Dealing with death

Published

Hi all,

Ive recently began my new grad year and am currently in a palliative care ward. Theres one patient whos close to dying, his pupils are fixed and dilated, hes unresponsive until you go in to him to give his regular pain relief, any thing that touches him he starts to cry out in this raspy gurgly moan, hes unable to swallow food, drink and medications.

Yesterday one of the other nurses said he looks like hes about to go.

The only time i have experienced death as a nurse was as a student and it was a traumatic set of circumstances for everyone involved. The nurse i was buddie with look strong through it all but he was use to putting on that mask, he later ended up breaking (it was intensive care)

So my today im looking for some advise for when the time comes for this man. Im rostered on for the next few nights, and im told that most deaths happen during the night or early morning, when ill be there. I know if i need help with it all i have an on call manager who can come help but im so afraid of managing it myself. Im naturally an emotional person, i cry far too easy, just writing this is making me cry! Talking to a patient about how caring she is towards the others makes me cry! I know that when this mans time comes, especially if its on my shift, ill be a crying mess. I try to shut off all emotion in those sorts of cases but its not really effective, you can hear it in my voice that im about to cry and then when someone says "are you ok or please dont cry" ill end up breaking.

So i need some tips, some advise.

I know that if i pull out of those night shifts i wont learn anytbing, itll be me avoiding something due to my own insecurities. I need to do these shifts to gain the knowledge of what to do.

So anything, any advise will be taken on and ill be very grateful for it.

Up Vote Up Vote ×
Specializes in Surgical, quality,management.

Ok,

Palliative care is an amazing thing for patients, their families and friends. This guy does sound like he is at the terminal phase of his life. As a nurse you have the honour of ensuring that he is comfortable on your shifts. Even if he can't talk use you non verbal skills to assess if he is in pain and medicate appropriately. If he is very gurggly reposition him after pain relief to help with the secretions.

I am guessing that you are not on your own - you have an EN or AIN who has probably much more experience than you with this situation. Follow their example, if you notice a change on your shift call his family and update them, even after 12 years it is hard to guess when someone will die - I have seen someone who was phase 2-3 just go to sleep and never wake up and a lady at phase 4 for 10 days. I always say I will call you unless they don't want to be contacted.

When he does die there is no need to panic, he is not in pain anymore. If you are the first there, check to confirm by looking for a pulse for 1 min. Take note of the time and document it. Follow policy around notifying the doctors, your manager etc.

Treat him with the same respect post mortem as you did when he was alive, I talk to the patient, explain that I am washing them (warm water), tell them I am putting them into the shroud and body bag. I wish them well for whatever is next.

Sometimes I am sad, distressed or at peace - usually depending on the way the patient was cared for before they died I get distressed with families that don't want their loved one to be "doped up" and they die distressed, I am sad if it a person or family I have known for a period of years (chronic liver), I am at peace if the patient has made peace with their death. There are not a lot of Aussie nurses here. Have a look on FB for The Nurse Path and New graduate nurse pages....one of my grads set up the VIC new grad page that has 100s of members.

Discuss your concerns with your manager and ask for assistance.

Up Vote Up Vote ×

Please make sure he is being medicated appropriately. That's the whole point of palliative care. Comfort.

When they pass, you treat them with the utmost respect in death. Post mortem care, caring for the family. You find the strength to not cry at that moment, but reserve a time later to release your emotions.

Death is hard, but it's a part of our life as a nurse. You picked a specialty in which you will see a lot of it.

Up Vote Up Vote ×
Specializes in Travel, Home Health, Med-Surg.

Learning how to deal with a patients death can be difficult whether the death was expected or not. First and foremost it is your duty as a nurse to provide the best care possible to the pt/family before and after the passing. You will learn how to do this in time. You have chosen a palliative unit so you will be around death/dying quite frequently and will need to keep your own emotions in check. This is also a learned skill. There is nothing wrong with you showing emotion per se as long as you remember that you are the nurse, not the patient/family. Your emotion should not be so much that it is interfering with your job, or their expressing their emotions/dealing with the situation (they should not be comforting you). As the above poster stated you need to find the strength (in you) to not cry in the moment. Just practice for now but this will come with time and experience. For now, just focus on the medical/nursing tasks (focus on your job duties) and try to compartmentalize your feelings/emotions (learn how to put them away for later). You can do this, it will come in time and trying!

Up Vote Up Vote ×
Specializes in Acute Care, Rehab, Palliative.

Palliative care is a very special job. You are assisting the patient on their final journey. Emotion is fine as long as it doesn't interfere with you being professional. The best you can do is make sure the patient is comfortable ( pain meds, especially before cares). Do good mouth care and keep them clean and dry. Before doing cares talk to them and let them know you are there and what you are going to do. Talk to them even if they seem unresponsive.

Up Vote Up Vote ×
+ Join the Discussion