Dealing with death as a student in clinicals?

PacoUSA, BSN, RN · Jun 23, 2012

My very first patient on my very first clinical (fundamentals) died an hour after we arrived on the floor (he was not assigned to me personally, just the first patient's room I ever entered as a student nurse). The instructor found it to be a good opportunity to observe post-mortem care, so there we were, 5 of us from the group observing the CNA washing the body as if she was wiping a table down at McDonalds for the hundredth time. It was an interesting introduction to my new career. About 3 weeks later we observed a code blue on the same floor, and the patient ended up passing away.

I think I saw more death than I bargained for at the beginning, but I take it as a good experience because as a nurse, seeing death is inevitable. And I suppose one eventually gets used to it. The first experiences are always shocking but they get easier.

Yes, these are sad moments to see, but take one thing from this post that I have learned in my brief experience: professionalism first! The families of these patients need you to be strong for them, be there for them to help them think and plan and to comfort them. Then later, you can always grieve and process in private.

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PirateArrrNnnn · Jun 23, 2012

The families of these patients need you to be strong for them, be there for them to help them think and plan and to comfort them. Then later, you can always grieve and process in private.
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This is huge about being supportive yet also out of the way. My grandmother passed away in the hospital that my mom worked (21 years) and aunt (9 years). The very floor my mom started in. When she passed, my mom and aunts were hysterical. I was not there but the nurses went a little hysterical as well which did not help the situation. They came in with condolences way too soon. Give families time to grieve on their own especially the first few minutes. Don't come in because we won't care about your tears. I hope to learn more from this as I become a nurse.

CRNBSN18 · Jun 23, 2012

This is huge about being supportive yet also out of the way. My grandmother passed away in the hospital that my mom worked (21 years) and aunt (9 years). The very floor my mom started in. When she passed, my mom and aunts were hysterical. I was not there but the nurses went a little hysterical as well which did not help the situation. They came in with condolences way too soon. Give families time to grieve on their own especially the first few minutes. Don't come in because we won't care about your tears. I hope to learn more from this as I become a nurse.

This is a good point! And thinking about all of this, this hadn't popped in my head yet. I can understand that though.

alocklear · Jun 23, 2012

I was wondering about this last night, and then I saw another post similar in another forum so I decided to post it.
Did any of you have to deal with a patient dying during clinical? The thought of this terrifies me! I don't know how i'd feel, handle it, or what I'd do. It's okay to cry? I'm just lost on this. I pray it never happens but I'm sure I'll encounter it.

I was absolutely terrified of getting old/death as I started my first year of nursing school. The idea of people fading away and then just being GONE was unthinkable to me, and something I fortunately haven't had to deal with on a very personal level yet. During my third semester, I was helping a fellow student do patient care on her assigned patient, who started coughing up and choking on blood while we were in there alone, and died soon after we notified her nurse and family. It was expected, but still pretty traumatizing to us. Our instructor was amazing, and as an experienced, very down-to-earth nurse, she debriefed us very well and realistically. The fact is, we're all going to die one day - death is part of this thing we call the circle of life (as hokey as that sounds). Being scared of it is what makes it scary. During our last semester, a patient had passed right before we came onto the floor one morning, and our instructor offered that the students could do post-mortem care. I pretty much volunteered, and grabbed another girl to go in there with me. We had never observed the procedure before, but it was pretty easily explained. I was much more afraid than I had expected myself to be/wanted to be when I walked in the room. It's very interesting - the care and handling of a body. Because it's just that - a body. We found ourselves handling her just as we handled other patients with decreased awareness or consciousness. I hope I never get to the point in my career of wiping someone down like a McDonald's table. We noticed that someone had painted her nails, that there was a CD player with a CD of beautiful music and debris from a large number of family in there. She had pictures and items from home. I had to keep praying silently and praising the Lord (which of course not everyone does) that she had a long, fulfilling life with a loving family that cared about her. We made it through, and a few days later I saw her obituary in our local paper. I am glad I took it seriously and allowed it to change and teach me. Death does not usually mean we failed as medical professionals. For me, it is a reminder that we are not the only ones at work in our world. Focusing on the positive things that person did in their lives is helpful, even if you have no idea and just imagine them.

decembergrad2011, BSN, RN · Jun 23, 2012

If your school offers an elective in death and dying, I really recommend taking it. I learned so much about the process of death, and I'm no longer afraid of death. I see it as a natural process of the life cycle. We are born, we live, and we die. There are many misconceptions about palliative care as well that were squashed in my class. An example is that it's often more humane to withdraw feeding tubes (or simply not place one to start) during the end stages of death, as well as palliative sedation when someone is in a lot of pain. It will also prepare you to better deal with patient deaths.

My first death was a young woman who had been in a motor vehicle crash while I was doing my ER experience. She came in and there were so many people in the room working on her, pushing medications, doing compressions. Ultimately, after 20 minutes of resuscitation efforts, they pronounced her dead. After everyone else left the room, the charge nurse asked me to assist the RN with preparing the body for the family. It was so sad to me because we had to take her to a small procedural room since the ER was busy and they needed the trauma bay for another incoming patient. We pulled all of the equipment from her body and prepared her the best we could for the family. Seeing a face that was so young...I was 22 at the time and she could not have been any more than 20 herself...was a real shock to me and I will never forget her.

I will never forget the way her family looked sitting out in the waiting room, holding each other and crying. When my fiance picked me up from clinical, I cried my eyes out and made him take me to get a hamburger. I remember feeling an urge to look up her name in the newspaper in the obituaries, feeling like I had shared something with her that made it necessary for me to know her name. I never did find out her name and it's probably better that way. There is NOTHING wrong with crying and feeling sad over a patient's death. However, you must maintain professionalism when you are with the patient and the family. As a student, you will not be expected to provide support to the family in a situation like this, and if you are there in the room, sometimes the best support is to quietly be present with them as a show of support.

I want to share this clip from Scrubs. It really sums up everything you feel when you lose a patient:

KelRN215, BSN, RN · Jun 24, 2012

I have been a nurse for 5 years. The only time I have ever done post-mortem care was when I was in school, I was working as an aide as a summer job. I had many patients die in the years that I have been a nurse but just happened to never be the one assigned to them on the shifts where they actually passed.

Bobmo88 · Jun 24, 2012

I haven't started nursing school yet but have had had many experiences with death from working in an ER as a Tech and even volunteering. There have been a lot of great responses on this thread. I too took a Death and Dying class and would highly recommend all people in nursing do so because it described the human response to death and various issues surrounding it like organ donation and advanced directives. I agree with those that say one must maintain their composure while the family grieves, we need to be strong for them to help them get through their tough times. I have never cried at work despite seeing many tragic cases but if I were on the verge of tears I would excuse myself from the room. The deaths that are hardest for me to cope with are when we have pediatric codes that we aren't able to bring back so I talk with my coworkers, try to wind down on the drive home or do something like playing basketball or going running to let out my emotions. I remember the first death I experienced as a volunteer. For me, after performing CPR and watching them pronounce the patient, doing post-mortem care actually provided me with a lot of closure. My experiences have taught me that death is simply a part of life and I hope I am able to live a fulfilling life before my time comes.

CRNBSN18 · Jun 24, 2012

Thanks for all of the wonderful responses. That class sounds interesting, l'll have to see if they have one like that!

PirateArrrNnnn · Jun 24, 2012

My first encounter with a dying/dead patient was when I was teen volunteer in HS. There was a code going on in the trauma room so I was alone at the nurses station. An elderly lady came to me and said her husband was not moving. I went in the room and sure enough, he had passed. That was actually traumatic for me. My second was when my uncle committed suicide but EMTs revived his heart en route to hospital. He was brain dead. He stayed on life support for 3 days before we took him off. I watched him with my aunt for the 30 minutes until he flatlined. That was very difficult for me but I learned a lot from it. Death is such a hard thing for everyone. As nurses,we need to be strong for our patients families but not too strong to appear cold.

mssjez · Jun 24, 2012

I'm beginning nursing school in the fall and while a death and dying class is not offered in our program, the clinical instructors and our faculty advisors will always be there for support and debriefing. I was reading a book called "Nurse" about a head med/surg nurse and her experiences. She has an entire chapter about how she learned to deal with death and dying, and how to interact with families during such circumstances. That section of the book really enlightened me about some of the experiences. While I know it will be completely different to experience death firsthand, it got me thinking about it.

sugarmagnoliaRN · Jun 24, 2012

I'm beginning nursing school in the fall and while a death and dying class is not offered in our program, the clinical instructors and our faculty advisors will always be there for support and debriefing. I was reading a book called "Nurse" about a head med/surg nurse and her experiences. She has an entire chapter about how she learned to deal with death and dying, and how to interact with families during such circumstances. That section of the book really enlightened me about some of the experiences. While I know it will be completely different to experience death firsthand, it got me thinking about it.

Who's the author of the book? I'd like to read it!