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Related Experiment Videos

Beyond the Sound: Evidence-Based Nursing Care for Patients With Terminal Secretions.

Jo Ann Wilson1

  • 1Jo Ann Wilson, MSN-Ed., RN, is assistant professor, School of Nursing, College of Science, California State University-Stanislaus, Turlock, CA.

Journal of Hospice and Palliative Nursing : JHPN : the Official Journal of the Hospice and Palliative Nurses Association
|December 16, 2025
PubMed
Summary

Managing terminal secretions, or the "death rattle," involves focusing on comfort and dignity. Nonpharmacologic interventions like repositioning and mouth care are recommended first-line treatments for end-of-life care.

Keywords:
anticholinergiccommunicationdeath rattleend-of-life careevidence-based practicenonpharmacologic interventionspalliative nursingsymptom managementterminal secretions

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Area of Science:

  • Palliative Care
  • End-of-Life Symptom Management
  • Nursing Practice

Background:

  • Terminal secretions, known as the "death rattle," are oropharyngeal secretions in patients nearing end of life.
  • These secretions, while physiologically benign, can cause significant emotional distress to families and healthcare providers.
  • Managing terminal secretions is crucial for maintaining patient comfort and dignity at the end of life.

Purpose of the Study:

  • To review evidence-based interventions for managing terminal secretions.
  • To emphasize nonpharmacologic approaches as first-line treatments.
  • To address barriers and emotional impacts associated with managing terminal secretions.

Main Methods:

  • Review of clinical trials, systematic reviews, palliative care guidelines, and nursing resource guides.
  • Emphasis on evidence-based practices for managing terminal secretions.
  • Exploration of both pharmacologic and nonpharmacologic interventions.

Main Results:

  • Nonpharmacologic interventions, including repositioning, mouth care, hydration management, communication, and family education, are recommended as first-line treatments.
  • Pharmacologic methods, such as anticholinergic medications, have limited supporting evidence and should be considered individually.
  • Nurse-led communication strategies can effectively reduce family anxiety and improve understanding of the dying process.

Conclusions:

  • A collaborative, interdisciplinary approach is advocated for the first-line, nonpharmacologic management of terminal secretions.
  • Nonpharmacologic interventions align with comfort care goals, prioritizing patient comfort and dignity.
  • Addressing implementation barriers and the emotional impact on clinicians and families is essential for effective end-of-life care.