1. Simple Tips for Being Present with Those Who Are Dying By: Norman Mitchell-Bereavement Coordinator- Memphis, Tennessee Edited by DeAnna Looper RN, CHPN, CHPCA. Chief Corporate Clinical Consultant/Certified Grief Recovery Specialist

2. Expect more from us. We do. Learning Objectives Describe tips on offering presence at the time of death. Discuss ways to offer simple gestures of compassion. Identify non verbal cues to avoid physical touch.

3. Expect more from us. We do. Facts A common fear for the terminally ill is “dying alone.” By nature, we are a species that prefer to be with others, seek meaning and fulfillment in relationships, therefore, why would death be viewed differently?

4. Expect more from us. We do. “As far as we know, we are the only species aware of the inevitability of our own death.” ~Elizabeth Kubler-Ross, M.D.

5. Expect more from us. We do. Tips for offering presence Introduce yourself- establish a rapport and respect the surroundings. If the individual is not awake, alert and/or oriented, talk to them as if they are. Keep the environment comfortable-based on the individual’s wishes or preferences. Use music meaningful to the patient/family Use the environment to assist comfort (family portraits, knick-knacks, sentimental treasures such as a doll, teddy bear, blanket.

6. Expect more from us. We do. Tips-continued Keep the moments intimately personal. Provide care to the “individual” not the disease Listen unconditionally and attentively. If the individuals is conscious and can communicate- listen. If they interrupt you-stop and listen If the person is not conscious, be cognitive of changes in his/her physical condition.

7. Expect more from us. We do. Have empathy for the person/family’s suffering. Know and learn how to sit and be with emotional pain without having to eliminate it. Appropriately share your experience and emotions as it relates to your purpose in being there. Honor the spiritual / cultural aspects of the individual dying.

8. Expect more from us. We do. Tips-continued Reduce distractions in order to create a calming and peaceful environment. Simple acts of compassion are some of the most special gifts you can give. A cool cloth on a warm forehead A soft tissue to wipe a person’s chin Softly stroke the person’s hair. Gently hold their hand.

9. Expect more from us. We do. Tips-continued Remember-the sense of hearing is the last to go- continue speaking to the individual and others as if the dying individual can hear. Pay attention that your touch may be irritating or uncomfortable for the individual. Watch for non- verbal cues such as Pulling away. Jumping/startling when touched. Grimacing or frowning. Restlessness.

10. Expect more from us. We do. Tips-continued Slow down and share the silence Be comfortable in saying nothing-when nothing needs to be said. “What I have learned most from my experiences with the dying person is that the most important aspect of the vigil is that I am there with them and present in the moment.” ~Frances Weld Peabody

11. Expect more from us. We do. Be ready to listen again….and again Be respectful Be aware of feelings and attentive to non-verbal cues Be comfortable with silence Be human Be gentle

12. Expect more from us. We do. Most of all…be there! Don’t expect perfection from yourself when you are with someone who is dying, your presence just being there is the greatest gift. Be yourself, be real, be vulnerable The details of what you need to do will be come evident to you as you quiet your mind and still the static in your thoughts ~Kristi A. Dyer, MS. M.D.

13. Expect more from us. We do. Remember: “The dying hold up a mirror to our hearts and give us the opportunity to see ourselves”

14. Expect more from us. We do. Q & A ??????

15. Expect more from us. We do. References Author unknown. “Supporting a grieving person” Helpguide.org. www.helpguide.org/mental/helping_grieving.htm. 07 April 2013 www.helpguide.org/mental/helping_grieving.htm Education for Physicians on End-of-life Care. Participants Handbook. Module 12. Last Hours of Living. 1999. Print.