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Dealing with a declining patient

by AM326 AM326 Member Nurse

Specializes in Critical Care. Has 2 years experience.

Hello, I am a current Pre-Nursing student who works as a PCT/Phlebotomist. One of the things that always worried me was how I was going to react when one of my patient begins to decline and eventually passes. I have yet to experience those emotions AS IT HAPPENS. I have participated in code blues and came close but they were fine. My worry is freezing or crying when it happens. I have never experienced a passing in front of me...and to be a nurse you have to be strong and not show emotion. Has anyone else experienced this as a PCT?... How did you react?

Straight No Chaser, ASN, LPN

Specializes in Sub-Acute. Has 5 years experience.

It is perfectly normal to cry, just try to do it when you aren't in front I the patient/family. Although I've had some patients I was so close to I cried with the family. Each situation is different and i can only tell you about elderly DNR/ Hospice patients as hats all I've experienced. It's hard but it gets easier as you do it more. Not easy, by any means but more like you adjust. If the person is elderly and very ill I find its less painful because they are suffering so much. It's about makin them as comfortable as possible until it happens. Towards the end they don't get turned or bathed much. Just oral care and mouth moisteners. Usually they aren't able to eat or drink and are pretty sedated in narcotics. Their breathing gets more and more labored until it ceases. It's a hard part of the job but I feel very privileged to get to be part of this very personal experience for some wonderful people

"No day but today"


Specializes in CVICU, CCRN. Has 2 years experience.

I believe that a lot of nurses have a difficult time with seeing patients pass. Likewise, if you find yourself having a very difficult time dealing with the situation, you may just have to consider the area of the hospital in which you work in. Some units have higher mortality rates just because of the nature of the area.

I work as a nurses aide in an intensive care unit and I am also a junior in nursing school. From my experience, I have never participated in a code blue or a sudden decline in a patient as a nursing student. If a client was found to be on a "downward slope", they are generally sent to the ICU.

However, as working as an aide in the ICU at my local hospital, I have seen a lot of death. I have had many occasions where patients are terminally extubated, choose to decline further treatment, or die suddenly during a code blue. At my hospital, the aides are usually responsible for chest compressions during a full code, so I have to be right in the fray. As it is happening, no one has time to think about their own feelings. You simply have to act as quickly and efficiently as you can to help this person.

Afterwards, you may have to take home the feelings are you recall the situation. Everyone has to deal with those emotions in their own way. I recall that dealing with my first code was difficult only afterwards. During the code, I was focused. However, from my experience, death becomes easier over time. It sounds cruel, but I have become a little more decensitized to the passing of a patient in relation to my first experience.

All in all, a nurse has to be prepaired for an emergency. For the immediate situation, a nurse has to be able to set his/her emotions aiside and do their job to help the patient. Likewise, I have talked to many other aides/nurses from other units that say they would be afraid to work in the ICU because of emergency situations. It makes them uncomfortable and that is okay.

For me its a lot tougher if its a younger patient, especially one Ive gotten to know during repeated hospital admissions. With the elderly patients it can be tough too, but at least theyd lived a full life and often have a fairly low quality of life at the time they die.

I usually dont find the moment of death to be a problem. It's usually anti climatic and can come as a relief for some patients, but it can be tough to watch a gradual decline and realize that this time the patient probably isnt going to leave the hospital alive. Usually patients will go home or go to a hospice facility to die, but this doesnt always happen.

One of the things that can be tough when a patient is nearing the end is trying to keep them as comfortable as possible while still taking care of other patients. It can be surreal to go from one room full of crying family and a patient whose breathing their last breaths, to another room with a patient whos throwing a fit because their TV remote isnt working.