NURS 519 Week 8 Questions and Answers 2 on Final Gifts and Nearing Death Awareness Example

Questions and Answers 2: Nearing Death Awareness, End-of-Life Visions and How Nurses Listen to What the Dying Say

1. What Is Nearing Death Awareness, and Why Does It Matter to Nurses?

Nearing death awareness is the term Callanan and Kelley (2012) use for the special knowledge many dying people seem to have of their own dying, and for the ways they try to share it. Drawing on their years as hospice nurses, the authors describe patients who speak of preparing for travel, who see or talk with people others cannot see, who seem to know when they will die, or who express a need to resolve something before death. Because these messages are often symbolic, families and staff frequently miss them or treat them as confusion. The authors argue that they are better understood as attempts to communicate, either to describe what dying is like or to ask for what is needed to die peacefully. This matters to nurses because they are often the first to hear such statements. A scoping review of 20 studies found that dreams and visions near death occur in cognitively intact patients, are vividly recalled, and often bring meaning, comfort and acceptance (Silva et al., 2025). A nurse who recognizes nearing death awareness can respond with attention instead of a sedative and can help the family hear the message too.

2. What Does It Mean When a Dying Person Talks About Travel?

When a dying person talks about travel, the person is often using symbolic language to say that death is near and to describe the experience of preparing for it. Callanan and Kelley (2012) describe patients asking for their coats, looking for tickets, worrying about missing a bus, or saying they need to pack, sometimes days before death. The authors explain that travel is one of the most common images for dying because it is a familiar way to express leaving one place for another. They advise families and nurses not to correct or dismiss such statements but to respond within the image, for example by asking, "Where are you going?" or "Do you have what you need for the trip?" The answers may reveal readiness, fear or unfinished business. In a qualitative study of palliative care professionals, most had seen patients describe dreams or inner experiences near death, and the professionals reported that patients often wanted to talk about them and felt calmer when someone listened (Nyblom et al., 2022). The nurse's task is to stay curious, document what is said, and let the family know such talk is common and can be met with gentle questions. In practice that means writing the patient's own words in the record, not a label such as "confused," so the next nurse and the chaplain can follow the thread. It also means telling a daughter who is upset by her father's request for his car keys that he may be telling her, in the only way he can, that he knows he is leaving.

3. How Should a Nurse Respond When a Patient Sees Someone Who Is Not There?

The nurse should respond by listening, asking about the experience, and assessing whether it is comforting or distressing, rather than reorienting the patient. Callanan and Kelley (2012) describe many patients who report seeing deceased parents, spouses or religious figures, often described as having come to help, and they note that patients usually find these visits reassuring. Research supports this description. A systematic review of qualitative studies in hospice reported that about 50% to 60% of conscious hospice patients describe a visit from someone not present, while dreaming or awake, and that these experiences are often comforting but tend to stay private unless someone invites the patient to share them (Rabitti et al., 2024). A simple question such as "Who did you see, and what was it like?" gives the patient permission to speak and gives the nurse the information needed to judge whether the experience brings peace or fear. If it brings peace, the nurse can share that with the family. If it brings fear, the nurse looks for pain, medication effects or spiritual distress and calls the chaplain or physician as needed.

4. How Can Nurses Distinguish Nearing Death Awareness From Delirium?

Nurses can distinguish nearing death awareness from delirium by looking at the person's overall clarity, the course of the symptoms and their emotional effect. In nearing death awareness, as Callanan and Kelley (2012) describe it, the person is usually alert and coherent apart from the specific message, recalls the experience clearly, and is often calmed by it. Delirium looks different: it develops quickly, leaves the person unable to hold attention, shifts in severity from morning to night and brings disorganized thinking, agitation or withdrawal, and it often has a cause that can be treated, such as infection, urinary retention, dehydration, or medication effects (Matzo & Sherman, 2018). Rabitti et al. (2024) warn that because dying is so often complicated by delirium, end-of-life visions risk being misidentified as delirium by professionals and caregivers. An international survey of 247 clinicians who care for seriously ill patients found that they encountered such experiences frequently and saw positive effects on patients more often than negative ones, yet reported gaps in training (Hamza Habib et al., 2026). The practical approach is to screen for delirium with a validated tool when there is any change in attention, treat causes when that fits the goals of care, and avoid medicating comforting visions.

5. How Can Nurses Help Families Receive the Final Gifts of the Dying?

Nurses can help families receive these final gifts by explaining nearing death awareness before it occurs, modeling how to respond, and making room for the conversations the dying person seems to need. Callanan and Kelley (2012) wrote their book largely for families, and they describe how a dying person may wait for a particular visitor, ask for reconciliation, or seem to need permission to die. A nurse can tell a family early, perhaps at the first sign of decline, that their loved one may speak about travel or see relatives who have died, and that these are usually signs to listen, not to correct. When a patient lingers, the nurse can gently ask whether anything remains unsaid and encourage family members to say what they need to, including that it is all right to go. From a Christian perspective, these moments can be received with hope. Stephen, as he was dying, said he saw "the heavens opened, and the Son of Man standing at the right hand of God" (English Standard Version Bible, 2001/2016, Acts 7:56), and believers may hear their loved one's words in that light. The nurse supports each family's own faith, or lack of one, without imposing an interpretation.

References

Callanan, M., & Kelley, P. (2012). Final gifts: Understanding the special awareness, needs, and communications of the dying. Simon & Schuster.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hamza Habib, M., Fontanesi, L., Motiwala, Z. Y., Çöltekin, A., Misra, S., MacLullich, A., Vinay, R., Hertler, C., Blum, D., Singler, K., Simões, C., Frisardi, V., Boccardi, V., Bellelli, G., Koca, M., Kerr, C. W., Jones, C. A., Peng-Keller, S., & Schlögl, M. (2026). Understanding clinicians' perspectives on end-of-life dreams and visions: An international survey. Journal of Palliative Medicine. Advance online publication. https://doi.org/10.1177/10966218261463311

Matzo, M., & Sherman, D. W. (Eds.). (2018). Palliative care nursing: Quality care to the end of life (5th ed.). Springer Publishing Company.

Nyblom, S., Molander, U., & Benkel, I. (2022). End-of-life dreams and visions as perceived by palliative care professionals: A qualitative study. Palliative & Supportive Care, 20(6), 801-806. https://doi.org/10.1017/S1478951521001681

Rabitti, E., Cavuto, S., Díaz Crescitelli, M. E., Bassi, M. C., & Ghirotto, L. (2024). Hospice patients' end-of-life dreams and visions: A systematic review of qualitative studies. American Journal of Hospice and Palliative Medicine, 41(1), 99-112. https://doi.org/10.1177/10499091231163571

Silva, T. O., Levy, K., & Kerr, C. W. (2025). End-of-life experiences in patients: A scoping review of types, characteristics, and implications for the mind-brain relationship. International Review of Psychiatry, 37(2), 142-156. https://doi.org/10.1080/09540261.2025.2503726