Question about patient's death and ethical issue

Pepper The Cat, BSN, RN · Dec 12, 2008

I'm in nursing school and we are touching on death, dying and grief. We were given a scenario to think about for discussion tomorrow:
Patient's family goes to cafeteria. While gone, patient dies difficult death and cries out for husband. Family returns from cafeteria, you have to tell them about her death. Family asks if she died peacefully and asks if she asked for any of them.
My thoughts on this scenario are this:
If they didn't ask, I wouldn't specifically tell them the negative details of her death. But, since they did ask specifically, I would be bound by nursing ethics to tell them the truth, difficult as it would be.
Have any of you run into similar situations?

My mother died while my father and I went to eat. That was 16 months ago and I still feel guilty.

What would you accomplish by saying "yes - she called out for you and died a difficult death".? All you are doing is increasing their guilt, sorrow etc. Better to say "no, it was a peaceful death". They will still feel guilty for going to supper, but nearly as much as if they knew how she died.

What nursing ethics make you believe that you have to be this trueful?

Batman24 · Dec 12, 2008

I'd have someone go and get the family from the cafeteria. If that couldn't be done I'd tell the family she died peacefully. I find that to be ethical given the circumstances. I wouldn't have a family guilty that they got a bite to eat at the precise moment she died. That would be a terrible thing for them to live with and I can't see the patient wanting that as their last memory of her.

leslie :-D · Dec 12, 2008

working as a hospice nurse in an inpatient facility, i have seen my share of grievous, painful deaths.

never, and i mean never, have i ever told a family that their loved one suffered.

even if they don't ask, i always add "they died so very peacefully".

that's what my nursing ethics have taught me.

leslie

sissiesmama, ASN, RN · Dec 12, 2008

I agree with you, Pepper. It's bad enough that they left to get a meal and the patient passed away while they were gone. In my opinion, there is nothing to gain in telling the family the horrible details that the passing wasn't peaceful. Depending on the health of the family members, you may have another patient on your hands.

Anne, RNC

Pepper The Cat, BSN, RN · Dec 12, 2008

I agree with you, Pepper. It's bad enough that they left to get a meal and the patient passed away while they were gone. In my opinion, there is nothing to gain in telling the family the horrible details that the passing wasn't peaceful. Depending on the health of the family members, you may have another patient on your hands.
Anne, RNC

I've seen it a million times - people leave to get something to eat and that is when their loved one dies. But let me tell you - its a whole different feeling from this side. I still can't help but feel guilty - if we had gone for supper earlier, or waited even 1/2 hour more, I would have been holding her hand when she died. Words can explain my feelings even 16 months later.

Nothing, nothing, can be gained by telling the family the truth.

rnmi2004 · Dec 12, 2008

I had a patient die in front of me. It wasn't what I would call a peaceful death. (Please note, death was not due to hospital error, and I was not trying to cover up anything).

Did I tell the family members this? No. I feel it would have been unethical of me to share information that would have unnecessarily added to the pain that this family was already suffering over the loss of their loved one. What good would it have done?

RNrural · Dec 12, 2008

I also work Hospice and I truly believe that the human spirit will many times prolong death until the moment the family leaves the room. I think they do not want to have their family see them die. I have also seen people hang on until a loved one arrives and die shortly thereafter. I do not find it necessary to inform the family of a difficult passing. My compassion for the family would prevent me from doing that.

nerdtonurse?, BSN, RN · Dec 12, 2008

In school myself, and just finished that chapter last week....as an LPN on a tele/ICU stepdown, I've seen a lot of people die, and I don't care if the person died screaming, the family will only know they "passed peacefully." I had a guy die from flash edema, choking and gasping and just bloody and horrible. When the family got there, their grandparent was clean, the bloody linens replaced, air refreshener sprayed and the window opened to air out the "blood" smell, soft lighting and I did everything so that he looked like he was sleeping.

Think of it this way. Your pt is expired. Your responsibility at that point is to the living (that's why tagging a body with any infectious diseases or telling the funeral home when you call them that the person has a pacemaker isn't a HIPAA violation, you're protecting the living). You clean up the body, remove/cover anything that would be upsetting, crack a window, spray air refreshener, whatever, and support the family. That's the last thing you can do for your patient, which is show respect and honor to their family.

Guitar_Heroine · Dec 12, 2008

I always focus on the more positive things, for instance letting the family know I was with their loved one when they passed and they weren't alone, that he or she looked comfortable. I also let the family know ahead of time that many people at end of life wait until their loved ones are out of the room to pass, either due to stoicism or just not wanting to let go while they are there.

NursePaula · Dec 12, 2008

I absolutely agree with what everyone has written so far. There is not one person that I know that would want their family to be told if, at the end of their life they struggled in any way. That is only inflicting more pain on the family. I think that we owe it to the patient that died to help their family to not feel guilty about eating, using the bathroom, or whatever. I also worked hospice for several years and I cannot even begin to count the times that the family never left the bedside (and I mean for days!) and then the instant they do, the patient passes. And I have even been known to encourage the family to take a break, with the explanation of something like, "Mrs Smith, your husband has been caring for and protecting you for 50 years (or whatever) and it is possible that he is hanging on now to try to protect you so that you don't have to see him pass. I will sit right here and not leave his side if you would like to take a little break." Much of the time they do pass rather quickly when the room empties out, and hopefully frail Mrs Smith at least took a minute to eat/go to the bathroom, etc.

Just my :twocents:

Paula

life_aknew · Dec 12, 2008

not in nursing school yet, but i'd like to share from a family member point of view.

it's true what one poster said about the guilt being omnipresent-always-when someone we love dies. just before the nurse came to tell me that my boy died, i remember clearly watching the sky illuminate into a beautiful orange red. he died just as the sun came up. when i held him in my arms for the first and last time, i asked my nurse so very quietly, so very meekly, "did he hurt...?"

i love her for telling me so very sincerely that he didn't. god knows the guilt i have of him dying all alone-dying period...it's still a pain in my heart over a decade later. i don't want to know what it would have been like for me had i known he died a complicated and excruciating death.

i'm glad my nurse chose her humanity over ethics:twocents: