelings about impending death
- The right to receive the attention of staff even when treatments designed to cure are ceased
- The right to die among company
- The right to be pain-free
- The right to receive honest answers to questions
- The right to die with dignity and peace
- The right to participate in decisions
- The right to have help from and for their family in accepting their death
- The right to be free from judgment
- The right to discuss their religious experience and beliefs
- The right to be respected after death
- The right to be cared for by people who want to help them face their death
It’s important to note that hopefulness doesn’t always mean that the patient or the caregiver are expected to hope for a cure or a miracle. Sometimes hopefulness refers to looking forward to what lies beyond death, to a peaceful passing experience, to care and attention throughout the process, or to an end of their suffering.
The dying person’s rights drive the CNAs decisions during end-of-life care. Any action, communication, or decision that might compromise any of these rights should be avoided.
The CNAs role in end-of-life care
Almost every CNA has felt powerless at times because of the nature of their role in the facility. You may not make decisions about the patient’s treatment plan, but you have incredible power to make a patient’s last weeks and days as peaceful and comfortable as possible. You alone have the power to decide how tender your touch is, how the patient’s family is made to feel by your presence, and how the care you provide impacts the patient during this intensely personal time in their lives. If you read further, you’ll find that your role is both broad and perhaps the most impactful on the team.
It is within your role to comfort the patient. Patients often develop deep relationships with their primary caregivers (that’s you!) and, as a result, are more comfortable sharing their thoughts, needs, concerns, and wishes with you. It is within your role to give the patient your rapt attention and support; to validate their feelings; to assist them in carrying out their wishes; to answer questions when within your scope; and to provide comfort.
It is within your role to ease the burden on family. Sometimes it is as simple as offering the family a hot cup of coffee or asking how they are. At other teams, it means offering to sit bedside so they can rest or get some fresh air. The CNA has the power to transform this experience for the family by showing them the same gentle, loving care that their loved one is receiving.
It is within your role to keep the patient comfortable. The CNA alone determines the patient’s comfort level during end of life by following or exceeding the care plan. You can dramatically impact the patient’s experience by speaking in a soothing voice, providing cares exactly as scheduled or more often, treating the patient with dignity, and actively seeking ways to make the patient more comfortable.
It is within your role to advocate for the patient. Perhaps most importantly, you often have the most intimate look into the patient’s end-of-life experience. If you believe the patient is in pain, is not benefiting from the care plan, is not being cared for properly by other staff, or has had rights taken away from them, it is within your role to share your concerns with the nurse overseeing the patient’s care.
In conclusion, the CNA plays arguably the most important role in the care of the dying patient. You can ensure the best possible experience for your patient by taking care of yourself, understanding and advocating for the patient’s rights, and working within your scope to provide dignity and comfort.