Dealing with Guilt and Coping

[clouds_creamy]

Hello all,

I've been a Med-Surg nurse for about a year and a half. Several months ago, I had a patient who was talking to me and seemed very normal. Nothing clued me that she would end up passing away that night. She did have some serious issues, with her heart (EF was very low), she was Oxygen dependent, etc. Later on in the night, after I came out of my other patient's room I heard the intercom for Code Blue. Took me a second to realize it was my patient. I rushed in there, and I see my Charge Nurse doing compressions on her. I couldn't believe this was happening. Before I could get more hands-on and help, I decided to grab my WOW while my Charge and another coworker were doing compressions and breaths. I decided to do this to get more accurate information on the patient because at this point, I didn't want to rely on my notes or memory for more info about the patient.

RRT arrived with the MD, and they asked me about her previous medical history, which I told them according to my papers. I just felt so useless at the time. I was even asked at one point what her K+ was, which I didn't write down (b/c it was normal)... Later on, I was asked if the pt had a pacemaker, which I remembered reading somewhere, but I couldn't remember exactly. I did find it in the notes though and let the team know.

To sum it all up, I thought I was able to move past this situation because even my Charge was telling me that she was quite sick, and there was nothing else I could have done that could have prevented that... And I tried to make peace with that, but at times, I would think about all the little things that I could have/should have done... Like today during my BLS, they were talking about using the CPR board, and I don't even remember if we did this during the Code... and how I could have offered more info when the doctor asked, and how I should have known right away that she had a pacemaker... Have been contemplating talking to this Charge about it, but I actually switched jobs, and I think bringing this up again to her might be a bit much...

I realize that death is something that we will encounter as nurses and that it is inevitable, but how do you guys cope with it when it happens to your patient? How do you deal with the guilt?

Thank you to all offering any insight.

[brownbook]

My first code, I called for the code team, but then when they asked me things, I couldn't comprehend enough to answer. Someone said "get a bag!" and it flummoxed me for the rest of the event. I knew we had them, but couldn't remember what they were. Totally useless. But my coworkers all had their own first code experiences, and understood.

At least you didn't go get a paper bag :). A CNA was helping in ICU, we had code, the very short resident asked for a stool, to stand on, he was eager to do compressions. The CNA had recently changed the patient's depends, she brought the soiled item to the bedside. The resident was so kind and laughed with her, not at her.

[Sour Lemon]

Maybe I'm a weirdo, but I feel worse when they survive. If there's one thing I've realized over the years, it's that death is never the worst outcome. To be "normal" one minute and gone the next is how I hope to go when my own time comes.

[Ruby Vee, BSN]

Maybe I'm a weirdo, but I feel worse when they survive. If there's one thing I've realized over the years, it's that death is never the worst outcome. To be "normal" one minute and gone the next is how I hope to go when my own time comes.

Death is truly not the worst outcome. I've seen patients survive a code and go home -- it happens. But it seems that most patients who survive codes end up lingering in the ICU for months, tubes in every orafice including a few that have been created just for said tubes. Very few people actually WANT to live that way . . . the majority of us want to be healthy right up until we keel over on the golf course or whatever.

[Nurse SMS, MSN, RN]

Particularly if the patient is elderly or in poor health to begin with - the outcome of "go home with no new deficits" is something like only 4% of the time.

[Lane Therrell FNP, MSN, RN, NP]

When one of my clients or patients is grappling with the "woulda-coulda-shoulda" factor, I like to remind them of one of my favorite sayings: "The two most dangerous words in the English language are 'if only.' "

You said there wasn't a debrief after this particular code... so, would it be possible for you to step up to the leadership plate and see if a process can be created at your place of work for debriefing future codes? Debriefing is a positive practice on so many levels.

EAP can be very helpful, and definitely should be encouraged, but sometimes it can take a while to get an appointment (at least in my neck of the woods). While you're waiting, here's a really good short article with some solid, practical, ideas for coping with guilt. I especially liked the suggestion of taking paradoxical action to stop the rumination cycle-- it's called "Guilt: The Crippling Emotion"

Guilt: The Crippling Emotion | Psych Central

[Neats, BSN]

When you are in an emergency situation there is a flurry of "happening" movements. We can train and anticipate until the cows come home until you have been in the action no one can ever teach you. This is why we train again and again and again. This is why we review afterward, maybe your unit needs to do this talking about what happen helps work out the guilt and questions. I think you did all that was appropriate and necessary, it was your patient time to go. Remunerating on this is good up to a point. Use this for the next one learning to get better each time. It sounds like everyone involved did what they were suppose to do. Thank you for being there for your patients and being the good nurse you are. I am glad you are my peer.

[Ckush]

It sounds like you are a very conscientious and a sensitive nurse. As a hospice nurse, all my patients die, so this is the goal in my arena of care. Because you are focused on cure and improvement, the dying patient may feel like a failure. Rest assured, you did all you could do and your soul searching only goes to show the quality of nurse that you are.

[EaglesWings21, ASN, RN]

As someone who has lost someone recently and played every scenario over and over in my head and thought, what if we did this instead of that. Sometimes the answer is people are just too sick, sometimes accidents happen, sometimes acute life-threatening illnesses happen to previosly healthy people. We will all die someday.

[SarahRN2013]

You did great. Seriously.

Its okay to be sorrowful that the patient died. Don't take the responsibility of it on yourself though. Your patient was obviously extremely sick. The rest of your code team didn't save her either. Would you call all of them failures too?

THIS.