According to Department of Statistic of Singapore, there are 3 in 3000 population pass on yearly (Singapore Statistic,2019).

INTRODUCTION
According to Department of Statistic of Singapore, there are 3 in 3000 population pass on yearly (Singapore Statistic,2019). Death is an unavoidable experience in the life, it is not openly discussing in this modern society. However, there is the needs to learn to perceive death as a natural cycle in life. Healthcare professional has higher chances facing life and death in their working environment. They face dying patient and interpreting the process base on their own belief, culture, religion background.

Nurses has a closer patient relationship in healthcare setting, death would be face at some point of time in their professional life. Their attitude towards and fear of death would determine quality of care render for terminally ill and dying patient. However, many healthcare professional feeling unprepared to deliver end of life or communicate with families about the topic of death and dying.

Experience Of Death
The meaning of death defines differently base on individual culture, religion, believe and education or experienced. In general death define as permanent cessation of vital function but it could be other meaning in nursing who nurse a patient (merriam-wester,2020).

Dealing with death or nearly death patient is a challenge to a person who is new to nursing. Death is not just simple as I think as an unresponsive body, but it conceals a lot of knowledge to be deal to a person. My experience toward death as a student follow by working in paediatric and oncology broader my mind and perspective on death, same time change my view on life.

Student time

Beginning on my career, death toward as a novice are so much different from an experiences nurse. The first encounter of death that filled with different emotions of fear and anxiety. Moment before to see a dead body, thought and image appear in my mind. The knowledge that a person lying in the adjacent room is really an unpleasant feeling. However, enable to complete my duty in ‘last office’ through cleaning body prior sending to mortuary, I’m take it as part of my job without consider patient as whole.

The whole process involved in caring for a dying patient, building a relationship with patient and ended witnessing the patient dying as a corpse lying in the morgue is frightening and evoke a strong emotional. According to Cooper and Barnett (2005), such process brought many feelings of sadness, vulnerability and helpless in the care of dying patient which mirror myself too. The negative emotion which making me so ineffective to dealing with death either to patient or their family members. A lot of the time, I’m avoid facing the dying patient’s family even they in agony of the lost.

Paediatric

In experience as paediatric, I’m embrace a lot of hope to see all my ‘little angel’ to recover from their illness. I’m always felt small kids is so powerful to bring joy and portrait strong determination to stay alive. However, the idea of mine is so much more wrong.

My first cancer patient, he was a little boy. He always makes me feel world is so harmless and innocent. He always so positive though don’t know why he keep admitting to hospital. Every time of admission he will look for me, his mother told me, he likes me, but I knew he was fear and need to look for a familiar facing to make him comfort.

He is not doing well, he underwent operation. However, being a nurse and his buddy, I bought a little toys and role play to let him understand the operation. The toy is our common language and he know the toys is our guardian angel which will protect him and give him courage

Unfortunate, he passes on and yet I never attend his wake to has a proper ‘goodbye ‘. I was too young and inexperienced. I could to better in his palliative treatment in supporting his mother or who love him too.
DEATH
KRYSTLE TANG HUEY WENG
0186673N
NUR 5009 PRINCIPLE &PRACTICE OF PALLIATIVE CARE


INTRODUCTION
According to Department of Statistic of Singapore, there are 3 in 3000 population pass on yearly (Singapore Statistic,2019). Death is an unavoidable experience in the life, it is not openly discussing in this modern society. However, there is the needs to learn to perceive death as a natural cycle in life. Healthcare professional has higher chances facing life and death in their working environment. They face dying patient and interpreting the process base on their own belief, culture, religion background.
Nurses has a closer patient relationship in healthcare setting, death would be face at some point of time in their professional life. Their attitude towards and fear of death would determine quality of care render for terminally ill and dying patient. However, many healthcare professional feeling unprepared to deliver end of life or communicate with families about the topic of death and dying.

Experience of Death
The meaning of death defines differently base on individual culture, religion, believe and education or experienced. In general death define as permanent cessation of vital function but it could be other meaning in nursing who nurse a patient (merriam-wester,2020).
Dealing with death or nearly death patient is a challenge to a person who is new to nursing. Death is not just simple as I think as an unresponsive body, but it conceals a lot of knowledge to be deal to a person. My experience toward death as a student follow by working in paediatric and oncology broader my mind and perspective on death, same time change my view on life.

Student time
Beginning on my career, death toward as a novice are so much different from an experiences nurse. The first encounter of death that filled with different emotions of fear and anxiety. Moment before to see a dead body, thought and image appear in my mind. The knowledge that a person lying in the adjacent room is really an unpleasant feeling. However, enable to complete my duty in ‘last office’ through cleaning body prior sending to mortuary, I’m take it as part of my job without consider patient as whole.
The whole process involved in caring for a dying patient, building a relationship with patient and ended witnessing the patient dying as a corpse lying in the morgue is frightening and evoke a strong emotional. According to Cooper and Barnett (2005), such process brought many feelings of sadness, vulnerability and helpless in the care of dying patient which mirror myself too. The negative emotion which making me so ineffective to dealing with death either to patient or their family members. A lot of the time, I’m avoid facing the dying patient’s family even they in agony of the lost.
Paediatric
In experience as paediatric, I’m embrace a lot of hope to see all my ‘little angel’ to recover from their illness. I’m always felt small kids is so powerful to bring joy and portrait strong determination to stay alive. However, the idea of mine is so much more wrong.
My first cancer patient, he was a little boy. He always makes me feel world is so harmless and innocent. He always so positive though don’t know why he keep admitting to hospital. Every time of admission he will look for me, his mother told me, he likes me, but I knew he was fear and need to look for a familiar facing to make him comfort.
He is not doing well, he underwent operation. However, being a nurse and his buddy, I bought a little toys and role play to let him understand the operation. The toy is our common language and he know the toys is our guardian angel which will protect him and give him courage
Unfortunate, he passes on and yet I never attend his wake to has a proper ‘goodbye ‘. I was too young and inexperienced. I could to better in his palliative treatment in supporting his mother or who love him too.
Adult oncology
In oncology, I always feel cancer patient supporting me more than I am supporting them. My patient, teaching me a lot of their life experience and teach me lot pf way to become a better me.
One of my patients, she is a teacher, she is in terminally stage and is on palliative treatment. She always like to sing an Indonesia song’ Begawan Solo’. She is so enthusiastic to telling me she admires the scene in this song. In a very awkward manner, I told her my feeling. I suggest to her, she can travel to Indonesia and sing that song. At the moment, maybe I just mention without any other meaning but the words is enlighten her. She takes my words and do exactly what I said before she dies. Her sister even thanks me help her to fulfil her wish. This is the time; I feel palliative care is so powerful just by identify a person wish.
Change Attitude on Death
In a survey done by Lien foundation on resident attitude (2014), almost half of the healthcare professional showing discomfort, difficulty and unpleasant feeling while dealing with dying patient. However, in the patient and family perspective, it is so important to start on the conversation before the death is happen.
Instance sudden death wound tremendously impact on the grieving process, some even has no time in preparing prior to the death. As a result, the mortality rate in care giver is higher during the process of grief. In palliative setting when time is allow, nurses should starting the conversation on the death ever more early than the sudden death can do. Care giver would feel they are somewhat preparing for the event and may through a period of anticipatory grieving (Chritopher,2007). At the same time lesser the worrisome from patient.
Throughout the experience of death, where I felt I should avoid shielding dying patient and their family’s feeling and withdrawing care from dying patient. Instead, time is so precious to help them settle down on their feeling and mind. Paul (2018), in his book of ‘when breath become air’ he said even he is dying but the moment he is not death he is still alive. It’s let me understand how important to address individual needs, hope and preference in our daily nursing care when they are still alive.
Now being a mother, I be accepting death is a normal circle in life which everyone will experience, it’s just a matter of time of when. There are no hiding from my own kids in each funeral which our family had and telling them frankly about what is death. I think everyone of us including the young should be prepared on the event prior to that happen to reduce their uncertainty.
In my religion as a Taoism, we believe whether a human can reborn as a human or animal after death is rely on what we did in before life (Hays,2018). It’s made me understand the meaning of death in everyone would be influence by believe, value and culture. It’s also building through by the information, education and person an individual met in live.

In the spiritualistic way, we should respect the person as person where they can be a role as father or husband. It’s happened to me unaware while I talked to my patient (Perkin,2016). The moment when they diagnose with terminal disease it could make them feel loss of hope and suffer from a spiritual pain. However, as a nurse we can rebuild or re-identify their hope through conversation. By talking to patient, we can identify what they want and reconciliation their thought to reform a new hope.
In end of life, I been long fascinating by ‘hope’ which is so important in our life. It’s not only when we are healthy but extremely important when we are sick, and time is short (Dibarrett,2018). ‘Hope’ can let us enduring pain, sadness and disappointment. That’s was a reason, I am spending time with patient to identify what exactly thing they never accomplish in life and encourage them complete before they are weaker. It may be just a word then said it if not write it, as we unsure when our life end but we can make it end beautifully.
Now being more experience towards care in cancer patient, I’m begun to understand my patient from their perspective of view. I’m was reading their bible and be physically around when they are praying as Christian, to me is another way to respect them as individual.
Overall, death can involve many aspects of care that I might never think of before. The meaning of good dying is how important to a patient. Meanwhile, identify patient goal on end of life and support someone in lost and grief is essential. Preparing a dying patient to death is an art we should embrace the principle of cure sometime, treat often and comfort always. The aim of the pathway is to ease their distress when facing the last phase of life (Murray,2012).

The Concern and Fear on Death
In a normal response, fear of death is common to happen when we know we are dying or when diagnose with terminal illness. Many of times, my patient trying so hard to find a peace to overcome their fear. The fear can be on their physical pain, future planning and end of life. All the fear could due to turmoil of uncertainty inside of their mind.
Pain is very subjective to individual; it is so common to hear from patient at the last phase of their life. Is easy as a nurse to say we can serve morphine when there is a pain but, in my patient point of view the worry of the next pain could be happen is really a disaster. No doubt with drug the pain is unresolved fully and need keep changing position to relieve it.
I can image, how suffering of a patient is in pain. Sometime, mind and body are so tired to deal with the pain and at last which can relief by drug. However, the question to them is when the next pain could happen, and the pain interval is becoming shorter and shorter. The interrupted sleep and uneasiness in mind making them and their family psychological and physical tire on fighting on.
The burden of death can be accumulating with how many roles we are practice as current. I was a mother is not just as only wife and daughter of others. The additional role I had, it makes me think more complex and difficult to let go. The fear on future is getting more as there is an additional role to play off. Fear how everyone I knew enduring the process of grief. They could denial, angry or depress feeling but can they accept the truth at the end?
The fear of future might not my future which is the future for those who I care. I will fear the growing process as a kid will be affected. Fear of after leaving the world my spirit can clearly see and hear how much they miss me and which I unable to reply. Those uncertainty, I believe It would be stronger when the time is close to die too.
When the time is close, that would be the time I worry on myself where I will go. Hearing a lot story from patient’s family member that there would be someone waiting for you and bring you to the place you are supposed to go. That’s will be a greatest fear because where exactly the place and person are, and could it be real or just rumour. However, come to the end, I think the fear of death would not be so strong as starting but I hope when I face same process of dying, someone can guide me through the process and prepare my family in the grieving process.

Conclusion
In summary, nurses being the one spending more time with patient should not avoiding initiating talk to patient about death. In our duty we treat patient physically, but we almost forget there is always psychologically or even psychosocial issues which is still unsettle by patient before end of their life. That’s important to treat medically but always remember an illness it won’t just influence by biological effect, but it impacts by psychological and psychosocially as well. Thus, we are treating a patient with hoplitic aspect to align with better outcome. Enable to reach the expectation of care, we need to have the initiative to start the topic on death in palliative phase of care.

Reference

Christopher, S (2007). Sudden versus unexpected death: Its complications and consequences. Retrieved from https://www.researchgate.net/publication/281447612_Sudden_versus_unexpected_death_Its_complications_and_consequences
Cooper, J., & Barnett, M. (2005). Aspects of caring for dying patients which cause anxiety to first year student nurses. International Journal of Palliative Nursing, 11(8), 423–430. doi: 10.12968/ijpn.2005.11.8.19611
Dibarrett. (2018, May 7). Supporting hope at the end of life. Retrieved February 20, 2020, from https://blogs.bmj.com/ebn/2018/05/07/supporting-hope-at-the-end-of-life/
Hays, J. (2018). TAOIST BELIEFS, PRACTICES AND DEITIES. Retrieved from http://factsanddetails.com/china/cat3/sub10/item91.html
How to Overcome Fear of Death at End of Life. (2017). Retrieved from https://www.crossroadshospice.com/hospice-palliative-care-blog/2017/march/24/how-to-overcome-fear-of-death-at-end-of-life/
Lien Foundation. (2014): Death Attitudes Survey Presser Final. Retrieved February 20, 2020, from http://www.lienfoundation.org/sites/default/files/Death survey Presser Final – Combined_0.pdf
Murray, B. (2012). Liverpool care pathway: doctors have always aimed to ease distress in dying. Bmj, 345(nov14 1). doi: 10.1136/bmj.e7606
Marriam-Wester (2020) : Death: Retrieved from https://www.merriam-webster.com/dictionary/death
Perkins, H. S. (2016). Giving End-of-Life Spiritual Care. A Guide to Psychosocial and Spiritual Care at the End of Life, 421–450. doi: 10.1007/978-1-4939-6804-6_14
Singapore statistic (2019): Population Trend. Retrieved from https://www.singstat.gov.sg/publications/population-trends

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