J. Worth Kilcrease

The four tasks a dying person faces also define the four dimensions of care for the dying person: physical, psychological, social, and spiritual.

Physical Dimension

Physical pain can be divided up into two categories: acute and chronic.  Acute pain is pain that comes on quickly in response to a specific injury or malady, can be severe, but lasts a relatively short time.  It is an indicator that something is wrong either in our environment or within our bodies.  Chronic pain, on the other hand, persists or progresses over a long period of time and is often resistant to medical treatments.  Chronic pain does not provide any of the important warning signals that acute pain does.  It is not diagnostically helpful nor does it warn us of any environmental dangers.  For those with a terminal illness, chronic pain is usually associated with the disease that will result in death.  Whether it is dull or sharp, constant or intermittent, chronic pain can consume a person’s attention and cause great distress.  Proper care for those with chronic pain requires that it, and the associated distress, be managed and diminished as much as possible.  Ways of addressing chronic pain include pain medications, working with the person to increase his/her pain threshold, and/or altering the nature of the person's pain perception. Therapies to help accomplish these include biofeedback, guided imagery, meditation, therapeutic touch, self-hypnosis, etc.  My blog posting Dying: Physical Dimensions of Care addresses the physical dimension of care in more detail.

Psychological Dimension

For many caregivers, the psychological dimensions of care can be more difficult to deal with than the physical dimensions.  When someone's suffering is psychological, i.e., involving feelings such as sadness, anger, fear, anxiety, and other so-called negative feelings, what can a caregiver do to help?  As I explain in my blog posting Dying: Psychological Dimensions of Care, there are three basic things a caregiver can do.  The first is for the caregiver to learn to be comfortable with his/her own discomfort when being around these "negative" emotions.  The second way a caregiver can aid a dying person is to learn to listen. The third way of helping a dying person is through touch.  In short, even though some preparation and training may be useful, almost anyone can provide the help a dying person needs as (s)he works through the psychological tasks of dying.

Social Dimensions

In this dimension, caregiving means being sensitive to those the dying person considers to be cherished individuals and understanding the nature of their attachment to the dying person. It also means helping the person who is coping with dying to find ways to maintain the relationships even if in a new, but still satisfying, manner. As energy levels continue to deteriorate, helping may also include assisting the dying person in re-examining the relationships and adjusting priorities.  Many times a dying person is concerned about how his/her community will fare without him/her.  An effective way of helping someone who is bringing up those kinds of questions is to talk to him/her about the concerns, give the person an opportunity to express them, and let him/her know they are valid.  Following that validation, the next way to help is to act as an advocate and help the dying person be empowered to act for him/herself in trying to satisfy his/her requirements.  My blog posting Dying: Social Dimensions of Caring goes into this dimension more deeply.

Spiritual Dimension

How can a caregiver assist a dying person in his/her spiritual quest and in answering the inevitable questions of meaning and purpose that arise as the end draws near? The first and foremost way is to be present and listen. It is by talking that many people are able to sort out in their own minds the answers to their questions. Their desire is not to be directed on their  journey, it is for someone to travel with them.  However, being present and listening doesn’t mean passivity.  Instead, it means being actively present and closely listening so that the caregiver can assist in the quest by supplying access to the tools the dying person finds helpful.  Another way the caregiver can give assistance might be to increase the opportunity for the dying person to have a means for creative expression.  Finally, caregivers should realize that just because a question is answered today doesn’t mean it won’t come up again.  Additional nuances of the old question may arise that now have to be addressed.  The spiritual quest is ongoing; there is no goal to be reached.  For nearly all, the journey doesn’t end until the last breath is taken; and who knows if the journey really ends even then?  For more on the spiritual dimension of care, see my blog posting Dying: Spiritual Dimensions of Care.