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  • Writer's picture Gabrielle Elise Jimenez

Bedside manner

Updated: Jan 16

When someone is lying in a bed and they are unable to verbalize how they are feeling or what they might need, that is the most important time for you to be sensitive, considerate and kind.

Please do not do anything without telling them first, they deserve to be included in anything that you might be doing to or for them. Talk to them before you clean their mouth, or change their brief or raise or lower their bed. Let them know you are about to touch them. It’s already scary enough going through their dying process, but can you imagine lying in a bed, without a voice, eyes are closed and someone comes along and shoves a mouth swab in your mouth or suddenly removes your pillow, or worse... puts medication in your mouth... none of which was without warning?!?!? Talk to them, tell them what you are about to do; this is their body, ask permission first, they have the right to be asked first, or at the very least, told. 

The liquid medications we use most frequently at the end of life are Morphine, Lorazepam, Haloperidol and Methadone, most of which absorb through the mucus membranes (sublingual), except for Morphine, which usually has to be swallowed. These medications are bitter and don’t taste good. I have learned that putting these medications in a moist mouth is less yucky than a dry mouth. If you take a (needle-less) syringe and drop one or two drops of water on the tongue before giving the medication, it can be a little easier for them. BUT!!! And don’t forget this part, tell them first! Just because they can’t verbalize, and might be sedated, does not mean they do not have feelings and cannot be startled or scared. Always tell them first when you are about to put something in their mouth. If you massage the cheeks, it helps the medication absorb a little easier. Sometimes a little trickles down their throat and causes them to cough; elevate their head a little more and reassure them you are there and it’s okay and relieve them of the fear that they might be choking. I like to reach my arm under their pillow, getting their head into the curve of my arm (near the elbow) and slightly lift their head up just enough to help them get the medications down, without having them pool or settle in the throat and cause that really uncomfortable feeling. Be gentle, be kind, take your time... don’t rush patient care... EVER! When someone is lying in a bed and they are unable to verbalize how they are feeling or what they might need, that is the most important time for you to be sensitive, considerate and kind.

Mouth care is a wonderful gift for someone lying in a bed, especially for those who cannot tell you how they feel. Don’t do mouth care after you have given medication though, wait at least 45 minutes to make sure it’s been absorbed. Mouth care before medication though, is lovely!!! Get that sponge in there, separate the teeth and gums which have a tendency of becoming very dry, moisten their tongue. Trust me... they will love this!!!

A few tips when providing cooling measures... a cool cloth on a warm head is lovely, do it and do it often BUT.... DON’T LEAVE IT THERE! It drives me insane to walk into a room and see someone lying there with a wash cloth on their head that I know has been there awhile. Remember, a cool cloth on a warm head becomes a warm heavy cloth and that does not feel good. Gently dab the cloth on the forehead, the cheeks, the back off the neck, and over the eyes. Not both eyes at the same time though, that can be claustrophobic, dab one eye and then the other. And don’t forget to tell them what you are doing the entire time. Medications tend to make eyes and cheeks hot, that cool cloth is a gift from you they will be so appreciative for. If they have an oxygen cannula on, remember to periodically raise and lower it from where it rests on the cheeks, it tends to dig deep into their skin and is uncomfortable.

Before I get off my "bedside manner soap box" I want to tell you one more pet peeve, although not the last I am sure... Do not turn lights on that will shine right into someone’s eyes without at least telling them first. And if you can provide care without that light, do it!!! In general no one wants light shining in their eyes but someone lying in a hospital bed, nearing the end of life, is more sensitive, more fragile and those lights can be blinding and will sting. 

Be mindful of what you do and say around someone who might not be able to speak up. You are their advocate and they need to trust that you truly do have their best interests at heart.

Be considerate and kind always... to your patients, to yourself and to others!

xo Gabby

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