Dealing with death

Dinith88 · Sep 8, 2006

I am looking for advice on dealing with death.
I graduated in May and began working in June on a tele unit. Aside from feeling quite similar to many new grads in the sense of feeling really stupid at times, I find my hardest dealing at this time to be with the death of a patient.
Since I started, I have had two Code Blues. Although I knew it would come sooner or later, I was hoping for later.
1st, for both codes, I feel I was ill prepared in the actual code process, again feeling stupid, not knowing how to document the situation as it proceeded. As the nurse, I understand my role is to report to the MD and be prepared as to the patient history etc. This part of the process I can improve over time and I am not concerned with.
However, my bigger problem is this, I made it through the codes as all the action was taking place, stumbling a little of course, but made it through. But, when the end came and the patients did not make it, I lost control of my emotions and cried. I questioned my abilities, my assessments, and my view of myself as being a weak individual for my expression of emotion. I also feel my peers see me as weak as well, although they state they don't. Both times I have taken this home with me and brewed for days over it.
I have had a very supportive team of nurses to help me, but some, with their explanation of "death is part of life" and "you'll get used to it as time goes on" just doesn't cut it for me and almost feels cold to me.
I was not naive to the fact that death would be a part of my career. I guess I feel some how I have not prepared myself well enough for it mentally.
I would like words of advice from others in how you have dealt with this throughout your careers.
Thank you in advance.

Whether you like it or not, you're still a 'baby nurse'. And although it may seem cold, your co-workers were right in that you'll 'get used to it'. That doesnt mean you'll become hard or un-caring, it simply means that, in time, you'll find a way to deal with it. NO one can teach you this. If you dont 'get used to it'/deal with it (hopefully in a healthy way), you wont be a nurse long...at least a nurse who cares for these types of patients.

zenman · Sep 8, 2006

I am looking for advice on dealing with death.
...but some, with their explanation of "death is part of life" and "you'll get used to it as time goes on" just doesn't cut it for me and almost feels cold to me.

Some people get used to it with cold hard detachment; others view it as a natural transformation. Some have the baggage of heaven or hell if they are from the one culture on earth that was kicked out of the garden. So...it kinda depends on how you see death...a bad thing or a good thing.

meownsmile, BSN, RN · Sep 8, 2006

After 13 years as a nurse i have to say i dont know that you DO get "used" to it. Its not the patient you lost as much as it is the empathy you feel for the family members left behind and knowing the sense of loss they feel and you also have gone through in your life. It tends to bring your own losses back to the surface as you try to struggle to find the "right" thing to say or do. You cant always just shut those feelings down.. Its called a compassionate soul. Dont lose it, keep your compassionate soul.

supernurse65 · Sep 8, 2006

I worked in peds for my first 13 years as a nurse so I went thru the "baby nurse" process experiencing mentally and physically handicapped children die. My dealing process was to always smile and think that "now they are whole and perfect". I think you do get "used to it" but you have to decide how you deal with the feelings it makes you have. Crying is a normal reaction. I have cried with many families of patients that I took care of for a long time and families of patients that I took care of for a short time.

TheCommuter, BSN, RN · Sep 8, 2006

You need to become fully comfortable with your own mortality before you'll ever be able to competently deal with death and dying issues. I am comfortable with the fact that I'm going to die someday; therefore, I don't fear death. I have come to the realization that human life is temporal and we're all going to die eventually. My only fear is dying at a young age in an untimely manner.

I have grown comfortable with my own mortality, so I can confidently deal with the death and dying issues faced by my patients.

Antikigirl, ASN, RN · Sep 8, 2006

Okay...you were working on a very stressful part of a job that is new to you...stress and adreniline is high, lots of confusion and things to do with no time. Gee go figure you would cry afterwards...you are HUMAN! It is a release from all you just went through...and since you are new that is 10 or more times greater for emotions by just the stress alone!

One thing to try...after a code or stressful situation...take some time and go to the bathroom and cry it out! Crying is a natural release, and it takes a ton of energy to bottle that up! I don't cry at codes (typically I am hyped for hours after one), but there are many other things I do cry about that hurt me at work. I take the time to release and refresh...or I will be no good to anyone..and I do this for others as well (if I see another staff about to cry or I know they are holding back on something I will help cover so they can take some time for themselves...it is part of teamwork!).

Another thing...and the reason I don't cry at codes...is I realised by the wise words of paramedics and nurses..."if a patient isn't breathing and doesn't have a pulse..they are dead...so anything you do afterwards is a bonus...considering there is only one being we know of that can bring back the dead...this is pretty impressive if we can! So do your best...rest assured you did...and take time to appreicate the work of others with you that tried!". I think that really gave me a great mindset!

Also, looking into how you view death yourself is essential. I have told this story before, but I had an AWESOME teacher that had us fingerpaint a piece of paper at the begining of nursing school that represented death. All the colors were dark and drab and depressing. Then a few weeks before graduation, she supplied the paints again with a heart shape paper and had us paint what we felt about being nurses and helping people! All the colors were light and cheery! Then she took the hearts, put them on the background page we made at the first of our schooling and laminated/framed them and gave it to us on the day before grad. This represented our feelings of death, but our thoughts about ourselves and our abilities that overcome it! And she was right...the background was there, but the heart took center stage...a simple thing, and put things into a really neat perspective!

Now, I know you may not be able to do that right now...but knowing your place in the cycle of life/death really helps! You will do your best, but it isn't something you can overcome when it is time. Best to focus on your HEART, and not the swirls of greys behind it .

Hope that helps :)!

sunseeker · Sep 8, 2006

I had an AWESOME teacher that had us fingerpaint

BEAUTIFUL!

km5v6r, EdD, RN · Sep 8, 2006

:icon_hug: However, my bigger problem is this, I made it through the codes as all the action was taking place, stumbling a little of course, but made it through. But, when the end came and the patients did not make it, I lost control of my emotions and cried. I questioned my abilities, my assessments, and my view of myself as being a weak individual for my expression of emotion. I also feel my peers see me as weak as well, although they state they don't. Both times I have taken this home with me and brewed for days over it.

You have had 2 pt's code and die in 2 months. That is more then I have had to deal with in the past 10 years. Of course you are upset. This is all new to you. You are human. You made a connection with your pt's and their families. There is nothing wrong with crying at the death of someone. Families will understand and appreciate tears as a sign that you really cared for their loved one. Some people cry after a code, some make seemingly inappropriate jokes and laugh. Each individual is different in how they deal with the stress and adrenaline. Your co-workers don't see you as weak. They are just happy they don't have to do the post code paperwork. Looking back and reviewing what happened, could I have done something different, did I miss something, is normal and appropriate. But once you have determined that nothing would or should be changed let go. In nursing we are frequently accused of "eating our young". Right now you are chewing on yourself a little to hard.:icon_hug:

allnurses Guide · Sep 9, 2006

1st, for both codes, I feel I was ill prepared in the actual code process, again feeling stupid, not knowing how to document the situation as it proceeded. As the nurse, I understand my role is to report to the MD and be prepared as to the patient history etc. This part of the process I can improve over time and I am not concerned with.
Thank you in advance.

I know you said this is not the part you are concerned with, but improving your role in a code does help with the after feelings. Take an ACLS course, which really helps put all the info into a coherent whole. Knowing that everything possible was done, understanding all the details, especially being prepared for the code to end, all helps with the closure. After the first time I took the course, and was recording on a code, it suddenly made so much more sense, and I felt like a much more competent member of the team.

A family member in the ER once said something to effect of how depressing my job must be, facing all the horrible things that happen to people. I looked at her in some surprise, and said "but I do something about it!". The code may not have been medically "successful", but you tried to do something about it.

:icon_hug: :icon_hug: :icon_hug:

elcue · Sep 11, 2006

dear save,

please don't be so hard on yourself. we all probably cried at least the 1st time we witnessed a death, if not more. i will always remember the face and name of the 1st person whose death i witnessed, and that was 30 years ago. it is one of the handful of faces you will keep with you throughout your career.

when my 1st time came, as a brand new na, the grizzled lpn with me said, i swear, "you'll never be a nurse if you cry when someone dies". how wrong she was. it's your compassion that makes you good "nurse material".

you will get to a point where you will look at patient deaths differently.

certainly, some deaths will be tragedies that will tear open every person in the room. but you will eventually find some satsfaction in being the last person who was able to do something - anything - for that patient. believe it or not, i find great satisfaction in providing postmortem care to a patient before sending them to the morgue. you may find that this offers you a sense of purpose and closure when your patient dies.

"getting used to it" doesn't mean you are unfeeling; it shows you have come to terms with the circle of life and understand the value of your role in the final act.

give yourself time, and don't deny your feelings.

linda

travel920 · Sep 12, 2006

I graduate from my BSN program this Dec. I know exactly what you are talking about. I have been in the same position that you are in. You don't know what to do. If you cry, you feel that others will consider you weak, a wimp, and you are afraid that it will get around that you are not "cut out" to be a nurse.

On the other hand, if you appear indifferent to it, or callous, then you are afraid that others will consider you uncaring and cold. Which is not how you feel, and how you want to be perceived as, because that is not how you are.

I know, because I have been there.

I gave a woman a bedbath last year in my capacity as a Nurse Tech. She died when I turned her. I felt bad because I was the only one there when she died. I felt that it was wrong, and that she should have been surrounded by her family when she passed. I didn't cry, but I still got told the "get over it" bit by the more experienced nurses.

I have taken care of 4 or 5 patients who have passed now, and one of them was a newborn. What helps me the most is my own beliefs about death, and yes, I have had to do some serious soul searching on what my own beliefs are.

Maybe it might help if you absolve yourself of any residual "guilt" that you might feel. You did not kill those people. You helped them, and cared for them appropriately. Maybe it might help if you think about all of the people who are better for the care that you give.

I don't think that you are weak because you did cry. I wish that I could cry sometimes. Different people handle different things differently.

D