Any advice on how to deal with death and dying?

[meluhn]

Hello hospice nurses. I am wondering if you could give me some practical advice. I am new to home care and in my previous work settings I did not have too much experience with death and dying. In LTC when somebody died, it was OK because they were ready to. I find myself having a really hard time dealing with young people with families that are dying. So hard that I am at a loss for words, not being therapeutic, kind of like a dear in headlites when they obviously are looking for support from me.

I mostly care for basically stable, healthy people that are just recuperating from a hospital stay. I have one pt that is in her 40s and has kids the same age as mine and is dying of brain ca w/mets to everywhere. I get so sad just walking into her house, I sometimes have to choke back tears or think about baseball. She is not a hospice pt but she is clearly coming to the begining of the end.

How do I separate myself and be therapeutic for her. I get so squeamish when she starts talking about dying and I am just awkwardly silent. What can I say or do? Any ideas?

[leslie :-D]

i would strongly encourage you to explore your personal beliefs about dying.

too often, it is a subject we do everything to avoid.

sadly, i have also cared for many, many religious folks who took superficial comfort in what they were taught, but never took the time to explore what they truly believed.

my goals when working with the dying, are to get their physical s/s under good control.

otherwise, communicating becomes secondary.

asking them questions such as, "how does/did that make you feel?": how do you feel about _____? what gave your life most meaning? if there's anything you could do now, what would it be? how can i help you? what is/was your biggest regret? what is/was your greatest source of pride/accomplishment?

any answers they give you (whether it is right then, or days later), can provide the nurse with wonderful opportunities in healing, putting closure, reviewing, redefining special events in the pt's life.

but none of this can really happen until one becomes (relatively) comfortable with the dying process.

and that takes contemplation.

here's a link that will give you the basics on therapeutic communication.

there's a ton of info out there.

http://www.deathreference.com/Ce-Da/Communication-with-the-Dying.html

wishing you the very best.

leslie

[tewdles, RN]

A big danger in hospice is empathizing too closely with our patients. When we care for people who are in similar age groups or circumstances as ourselves it becomes easy to feel their pain too clearly. In order to work in hospice long term one must be able to keep those emotions in check.

For instance, I am currently caring for a young 70s woman with COPD and working with her daughters one of whom is a pedi nurse. This was me and my sister with my dying mom just a couple years ago...

I recently took care of a man the same age as my husband with a disease that could visit anyone, I am currently caring for a woman my age with lung ca...my early 40s patient with brain mets died last week and I had to comfort her 21 year old son (same age as my son)...all of them tragic cases...all of them traps for us emotionally.

As leslie said, you have to examine your personal feelings about life, death, and dying in order to keep your feelings separate from those of the patient and families. It is not that we cannot or should not feel sad for these people, it is simply that those feelings must be far from the priority in any and all of our interactions. When I speak to these dying people about what they fear, what they desire, what they hope for...I occasionally get leaky eyes or a cracked voice. Their stories are so compelling and touching... It is not bad or unacceptable for you to be moved by the situations...it is simply important for you to control that so that your emotion or feelings in no way color the situation for the patient or family.

Given that you stated that this woman is nearing the beginning of the end I would request that you discuss hospice with her physician. Home Care is not designed to provide this patient and her family with the support and expertise that hospice can deliver.

Thank you for providing such compassionate care for this woman at the end of her life!

[meluhn]

Thanks Tewdles, Examining my feelings about death is easy, I know it makes me extremely sad, keeping it seperate is the hard part. I know how much I miss my own mom, and she was older. I cant imagine losing her when I was young and still so dependent on her. There is so much for her to teach them, so much unfinished business, that it just kills me. I could cry just thinking about it. I am so bad at keeping my feelings in check when it comes to grief. I guess I just need to turn the focus to the pt and forget my own experiences. Easier said than done.

[leslie :-D]

Thanks Tewdles, Examining my feelings about death is easy, I know it makes me extremely sad, keeping it seperate is the hard part. I know how much I miss my own mom, and she was older. I cant imagine losing her when I was young and still so dependent on her. There is so much for her to teach them, so much unfinished business, that it just kills me. I could cry just thinking about it. I am so bad at keeping my feelings in check when it comes to grief. I guess I just need to turn the focus to the pt and forget my own experiences. Easier said than done.

meluhn, i am sorry about your mom.

regardless of when she died, if you have not finished grieving, then yes, it will be near impossible for you to effectively care for the dying.

i would suggest for you to heal a bit more and then re-evaluate.

give it all the time you need.

when my dtr was killed (many yrs ago), i know it took me yrs of therapy and reflection to come to terms about the meaning of life and death.

only then, could i go to nursing school, knowing i wanted to work in hospice.

once you are able to separate your grief from your pt and families, then crying with them is perfectly appropriate since you will feasibly be able to move on.

when it is our own grief, moving forward is much more challenging.

leslie