NOT DELIRIUM


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Clinicians should note that ELDVs are not hallucinations, and they are not the result of medications or confusion. These phenomena play an important role. Their content holds great meaning to the patient who nears the end of life. Patients who experience these phenomena are not delirious; they think clearly and are aware of their surroundings. In contrast to patients who are in a state of delirium, ELDVs typically occur in persons who have clear consciousness, heightened acuity, and awareness of their surroundings.

Although the phenomena bring a sense of impending death, they also evoke acceptance and inner peace. These are crucial distinctions, since if a dying patient with ELDVs is considered delirious and is treated as such, the medication may interfere with the comforting experience that ELDVs can bring to the dying process. Not being able to derive that comfort at the very end of life could lead to isolation and unnecessary suffering for the dying patient.

Oncology nurses and other clinicians can play an important role in the dying process by not assuming that the patient experiencing ELDVs is delirious and needs more medication.

“The results of this study suggest that a person’s fear of death often diminishes as a direct result of ELDVs, and what arises is a new insight into mortality. The emotional impact is so frequently positive, comforting, and paradoxically life affirming,” the hospice team explains.1 The person is dying physically but emotionally and spiritually, their identity remains present as manifested by dreams/visions.

“In this way, ELDVs do not deny death, but in fact, transcend the dying experience, and present a therapeutic opportunity for clinicians to assist patients and their families in the transition from life to death, thereby providing comfort and closure.”1

REFERENCE

1. Kerr CW, Donnelly JP, Wright ST, et al. End-of-life dreams and visions: a longitudinal study of hospice patients’ experiences. J Palliat Med. 2014;17(3):296-303.