Back to Courses

Nearing Death Awareness


Overview & Objectives

In 1992 a book called Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying was published by hospice nurses Maggie Callahan and Patricia Kelley. In it they described common characteristics of nearing death awareness (NDA) in hospice patients, but is it delirium or a divine mystical experience? This module is a review of nearing death awareness by these authors and others. It describes the language patients might use to convey the experience and how hospice aides should respond, both to patients and families. It also addresses the needs of dying patients who display these behaviors and ways to facilitate a more peaceful death. The following learning objectives for this module include:

  • Describe the difference between near death experiences and nearing death awareness
  • Discuss descriptions and definitions of nearing death awareness
  • Identify examples of symbolic language that might be used by patients
  • Review how to respond to nearing death awareness in patients
  • Discuss examples of NDA communication with patients


  • Learning Module
  • Module Extra: Guidelines for Communication
  • Test Questions
  • Instructor Answer Key
  • Attendance Sheet
  • Evaluation Form
  • Certificate of Attendance