Readiness to Die

In document Nursing Care at the End of Life: What Every Clinician Should Know (Page 39-43)

The need to better understand the experience of patients confronted with impending death was examined by Copp (1997). She sought to explore this experience particularly from the nursing perspective and exploring the nurse-patient relationship within the context of patients living with impending death. Copp found that patients who knew they were going to die at an uncertain time made many references to a separation between theirbody and theirself,as though they were separate entities. This split in between oneself and one’s body was examined closely to better understand the individuals’ readiness to die. The readiness to die theory was based on four patterns or modes that individuals could be going through at any given time that relate to the degree of readiness of their body and their self to death. Dying persons could only be in one mode at a time but could change between modes as

their illness progressed and as they came to terms with their mortality. These four modes are organized by:

• Person ready, body not ready • Person ready, body ready • Person not ready, body ready • Person not ready, body not ready

It is quite possible that death could occur within each of the four defined modes; however, as clinicians we could only hope that the majority of our patients would be within the “per- son ready, body ready” mode. In this mode, both the patient’s body and the patient’s inter- nal self are aligned as being ready. Copp’s theory provides a different way to think about how patients who know they are going to die might be processing that information.

What You Should Know

• Theories, such as the Quality of Life Model and Uncertainty in Illness theory can help nurses understand commonalities in the illness experience of their patients.

• Patients can go through 5 stages of dying including: denial, anger, bargaining, depression and acceptance.

• An open awareness of dying often has the best outcomes for both the patient and clinician.


Agard, A., Hermeren, G., & Herlitz, J. (2004). When is a patient with heart failure ade- quately informed? A study of patients’ knowledge of and attitudes toward medical information.Heart & Lung, 33,219-226.

Copp, G. (1998). A review of current theories of death and dying.Journal of Advanced Nursing, 28, 382-390.

Curtis, J. R., Engelberg, R. A., Nielsen, E. L., Au, D. H., & Patrick, D. L. (2004). Patient physician communication about end-of-life care for patients with severe COPD.Euro-

pean Respiratory Journal, 24,200-205.

in a shrinking future: Living with advanced heart failure.Journal of Cardiovascular Nurs- ing, 22,480-487.

Edmonds, P., Karlsen, S., Khan, S., & Addington-Hall, J. (2001). A comparison of the pal- liative care needs of patients dying from chronic respiratory diseases and lung cancer.

Palliative Medicine, 15,287-295.

Elkington, H., White, P., Addington-Hall, J., Higgs, R., & Edmonds, P. (2005).

The healthcare needs of chronic obstructive pumponary disease patients in the last year of life.Palliative Medicine, 19,485-491.

Glaser, B. G., & Strauss, A. L. (1965).Awareness of dying. New York: Aldine Publishing Gott, M., Small, N., Barnes, S., Payne, S., & Seamark, D. (2008). Older people’s views of a

good death in heart failure: Implications for palliative care provision.Social Science &

Medicine, 67,1113-1121.

Guthrie, S. J., Hill, K. M., & Muers, M. F. (2001). Living with severe COPD: A qualitative exploration of the experience of patients in Leeds.Respiratory Medicine, 95,196-204. Habraken, J. M., Willems, D. L., DeCort, S. J., & Bindels, P. J. E. (2007). Health care

needs in end-stage COPD: A structured literature review.Patient Education and Counsel-

ing, 68,121-130.

Kuebler-Ross, E. (1997). On Death and Dying (Reprint). Scriber Publishing Group: New York City.

Mishel, M. H. (1981). The measurement of uncertainty in illness.Nursing Research, 30,


Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory.Image: Jour- nal of Nursing Scholarship, 22,256-262.

Murray, S. A., Boyd, K., Kendall, M., Worth, A., Benton, T. F., & Clausen, H. (2002). Dying of lung cancer or cardiac failure: Prospective qualitative interview study of patients and their careers in the community.BMJ, 325,929-932.

Oliver, S. (2001) Living with failing lungs: The doctor-patient relationship.Family Prac-

tice, 18(4), 430-433.

Polit, D. F. & Beck, C. T. (2014).Essentials of Nursing Research: Appraising Evidence for Nursing Practice(8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Ray, A., Block, S. D., Friedlander, R. J., Zhang, B., Maciejewski, P. K., & Prigerson, H. G. (2006). Peaceful awareness in patients with advanced cancer.Journal of Palliative Medi-

cine, 9,1359-1368.

Rogers, A. E., Addington-Hall, J. M., Abery, A. J., McCoy, A. S. M., Bulpitt, C., & Coats, A. J. S., et al. (2000). Knowledge and communication difficulties for patients with chronic heart failure: A qualitative study.BMJ, 321,605-607.

Seamark, D. A., Blake, S. D., & Seamark, C. J. (2004). Living with severe chronic obstruc- tive pulmonary disease (COPD): Perceptions of patients and their carers.Palliative Med- icine, 18,619-625.

Willems, D. L., Hak, A., Visser, F., Van der Wal, G. (2004). Thoughts of patients with advanced heart failure on dying.Palliative Medicine, 18,564-572.

U.S. Department of Health and Human Services. (2014).Healthy People 2020: Leading health indicators development and framework.Retrieved from Indicators-Development-and-Framework

Models of Organized End-of-Life

In document Nursing Care at the End of Life: What Every Clinician Should Know (Page 39-43)