This information is to help you understand what usually happens and the care we give when someone is believed to be in the last days and hours of their life.

Nothing can take away the feelings of grief and other emotions, but having this information may answer some of your questions and help you to cope. If you have any more questions, please ask a staff member.

Recognising when someone is dying

It can be hard to know when a person is entering their final days and hours. When the doctors and nurses believe that someone is dying and only has days or hours to live, they will explain this to you. You will be able to ask questions and discuss any concerns with them.

If it is possible and appropriate to discuss changes in physical health and decisions about care with the patient, we will always do this. However, they might not be well enough or they might not wish to have these conversations.

We also value the views of family and friends to help us to plan and give the best care and support possible. Tell us what is important to them and you, and how we can best support you.

Some people die very quickly with little warning and others gradually become worse over several days. Occasionally, people we believe to be dying unexpectedly improve and their condition stabilises.

Every day doctors and nurses check to make sure the care we give is still appropriate. If there are any major changes we discuss them with the patient, their family and friends, as appropriate.

Care needs of dying patients

When we believe a person is dying, we want to give them care which supports their needs. Patients may have already told you or us about what is most important to them, so please discuss this with us. Here are some things people often find important:

Food and drink

We provide food and drink for as long as needed to help someone feel comfortable. It is normal for someone who is dying not to want much food or drink, and sips of water may be enough. The nurses will regularly clean and moisten the patient’s mouth and we can show you how to help with this, if you wish.

When a person stops eating and drinking, it is not always easy to accept this change even when they are nearing the end of life. People sometimes ask if artificial fluids (a drip) will be given. These usually do not prolong life or improve its quality, and can cause problems such as fluid retention.

Doctors and nurses assess food and drink on an individual basis. We will explain our decisions to you and review it regularly.

Religious, spiritual, pastoral and cultural needs

When someone is approaching the end of their life, they might find it helpful to talk to someone. Often this comes from family and friends, but sometimes it can be supportive to talk to someone else.

The patient might like to see a representative of their faith to support their religious and spiritual needs, or to receive pastoral support. You and other family members or friends might also find this helpful.

There are chaplains from different faiths available and you can ask for their help and support even if you have no identified faith or religious affiliation. Ask a nurse if you would like a member of the chaplaincy team to visit. The chaplaincy team is available 24 hours per day.

Medicines

When a patient is believed to be dying, doctors and specialist nurses decide whether the medicines they are taking are still helpful. If it becomes difficult to swallow, we may give medicine in a way that is easier for the patient, such as by injection or pump.

Doctors can prescribe a range of medicines to help any troublesome or distressing symptoms such as pain or sickness. Sometimes we give patients a syringe driver which is a small, portable pump. This delivers medication continuously by injection, day and night.

Comfort measures

It is important that all staff caring for the patient meet their needs and also support you. You might find it helpful to write down what you think is important in the ‘My notes’ section below.

You can bring in personal belongings for them such as nightwear, a blanket from home, a special perfume, or photographs.

Some family members and friends want to help nurses to provide comfort and care. Tell a member of staff if you would like to be more involved.

Some family members and friends want to record familiar sounds such as children, grandchildren or family members singing or talking to the person. It can also be soothing for a patient to hear their favourite music played.

Children are welcome to visit to say goodbye. Let the nurses know if a child is coming to visit or if you wish to discuss this.

Changes in appearance

Every death is different. It is impossible to predict how someone will look in their final hours, but there are some common physical changes that you may notice:

  • People often become drowsy and spend much of their time sleeping.
  • Hands and feet can feel cold and skin may become pale and moist. Skin often becomes more delicate and vulnerable to pressure or moisture damage, skin tears, bleeding and infection. These can happen quickly and are not always easy to avoid, even with the best care.
  • People can lose all interest in their surroundings or even in their close family or friends. This is a natural part of the process.
  • Eventually, the person might lose consciousness. For some this happens just for a short time but for others it can last several days. Even though unconscious, they may still be aware that you are there and be able to feel your touch and hear your voice.

At such a sensitive time, family and friends may want to be involved in a practical way. If you would like to, we encourage you to take part in giving care, for example, by giving them something to drink (if they can safely swallow) or by moistening their mouth. Our nurses will explain the best things to do to help.

Other changes

Restlessness

A person who is dying is sometimes restless. This is often caused by chemical changes in the body that affect the brain. Restlessness can also be caused by emotional distress. If this is the case, the person may find it helpful to talk to a trusted professional, close friend, or a chaplain.

There are some medicines that can help, if needed.

Incontinence

A person who is close to death may lose control of their bladder and bowels. If needed, we will provide equipment such as incontinence pads or a catheter (a narrow, plastic tube that goes into the bladder).

Noisy breathing

Sometimes, the person’s breathing becomes noisy due to fluid collecting in their airways. Although this can be troubling to hear, it does not usually seem to worry the dying person. Changing their position can sometimes help and we might suggest trying some medicine. Suctioning is sometimes considered but can be distressing and make symptoms worse. We will monitor things closely and decide what care is best in each individual circumstance.

The final moments of life

The end of someone’s life can be an emotional time for everyone. It can be hard to know what to say to them or to each other. Simply being together and sharing their company in silence might be comforting and therefore all that is needed. For many, the final moments of dying are peaceful.

At this time, breathing usually becomes slower and more irregular with long gaps in between breaths.

When death is very close (within minutes or hours) their breathing pattern may change again. Sometimes there are long pauses between the breaths or their abdominal (tummy) muscles take over the work with their tummy rising and falling instead of their chest. Breathing may appear laboured, but it does not usually cause distress to the person who is dying.

These final moments can take a few minutes or last for a few hours, and occasionally even longer.

After death

After their death, you may feel shocked even if you felt well prepared.

Usually, you do not need to do anything straight away and you can stay with them for as long as you need. When you are ready, hospital staff will explain what to do next and give you this practical information leaflet to take away with you.

A doctor or nurse will certify the death. Nurses prepare the person to be taken to the hospital’s mortuary. This includes washing the person and changing their clothes. You are welcome to help or to carry this out independently if you prefer.

Family members and friends can visit the person in the mortuary. Please let us know if you wish to do this.

Further information and frequently asked questions

Sometimes, the coroner needs to be notified when a person has died. Staff may know in advance if it is necessary but, if not, they will let you know as soon as possible after the death.

If you have any spiritual, cultural or practical wishes following the person’s death, such as an urgent release for burial or cremation, let our staff know and we will try to meet these needs. We wish to deliver care that is sensitive to the cultural and religious needs and personal preferences of the dying person, their family and others close to them.

When a person has died, they may be able to donate organs or tissues (such as eyes or skin) for transplant. This might be possible even if the person had long term conditions and/or cancer. It may be feasible to donate up to 24 hours after death. Speak to the medical team if you want more information about organ donation or if you are aware of any special arrangements the person made.

Talking to children about a person approaching the end of their life can be challenging and what you decide to tell them often depends on their age and level of understanding. Usually, it is best to be as honest as possible with children. This may be upsetting, but it can help them to deal with the death a little better.

The hospital has a specialist palliative care social worker who can advise you about what to say.

If you are not in the hospital when the person who is dying deteriorates, we will let you know as you may wish to come in. Our staff will make sure we have up-to-date contact details for you. In the meantime, we will observe closely and spend whatever time we can with them.

Some people can hear and communicate but this varies. Some people communicate by squeezing hands until they are too weak to do so. Some people can speak a little but they communicate less as their condition deteriorates.

Their sense of hearing may remain until near the end and it can be comforting for the person to hear familiar voices. You may wish to play some quiet music, especially pieces the person particularly enjoyed.

It is generally best if the environment is calm and quiet and we will try to support this as much as possible.

If several family members or friends wish to spend time with the person, you could consider taking it in turns to sit with them.

To find this time easier to bear, some people find it helpful to bring a newspaper, magazine or book and perhaps talk about what they are reading with the person and/or others present.

We will pack up the person’s personal belongings ready to take with you if you are present. Otherwise, we will send them on by post.

Facilities to support you

Whilst you are on the ward, the following will be available:

Open visiting for our dying patients is an important part of their care. We encourage you to come as frequently and for as long as you wish.

We understand that it is not always possible or appropriate to stay for long periods of time. Families and friends sometimes alternate their visits to allow people to rest and re-charge whilst those present can have some ‘quiet time’ alone with the person. There is no right or wrong; only what is right for you.

A ‘Zed-Bed’ or recliner chair might be available so you can rest overnight at the person’s bedside if you wish. Ask the nursing staff if you would like to stay overnight.

Refreshments such as tea, coffee, drinking water and biscuits are freely available on the ward. You are also welcome in our restaurants and cafes, but please be aware that they do not accept payment by cash.

  • Hospital Restaurant – Level 2 Kingston Surgical Centre (7am to 3pm every day)
  • Costa Coffee – Main entrance (7am to 8pm weekdays (9am to 8pm weekends)
  • Main outpatients volunteer café (open for a few hours most days)

Exemption from car-parking costs. Car parking is operated on a pay as you exit system. There is limited allocated parking available for visitors of our dying patients. If this would be helpful for you, ask one of our nurses. If you have any questions about parking, contact the Facilities department on 020 8934 2003 or khft.carparking@nhs.net.

Questions for doctors and nurses

Date My questions and notes
 

 

 
 

 

 
 

 

 

 

Contact information


Speak to a member of staff on the ward if you have any questions or concerns

Telephone:

020 8546 7711 and ask to be put through to the ward