My client is now unconscious/how to be effective

fastwalkslowtalk · Oct 19, 2012

It's pretty tough stuff. My first experience with death in a professional/clinical setting was actually while I was attending my CNA clinical's through the Tri City ROP CNA program in Whittier, CA back in 1998. The Nurse Instructor brought the class in to show us how to make hospital corners while an elderly patient was passing away. It was a very awkward and somber experience.

I moved back to Oregon and started working in MR/DD group homes for a number years up to the State level before landing a job at an RCF as a Nurse Assistant working in the Health Center (the assisted living ward). I was promoted to Med Aide and then again to the Resident Care Coordinator after obtaining my Oregon CNA1 where I worked very closely with Hospice. The first time is never easy, and it does not get much easier after that. Just remember to be the professional that you are and to do what you were trained to do with compassion and respect.

amoLucia · Oct 19, 2012

I learned this very early in my nsg career - the sense of hearing is the last to go. It is believed that comatose pts are still able to hear things, and that some pts have awoken to repeat things that were said in their presence while they were unresponsive.

In your schedued time block, talk of simple, easy things. Put on the TV for her favorite show, (if you two watched it), or some nice music. Read a newspaper out loud, etc. It will be more comfortable for you, and it will be respectful & comforting for her. Keep up with your professional comfort care measures.

Thank you for your caring on her behalf.

rivershark2005 · Oct 19, 2012

My first time checking on an unconscious pt was different for me. She was total care, cath'd, in diapers, with surgically implanted feeding tube (don't know the technical name). I went in to check her diaper and she was dirty. Her daughter was in the room, talking to me as I went through the at steps of changing her. As I cared for her, I told her what I was doing, as I do with all of my pts. Her daughter had a dumbfounded look on her face. I finished my changing and was getting ready to tell her daughter I'd be back in a little bit to check her again when she finally asked me why I explained the procedure and apologized for cold wipes. I told her that this was something I do with every pt I change and that I wasn't going to treat her mother any different just because she couldn't respond. She looked me in the eyes as her's filled with tears. She said that no one else in the facility talked to her mother like nothing was wrong with her.

A couple of weeks ago, I went in to check her vitals and she had no pulse. I checked radial, femoral, and carotid. I went and told the nurse just as her daughter walked through the door. I accompanied the nurse to the room and she asked her daughter to wait outside. She checked the pt then asked the daughter to come in. She broke the news and I just kind of stood there. The daughter started to cry and that did it for me. Four days a week for four weeks I cared for this woman. I had gotten to the point that I would come in just to check on her then spend a few minutes just talking to her daughter. Yes, I lost it. Yes, it was unprofessional. But I do not regret being human.

Dealing with unconscious pts is nothing to be scared of. Just treat them as you would any other pt. yes, dealing with death can be hard. But in all honesty, as long as you continue to treat them with dignity and respect, you shouldn't have a problem. Remember, she is the same pt you have gotten to know over the past few months. Talk to her the way you normally would. Like a previous poster suggested, read to her, watch TV with her, play some calming music for her. She's still in there. If she liked you conscious, as long as you act normally, she'll like you unconscious. My suggestion would be to do your best to not cry in front of her. It may be hard, and it may involve you having to excuse yourself, but I think showing that kind of emotion could potentially detrimental.

I wish you luck. I know this can't be easy on you. It would eat me alive.

Jessicainsantafe · Oct 19, 2012

Thank you all so very much for the advice. From the bottom of my heart.

tomc5555 · Oct 20, 2012

Been there a number if times. I take the lead from the RN. When I'm doing cares or talking to the person, I tell them everything is alright, their family is alright and safe and happy. I tell them all they need to do is relax and rest.

Always tell them what you are about to do when starting cares. Be reassuring and calm and positive. If you do start to cry, please step away from the person. We don't want to cause concern for the person.

I definitely touch the person, hold hand, lay my hand on their shoulder. I have always found touch is calming for the person. I must tell you I've had a few pass when I am touching them, hand on their arm.

We all will pass and hopefully it will be a calm peaceful transition.

Good luck and I'm happy this person has you there for her journey.

loriangel14, RN · Oct 20, 2012

All of the above advice is excellent. I also do regular mouth careto keep them comfortable. Usually they are mouth breathing and they get dried out really quickly.

Jessicainsantafe · Oct 22, 2012

My client passed away early am 10/18, even before I was able to care for her. I was in between classes when I turned on my phone and there was the message......so I did not get to say goodbye. I was saddened and relieved. Does that make any sense???

But I do appreciate all of your comments and stories. I don't know if I will ever be ready to deal with the passing of a beloved client, but with all of your advice, I will be able to do my best. In the end, that is all we can ever do.

I thank you all again, from the bottom of my heart.

sjbrk · Oct 23, 2012

The first one is really hard. Ya know, when you work in hospice or LTC you know that the residents aren't going to get better. In that way, at least it's not unexpected. However, you do develop relationships with people, and caring for them as they die is hard. My first one was not a very calm or peaceful death...I was spending an insane amount of time in her room while my 10 other residents waited for hospice to come and relieve me. I wouldn't change that, of course. She was my priority at the time.

Sorry to ramble. The point is, I went home and cried and cried. It was hard. Now, it's easier. At times, I am grateful when my residents die, because mostly they are really sick, in lots of pain, and have no quality of life. It's ok to feel for your patients. It's ok to grieve for them. And it does get easier after the first one.

(That said, my coworkers and I still do the "I hope I'm not on shift when so and so goes." Even though its easier doesn't mean it's fun.)