A Pause at the Moment of Death: Your Thoughts

"The Pause" was initiated by a nurse in Charlottesville, Va. The author describes what it is and asks the reader for their thoughts on its impact. Nurses General Nursing Article


The patient came in by ambulance after a motor vehicle accident. His body was intact because the impact had not been severe, but it appeared he had had a medical event that precipitated the crash and the team was getting no response to their all-out efforts to revive this gentleman in his 50's.

The chaos of the initial moments of the code passed, and the ER bay settled into the rhythm of chest compressions, respirations, defibrillation, medications...and starting over, doing it again. After 40 minutes, the ER physician in charge suggested that they call the code and name the time of death.

As machines were turned off, an unnatural quiet settled over the room and one of the team members, a nurse, called for a moment of silence to honor the man who had just passed on. "We are with this man who has just died. Let us honor the significance of his time of passing with our own moment of silence." At that, the group in the room, nurses, respiratory therapists, physicians, residents and pharmacists all paused. Some closed their eyes, as if in prayer, and others just stood quietly, observing in their own way, the significance of this patient's passing.

Having a moment of silence after a death in the hospital or other facility is an idea that started with Jonathan Bartels, RN, a palliative care liaison at the University of Virginia Medical Center in Charlottesville. Whether in the ER, ICU, other hospital setting or extended care facility, the moment of death is a significant event-no matter what faith tradition team members and caregivers originate from.

The pause, taking a minute, sometimes less, to acknowledge the person who has died shows respect: respect to both the deceased and to ourselves as members of the care team. The way a pause shows respect to the person who has died is obvious-offering a moment of silence acknowledges that this body was once someone's loved one. The manner in which a pause shows respect to the team is a little less easily understood. Often, as nurses and other professionals, we do not know much at all about the person we are providing urgent care for- but this makes no difference. The team gives the life-saving efforts their all, trying everything to get the best possible outcome for the patient. By pausing after a death, instead of walking away, the team takes a moment for closure, to acknowledge their own hard work and expertise and the fact that there may be a sense of disappointment that the outcome was not what they hoped.

By taking a moment, pausing briefly, team members can allow themselves the grace of reflection before moving to the next patient. We can acknowledge that the team has just shared an experience and there may be pain involved for some. This small time of self-care might possibly help some professionals stay healthy mentally, spiritually and emotionally as they offer care over the long haul to others. According to Bartels, "The pause slows our racing minds, offering mental space so that we are not drawn into the vortex of failure versus success." (The Pause)

It is important to allow team members to participate or not, according to their own needs and inclinations. For some, it may be exactly the right thing to do, taking that minute to be fully present, to acknowledge this person who has just died; for others, all of that is too difficult during the workday and they prefer to wait and pause in their own way and time. Proponents of the pause advocate for a religiously neutral observation, suggesting instead that each person in the room feel free to respond privately according to their own religious faith. With this in mind, the pause doesn't run the risk of becoming about one particular person's faith tradition but instead about the patient who has died and about personal self-care.

The Pause is moving beyond the University of Charlottesville in Virginia. Marilyn Reiss-Carradero, Critical Care, Rapid Response Team at Santa Clara County Valley Medical Center, states: "CPR, electricity and jabbing in a litany of tubes can be viewed as a barbaric way to die. The "pause" or the "moment" helps to humanize this experience and to provide a moment of dignity to a life lost. It should be taught right alongside BCLS/ACLS." ("A Moment of Silence" Crit Care Nurse published online October 29, 2015) Her response was written as a follow up to Bartel's article and reveals the timeliness and potential importance of a practice as simple as an intentional pause after a death.

It is important to remember that any team member can call for a pause-whoever is present at the bedside during the time of death can ask for everyone to stop just a minute and remember the person that died, celebrating them as someone who was loved and who loved. The Pause is for those that are present, who worked together to try to save the life; for the people in the room, not necessarily for the whole unit.

What about at your facility? Would you consider initiating a pause? How do you think it would be received? Is this a practice that you think might be helpful to you and to others?

Joy Eastridge

That funny, the fact that its planned/required is the thing I hate the most about it! Don't you think making it mandatory can make it insincere? My other issue with it is if family is present, you don't know if this pause thing is going to help them or make it worse, IMO its better to tailor your response to the family as best as you can (be especially mindful of cultural preferences).

I'd like to see some study done on this, it might be a good thing I can only guess!

That is nice, I worked in oncology for 10 years and we never did that. Moment of death a family member would run out to nursing station a total wreck and I would comfort them (I never made it through that dry-eyed. The patients were in and out, we got to know them.)

Last death I saw was quite peaceful, elderly lady already comatose with a Morphine drip and orders to titrate if I saw a hint of distress.

I am a corrections RN now and hope not to see a death given the only deaths we see in jail are homicides and suicides. Patients who are otherwise ill or injured go out to the hospital.

That really is a wonderful idea in the hospital, I would think it would help to remember it was someone elses' mom, dad, sister, brother rather than just another code.

I have been informed that in certain areas this is in fact a part of the simulation in ACLS (Boston MA). I hope it starts to be a applied in other simulation scenarios. I am just blown away at its expanse from my 1 patient.

In order to spread this and avoid any one agency laying claim I created a web site with my own money : The Pause | Jonathan Bartels | Pausing after death as a means to offer closure to the medical team, family and offering honor to the patient . I wanted the individuals who use it to own it on a personal level. I have sent people interested in implementation to this site. There is a pretty cool video I made as well. Good Luck.

Specializes in Faith Community Nurse (FCN).

Thank you, Johnathan, for helping get The Pause started! And thank you for your input here. All the best to you. Joy

As the person that reintroduced this practice I could not agree more about making it mandatory. On my web site I specifically say that this is an invited practice...invited by the practitioner...requested if its OK to family... and making it possible to allow those less comfortable to excuse themselves. Never...ever .... a Policy. the act is no panacea for the multiple losses we have faced. It is the beginning of approaching death differently than just a failure. Approaching the death as a natural progression of life. Allowing staff to take a moment in a busy (or non Busy) setting. Using silence allows people to hold space in their own 'cultural' way in order not to impose. It is simply an honoring of a life and an honoring of the work applied in order to try and 'save' that life. A brief moment to recognize.