End-Of-Life Care Principles for Practical Nurses

End-of-life care is not synonymous with depression. Sadness, fatigue, sleep or appetite changes, withdrawal, and thoughts about death may arise from physical decline, medication effects, anticipatory grief, spiritual distress, or depression. Several of these can occur at the same time. The experienced nurse listens for the pattern beneath the symptom list. A patient who is tired after advanced illness may still connect with family or respond to meaningful events. A patient with depression more often describes a persistent low mood and a narrowed sense of possibility: “There is no point,” “I am a burden,” or “Nothing matters anymore.” At least two weeks of depressed mood plus one or more of hopelessness, helplessness, worthlessness, guilt, lack of reactivity, or suicidal ideation warrants a full assessment rather than automatic attribution to grief. Grief and depression can coexist. Grief may fluctuate, while depression tends to remain pervasive and can make comfort, connection, or previously meaningful experiences feel inaccessible. No single statement proves the diagnosis. Suicidal ideation always changes the priority, even when it occurs in the context of understandable grief. New confusion should...