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- Sep 15, '12 by amoLuciaTo respond to OP's thread - I believe my attitude toward death & dying to be more of a pragmatic, practical, realistic approach rather than insensitive or 'callous' as Darkfield calls it, but I think s/he is probably more along the same lines as I am. I work LTC, so death is not unexpected for many - just part of 'the circle of life', as iti is for critical care/hospice/oncology. etc.
When I receive shift report that a resident is actively declining, or when I newly assess someone as such, my first question is to code status and then to family awareness. I dislike having to notify family of an imminent event such as sudden deterioration or actual death, esp on 11-7 shft at some unholy hour. I do manage as gently and reassuringly as possible. When there is no Adv Dir/DNR, I most esp dislike having to question them about how aggressive do they want us to be as hospitalization is still an option if chosen. This SHOULD HAVE BEEN DONE already.
I have no problem broaching the subject of DNR/DNH as I explain 'comfort care' very honestly to assay any fearful concerns. I find that within 24 hrs, family has been in, MD notified, and paperwork initiated. This situation actually did occur as I did a vigorous sternal rub/painful stimuli revival to a minimally responsive pt. Had she been found 5 mins later, she would have been coded or on her way to hosp, or being pronounced by the 911 squad. Dtr came in within a few hours.
And yes, I have applied this approach to my own parents. In 1993 during the Waco, Texas confrontation, my mom was in the ER in severe cardioresp failure. ER kept assuring me "her O2 sat is 92%". Had to play the RN card to tell them, "I'm a long time nurse from the old school; do ABGs and humor me. If they're OK, I'll shut up and not bother you again". Well, they got gases; then I hear xray being paged, then I hear RT being paged, then pulmonary. ER MD shows me xray and ABG results (I didn't know life was compatible with the ABG results I was shown!) She was critically sick.
Being a nurse and a LTC nurse, I knew what the course of therapy had to be immed and long range. She needed intubation. I knew it was time for the family and to have The Talk. I could see The Big Picture because I knew my mom. There'd be long term intubation, poor weaning effort, extubation?, trach? LTC/LTAC? SNF? spend-down, Medicaid. etc The decision was made for DNR/DNI but to treat her medically.
Amazingly, she recovered and was discharged home. About a month later, she and I had our talk about the DNR/DNI. She said we did right for her, and then she and my dad had an attorney make a house call to draw up their dual Wills, POAs and AdvDirs. She died a few years later.
Six years or so ago, my dad went the same route. PMR, valve replacement, on/off intubations, J tube, trach, code, blood, cardiac ICU, ICU, LTAC, SNF. But he wanted to fight on when he was asked along the way. He did finally pass away in his sleep at a skilled rehab.
I didn't see myself being terriby distraught by their deaths. I cried then and I'm getting a little mushy as I type this. But I like to remember life goes on. I had my legal paperwork done just after my folks had theirs done. It was just the right thing to do. I've read here on AN that there's another document needed that I have to followup on.
- Sep 15, '12 by logachelleMorbid humor is a coping mechanism that is very common in those on the front lines and see a lot of death. I have worked acute care and I have worked hospice. I feel blessed to be able to provide comfort and symptom management to the dying and is a rush to save those who still have a chance at life. The old are easy for me, the young are hard and I am certainly not above a little dose of morbid humor on occasion
- Sep 15, '12 by aknottedyarnI believe our roles as nurses is to treat patients. We fight dis-ease rather than death. If death is a natural outcome of the disease we need to recognize our limitations to treat. We fight discomfort. This may be in pain relief, prevention of secondary complications, and in some cases discussions with those who do not understand aggressive measures by physicians who fight death.
Every death I have attended is with a bit of sorrow, mostly for others who lost a family member. I rejoice in the fact that the person no longer has dis-ease. As many codes and as many natural deaths as I have been part of I do not think I have become hardened. Perhaps I have a callous where it used to hurt more but it still is very personal to me. When the spirit leaves the body things change. Until that time I fight for what will deal with the dis-ease. It may be aggressive interventions or hand holding and music playing. Either way the loss of a person does impact me. I do not recall each death I have attended. I do recall the feelings of loss, peace, and at times anger for a life snuffed out too soon.
We use humor to cover our pain. Things are only funny if they are true. Sometimes it comes out in unusual ways. It may be black humor or it may be wisecracks. Usually when I do this I feel stupid later.
- Sep 15, '12 by SoldierNurse22Quote from anotheroneI'd hate to be the patient that dies three times a shift!I have seen MANY MANY MANY of these patients die sometimes once a week, once a month, other times 3 a shift!
Sorry, anotherone. I couldn't help it.Last edit by SoldierNurse22 on Sep 15, '12 : Reason: emotive fail
- Sep 15, '12 by txwildflower57I work in LTC and I think that we do still have feelings about death but we have to protect ourselves so we don't "fall apart" everytime someone passes away. Especially if you work in LTC or Critical Care where it can be a daily situation. I do feel something when we lose a patient at our home but I also know that it's like most anything else in nursing - we don't have a choice but to suck it up and keep on going - we have other patients depending on us. We live in a small town and I know people get upset sometimes because as the DON I don't go to the funerals but I can't - that pushes me past my protective zone. We have to take care of ourselves or we aren't any good to anyone else.
- Sep 15, '12 by Kittypower123I work in LTC and have done CPR on frail older folks. I've seen the trauma it does to their bodies, felt the ribs/sternum breaking, and hated it. Those are the deaths that bother me. The ones that were kept comfortable and allowed to pass with dignity and peace, those don't bother me. I'm a huge fan of DNRs. Even though I know they are not appropriate in every situation, for most of those I care for a DNR is appropriate. I also think hospice is a great resource that should be utilized much more frequently than it is. Comfort medications are ordered by the hospice doc reagardless of what the regular MD thinks (only one great thing about hospice - there's lots more).Last edit by Kittypower123 on Sep 15, '12 : Reason: Added statement
- Sep 15, '12 by Hygiene QueenQuote from DarkfieldHaving always worked in geriatrics and seen more than my share of death, I did find that I have developed a peculiar reaction to it when it came to my grandparents.
My question for all of you who have had experience with dying patients is this; does touching and handling death on the job change your perspective when one of your own family members is dying? Are you more likely to make Grandma a DNR or be at peace with someone's passing?
I never cried, saw it as a blessing and, strangely, caught myself looking for signs of impending death.
I would think: "well, this is Grandma's second wind... everyone think she's getting better, but I don't think so", "hmmm... Grandma's legs are mottled", "Grandma suddenly has that 'pinched' look", "that is a death rattle"... etc.
I never verbalize this, though one time my mother noticed my grandma's appearance literally change before our eyes. Mom commented on it and I confirmed what she was thinking. Of course, I was right.
I do not do this when confronted with the death of younger people and I attribute this to my desensitization from working geriatrics for so long.
- Sep 15, '12 by clfrnI can't say I am comfortable with death. I work with alot of the older population and deal with strokes and brain injury or tumors. I can say that my opinion on DNR-DNI has changed over the years. I now believe in quality of life over quantity. I talk to families more open about their loved ones and when I have a patient pass, I am sad but I don't feel bad about the fact that this patient was laying in bed and unable to do anything for themselves. I shed tears for the family because they have lost a family member but not for the patient who is now at peace. I don't want to rush them to death but why prolong a life that is now longer viable. I have cried with families and am not ashamed of it. I feel I still have compassion and I can make a difference in a families life by being human.
- Sep 15, '12 by butterfliesrusI wouldn't say I am comfortable with death. I work in a nursing home and we have hospice patients who pass every few weeks because our company is very close partners with a hospice company. The nurses are wonderful and allow me to pray for every client as they approach their time, sometimes even joining me. I wind up crying every time a client passes, especially if they were long-term residents of the home. Death itself doesn't bother me, but the fact that I won't be able to see the patients the next day does. I pay my respects to every family, thanking them for bringing their loved one to the home so we could appreciate their lives. I haven't been to any funerals, but that's because I didn't think it would be appropriate. Taking care of and appreciating a patient's life is different than celebrating their life and past. I also don't really like funerals.
In regards to how patients are to be cared for and DNRs: every patient has the right to as painless of a passing as possible and every patient has a right to protect their lives. Our personal biases are void of meaning. With myself, I'll probably be DNR, just because living on a machine isn't really being alive. Also- more pain versus no pain isn't very fun sounding. But- every one has their own choice. (Huge fan of DNRs personally- but sometimes I can't understand why younger patients are DNR.)
Quote from txwildflower57I read above that a doctor only prescibes Tylonol? That is torture and should be reported to the authorities asap. That's unforgivable.I work with a doctor who believes that the elderly in the LTC shouldn't have anything more than Tylenol! He's a jerk! Patients should always have all comfort measures at end of life.