September 04, 2018

The Last Hours of Living: Dying in Institutions

This is the sixth article in a series entitled: 'The Last Hours of Living'. This article is mainly targeted at healthcare professionals as it contains practical advice for clinicians in charge of providing care to people in the final hours of life.

Dying in Institutions

The preceding discussion is relevant to patients dying in any setting (eg, at home, in hospitals, in nursing homes, other extended care facilities, prisons, etc.). However, there are particular challenges to ensuring a comfortable death in an institution where the culture is not focused on end-of-life care.

When death is imminent, it is appropriate that patients remain with caregivers that they know rather than being transferred to another facility. Institutions can help by making the environment as home-like as possible. It is appropriate for the physician, nurse practitioner, or physician's assistant to order a private room where family can be continuously with the patient if they so choose and be undisturbed. The clinician will want to talk with the professional staff and encourage continuity of care plans across nursing shifts and changes in house staff.

holding hands

Priorities and care plans at the end of life differ considerably from priorities and plans focusing on life prolongation and cure. It is frequently challenging for physicians, nurses, and other healthcare professionals to incorporate both kinds of care into a busy hospital or skilled nursing facility. For this reason, specialized units where patients and families can be assured of the environment and the skilled care they need have been developed in many institutions.

1). Medscape Internal Medicine. The Last Hours of Living: Practical Advice for Clinicians. Retrieved 5.3.2011. Available online:

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