Best and worst things to say/do when your patient dies to support the family/friends?

[BeatsPerMinute, BSN, RN]

I'm in ICU. 8 years critical care experience. I've said some unhelpful things (esp when a newbie) and I've done / said some things that have made the family felt truly cared for after their loved one has passed. 

Unhelpful things I've done / said: I'm sorry, really sorry (in a awkward way, obviously physically tense way, ready to get out of the room ASAP or constantly needing to go check with someone because Im too uncomfortable or uncertain about how to handle the situation... and they can see it). One of the worst things happened when I didn't realize that I was taking on an assignment where the patient was dying, and family kept coming up to nurses during report, and I simply stated "we will be there as soon as possible - we're doing report" ... that was bad. Even though I didn't yet know, I still feel guilty about that one. 

Helpful things: at the very least -offer things that are physically comforting physical  (warm blankets, snacks, water, extra chairs). Emotional supportive things such saying "I am so sorry for your loss and I cannot even imagine what you must be feeling right now, he/she was obviously someone loved very much.  if they like music, bringing in my bose speaker for them to use to play favorite songs that remind them of good times . I'll inquire about what the patients favorite things were, to encourage good memories for them to thing about, which can ease a very painful moment, and exchange favorite and pleasant memories. If there are young kids present: get paper with drawing materials + markers for them to just go to town with drawing all over the white boards in the rooms. Paying close attention to the emotional level; learning gauge when / if its a good time to check in if better to allow space def takes a bit of time , practice and skill. When fam is to leave: ensuring they have any / all important personal belongings (of their own and the deceased patient), and information that will allow them to make the next steps easier and less confusing, hard, or stressful. A sometimes more delicate / and maybe riskier thing? taking a moment to share with the family / friends there that what I see is that this is someone who was loved very much, and how lucky it is to have that (how I've communicated that has varied... idea is to communicate to them how lucky is it have lived a life with people who loved and cared about them so much) . 

Def not been perfect, still learning. 

What are things that you think of when you see, hear, or have done yourself, that was helpful / supportive... and the opposite, unhelpful?

Curious to hear some stories. 

[No Stars In My Eyes]

If the patient is terminal, like a hospice patient, even if they don't seem 'with it', I tell family members to just sit by them, hold their hand and talk; say things you wish you'd said, tell the patient the good ways they've affected your life, reminisce about humorous in-jokes that may mean something to them; sing, pray, whatever, to let them know they are not alone.

I cannot tell you how many times I've been thanked for telling family members to do that. Sometimes it helps the patient, more often it helps family members. I do remember one lady who told me she never would have thought her brother might smile while he was making his way to his death, and how much better she felt after communicating with him and the response he had to her.

[Okami_CCRN, BSN, RN]

Learning how to approach end of life is such an important skill for nurses to master. I will usually explain to family how the dying process unfolds and what is normal; emphasizing that they can come and get me if their loved one is displaying any signs of distress or discomfort. 

I will usually dim the lights, place multiple chairs around the bed, play the patient's favorite music at a low volume, order a bereavement cart from the kitchen for the family (includes light snacks and drinks), and of course encourage the family to interact with the patient even if they were not conscious. 

These small gestures resonate so strongly with families in a time of incredible stress and anxiety. 

[Nurse Beth, MSN]

One thing that happens in acute care is your patient dies and you still have other patients to care for, pain meds to give, blood to transfuse, etc. In addition, you now have to manage the end of life process- organ donation, mortuary transport, documentation, body bag, belongings, etc.

You may well be pressured to free up the bed for a new admit.

At the same time you want to be compassionate and care for the family, so you have multiple opposing forces.

If the family is grieving you need to provide support and at some point coordinate the closure that needs to happen. I learned that if a loved one is emotional I could move them to the cognitive state by asking something like "He told me he was a teacher at South High, what subjects did he teach?"

From there you can gently move to mortuary arrangements and so forth.

[BeatsPerMinute, BSN, RN]

On 5/30/2022 at 2:48 PM, Nurse Beth said:

One thing that happens in acute care is your patient dies and you still have other patients to care for, pain meds to give, blood to transfuse, etc. In addition, you now have to manage the end of life process- organ donation, mortuary transport, documentation, body bag, belongings, etc.

You may well be pressured to free up the bed for a new admit.

At the same time you want to be compassionate and care for the family, so you have multiple opposing forces.

I feel like in ICU you basically play hospice nurse all of a sudden and only for a hot minute. 

I still remember this one time approx 4ish years ago while working in another ICU: I came onto shift in the evening, and the moment I finish getting report from day shift RN (on a deceased patient) the charge nurse approached me stating "OK family just left so get the body outta here. we have an admission coming in soon. I need you to take it and we need that room asap"

The charge nurses words just made me cringe, and feel icky. Like, seriously?