Dealing with Death

[2caringRN]

I know death is something all nurses have to face and deal with at some point, and i assume the sooner in ones career the better...i guess the more you do something the better you get at dealing with it. I've been nursing now for just over a year and experienced the death of 4 patients. The first time was hard, i thought about it for weeks after and felt traumatized. The second was a code that happened right at the end of my shift and was even harder than the first death...i remember leaving just before it was called and going down the elevator with a co-worker thinking to myself "just make it out the door", saying our goodbyes as we went our separate ways and breaking down, literally, just as i walked out the front door onto the side walk. I was traumatized, i had never cried because of work before... I couldn't make it to my next shift because the night before I broke down again and cried uncontrollably until 3 am. i analyzed everything about it, her symptoms, what i could have done differently, maybe if i had more experience i would have been able to pick up on more signs and saved her, etc. I felt like i needed time to heal but it still bothers me from time to time. Last friday I experienced the death of yet another patient, it was my second day working with him and it was expected, but when i noticed he had passed, I felt traumatized again...i was shaky and nervous, i couldn't concentrate, and was upset for most of the day. Initially my first reaction to death...as horrible as it sounds...is why on my shift? this makes me feel so guilty and I feel so sad for the person but know the effect it will have on me later on, i know that i will take this home to my family and think about it for many days to come. It so difficult to separate work from home when it comes to this. You cant help but be upset and a little down after. When having to provide post mortem care, I don't want to touch the body...it almost feels like a phobia...its not rational. For the rest of the day i think about it. When i leave i analyze every aspect of it, and feel guilt, sadness, every emotion under the rainbow until i occupy myself. I find the worst time is at night just before bed, because my mind drifts and again i go over everything in my head. I almost feel like i'm torturing myself but cant control it. Tomorrow is my first day back since the incident and i feel a huge sense of dread, fear and anxiety. I am religious and pray...i do talk to my colleagues and my family about this, but i dont think they understand the magnitude of it. I question if im cut out for this. I question if it is normal to feel this way or perhaps its not normal and what im experiencing is at the point where its unhealthy....

[skylark, BSN, RN]

Just a couple of comments, no great philosophy to share just ideas from someone who has been doing this nursing thang way too long . . .

First , I want to ask what support there is within your team? The first death encountered whether as a student or as a RN is always traumatic and stays with you. The best teams are those that take time at the end of the shift to talk and debrief, always making sure the newbies have someone to talk to.

It sounds to me that you didn't get that support, and so just kept it all inside. Bad move.

Second, and this may sound callous but you need to acknowledge this if you are going to continue nursing, EVERYONE DIES.

Its a fact 100% of lives end in death. Nobody outsmarts it.

The trauma of it is twofold - the dying process, if it is prolonged or painful, and also the coping for the relatives left behind.

You have a responsibility to promote the comfort of your patient and help them to have what is often called a "good death".

Dignity, painfree, family present, - you get the picture. not always possible in ER and other cardiac situations but still something to strive for.

Family - well again it sounds mean but sooner or later everyone is going to have to face the death of a relative. A parent, a husband or wife, a child . .

Their world will fall apart. they will wonder how they will carry on. but slowly they rebuild their lives and move on. Months and years ahead they will still remember and grieve but the pain will subside and they will be able to live their lives.

You can minimize the 'replaying' of deaths by knowing you did your best. Provide the best care you can, make the patient presentable for the family to see once they have passed, and be the comforting yet silent presence they want in hte background while they cope with seeing their loved one's body.

If you KNOW you did everything you could for both your patient and their family, then you have no reason to dwell on it.

Its tough, especially if its unexpected, or perhaps a child death, but you will have to learn to deal with it, and detach yourself to an extent. You cannot take on the grief of every family you encounter, you will crumble sooner or later.

A good team will give you time out after the family leaves, just some space before returning to the floor and carrying on.

[LETRN]

I had my first on the job death about a month ago...a 5mo old came in asystole and we ran the code for about an hour. It was my room, so I had to go with the doc to tell the parents. I still can't get that experience out of my head.

I think you're reaction is totally normal, and I would be more worried if you didn't feel anything at all!

[Little Panda RN, ASN, RN]

Many hugs to you!!!

My first resident death was an unexpected one and it was very difficult for me to deal with. I work for a assisted living facility and am the only nurse on when I am working. I got summoned to the dining room to check on a resident, dietary thought the resident had fallen asleep at the table. When I walked in the dining room and saw him I knew something was really wrong.

He was gray, diaphoretic, staring at the cieling with agonal respirations. I went into autopilot and did what I had to do. I had never done CPR before and let me tell you it is a whole lot different than doing it on a dummy. I was devastated!!!! I did end up going to see my doctor and got something for anxiety. Every time I would go to work after that, I was jumpy and on edge.

That was 10 months ago and it has gotten better, but I now realize that those I am caring for can die at anytime, I sure see things alot differently now.

Hang in there it does get better and by all means go and see you doctor, mine was a wonderful support person for me.

[tnbutterfly - Mary, BSN]

I am sorry for your difficult experiences with death. It is never easy, but over time you will develop coping mechanisms to get you through it.

You might find some helpful comments and stories that have been shared by members in the following blog about how they have coped with personal grief situations.

Nurses Coping with Personal Grief - Nursing for Nurses

[Maria Lenore,RN]

My first experienced with death, when I was still a student nurse. It was really horrible,and my team spend an hour discussing about the experience. It helps, because I was able to debrief, and cope with death.

[rn/writer, RN]

It's normal to be affected by a patient's death. What isn't normal is the intensity you're describing. When you are so traumatized that you can't function well, that's a tip-off that something more is going on.

I would encourage you to contact your HR department and see if your facility/system offers an EAP--Employee Assistance Program. This is a service that helps employees with counseling to assess a variety of challenges, and it's usually free to start out with. If iit appears that short-term help is not sufficient, they can make referrals and help you find a practitioner that works with your insurance.

I wonder whether you have had a traumatic experience in the past that these patient deaths have tapped into. Or if you have an unrealistic view of your own capabilities and responsibilities as a nurse. The fact that you spent so much time analyzing and re-analyzing the situations and took them so hard suggests to me that you have not made peace either with death as a part of the human experience or with your own limitations. We can't save 'em all.

I wish you the best.

[HouTx, BSN, MSN, EdD]

((((((hugs)))))) to the OP - and kudos for taking a risk by opening up and asking for help.

In my BSN curriculum (1980-ish), we had a course in "values clarifiction" that required each of us to reflect on how we felt about various aspects of patient care based on our own belief systems. Although - of course- we students were far more interested in learning about 'real nursing' stuff, I believe that this course made the most difference in my career.. ensuring that I had coping skills when they were needed. I don't know how many other programs include this content, but I wish they all did!

I am a spiritual person - not "religious". I believe that there is a higher power, and that 'life' does not end with physical death. No matter what resuscitation interventions are undertaken, the ultimate result is out of our hands. Over the years, I have participated in well-orchestrated codes that were unsuccessful, and poorly-run codes that (despite all odds) resulted in 100% success. Codes are always stressful, and there is always a need for self-reflection afterward; to review our own performance, our feelings about what happened and to process any 'learning' that ocurred.

I agree with the PP, hospitals have an obligation to support clinicians whose jobs involve exposure to emotionally stressful events such as resuscitation. Too often, veteran nurses adopt a "ballsy" facade - with derogatory comments for anyone that reveals an emotional vulnerabilty. We have a moral obligation to provide authentic support for our co-workers, including helping them to realize that they may need additional help to recover from a traumatic event. It would seem that the OP fits into this category and counseling is in order.

[NotReady4PrimeTime, RN]

I am a spiritual person - not "religious". I believe that there is a higher power, and that 'life' does not end with physical death. No matter what resuscitation interventions are undertaken, the ultimate result is out of our hands. Over the years, I have participated in well-orchestrated codes that were unsuccessful, and poorly-run codes that (despite all odds) resulted in 100% success. Codes are always stressful, and there is always a need for self-reflection afterward; to review our own performance, our feelings about what happened and to process any 'learning' that ocurred.

I agree with the PP, hospitals have an obligation to support clinicians whose jobs involve exposure to emotionally stressful events such as resuscitation. Too often, veteran nurses adopt a "ballsy" facade - with derogatory comments for anyone that reveals an emotional vulnerabilty. We have a moral obligation to provide authentic support for our co-workers, including helping them to realize that they may need additional help to recover from a traumatic event. It would seem that the OP fits into this category and counseling is in order.

I so agree with you. I wish my organization could see that they're failing their staff by expecting us to just get on with it after a traumatic event. Several months ago we had a disastrous resus on our unit on a Saturday, and although our manager just happened to be in house doing the vacation hours up, there was no suggestion that the staff involved (more than half of us were in there, including three very new nurses) needed any kind of debriefing or support afterward. She actually stood just outside the room and watched for a while then disappeared back to her office. There have been other instances, but none so pointed as this one.

[leslie :-D]

In my BSN curriculum (1980-ish), we had a course in "values clarifiction" that required each of us to reflect on how we felt about various aspects of patient care based on our own belief systems. Although - of course- we students were far more interested in learning about 'real nursing' stuff, I believe that this course made the most difference in my career.. ensuring that I had coping skills when they were needed. I don't know how many other programs include this content, but I wish they all did!

thank you, houtx!!

i was just going to post, how important it is to reflect on your own thoughts about death.

i understand that religions teach dogmatic principles about death, but it's even more important to peruse your very individual and unique theories about life and any hereafter.

only then, can we apply our principles to others who die, and often, will serve as an effective coping mechanism.

op, it sounds like you really do need some additonal support, and i hope you seek and find it.

be well.

leslie

[StayLost, BSN, RN]

There is a lot of death on my unit, & for me it has been the opposite. Just like everyone else, i was terribly scared of a dead person. Being a new nurse the idea of touching a dead body freaked me out-- scary--creepy.

My first pt that died was maxed-out on the vent & still "drowning" when the family decided to provide comfort for the pt. I can't explain it but it's very satisfying to relieve the pt's suffering when death is imminent & to be a support for the family. I feel honored to be a part of such an important moment in their lives

What traumatizes me is when a family wants us to save their 90 y/o grandma at any cost: cracking ribs, shocking, prodding, turning, & sticking when it's hopeless instead of letting her drift off in peace.