This is for all the OB nurses out there. I have been an OB nurse for a couple of years and had my first death of a patient this month. I have cared for many fetal demises and neonate losses but never have I been personally involved in the care of a patient who dies. Without breaching any kind of privacy I can say that this patient was young, did not have any co-morbidity that we often see with maternal death and the death was very unexpected. I have worked on med surg floors where patients have dies and done comfort care, but this death is hitting me very hard. I think that one of the biggest factors is that I bonded with the patient and laughed with her for days. But I also have a lot of anger about her death. All of the hospitals investigation has come up that there is no problem with our processes and that there was no way to save this patient. I do not feel like this is an accurate representation and administration did not invite nurses to be part of the process review. Our directors represented us but did not really consult us prior to the meeting. I had concerns about the patient on her 1st post op day which I shared with the on call doc. He literally laughed at me (not meanly) but was completely dismissive of my assessment and told me the patient had gas. I did document this and followed his orders and encouraged the patient to follow his orders. She did not. In fact she was almost completely non compliant. I was frustrated with this and had a hard time with her not listening to the advise that I gave her. After her death I feel like I could have done more to make her understand why she needed to follow our recommendations.
I am also very angry that the last time I took care of her my patient load was so heavy that I did not then nor do I now feel like I was able to properly care for her. This is not a case of failure I think as she had many reassuring signs after this night and was due to go home two days later. Her family has expressed to all the nursing staff and our director that they thought she received excellent care. I do believe that to be true but I can't help but look back and feel an enormous amount of guilt about her death. I had a gut feeling days before and I am so mad that I was not more assertive.
Has anyone else experienced a traumatic maternal death? How do you cope? How do you stop treating all patients like they have some hidden medical problem and want to overassess everyone?
It is easy to forget that giving birth is still such a huge risk. It is just seems so wrong when it usually goes so right, if you know what I mean. I know that giving birth is natural but for all of those women who roll their eyes at me when I roll my machine in to do their vital signs would be wise to know this.
It sounds like the doctor dismissed your concerns which turned out to be valid? Do you think this doctor was negligent in their care? Do you feel all emotion aside that this death was preventable from a medical standpoint? It seems like you feel more should have been done by the doctor involved. As the patient was non-compliant did that also have a hand in her demise? I ask only because sometimes figuring out the source of our pain helps us to put it in order and move on.
Sorry you are going through this. I totally understand you can't share more info. I would hope the family has a lawyer looking into a malpractice suit. Short of contacting the family and conspiring in a lawsuit, a few thing to consider. Does your hospital have a safety hotline? Is there an incident report you could fill out to report that these symptoms were reported to the doctor and he laughed? There should be someone you can contact at your hospital, a safety officer, or go straight to the CNO or CEO.
Also - Did you document that your reported the symptom to the doc in your note that day? Did you document that you instructed the patient to do something and how she responded? I am always paranoid about documenting for these reasons. Always make sure what is reported to the doc and their response, and what teaching you do and the pt response. My guess is that the family will have a layer look over the records. Do not be surprised if you are contacted by a lawyer bc you took care of this pt. If you documented well you will be OK, and if you get a chance to testify you can explain then.
You are wise (and following AN's Terms of Service) to keep the details vague.
I'd like to add an observation that hasn't yet been mentioned. Yes, it feels bad to lose a patient you've bonded with. And, yes, it's difficult when the death is unexpected and the patient is young and otherwise healthy. But I think what makes maternal loss even more tragic is the fact that giving birth is supposed to be about life, and you have found death in its place. And now there is a newborn without a mother. And a dad without a partner. And a family with broken hearts.
It's normal to experience the "if onlies" after a case like this one. If only I'd been more persistent. If only she'd followed the doc's directions. If only this thing or that thing had been different. But what happened happened and nothing can change that now. A reasonable amount of review can be helpful and teach you for the future, but at some point you have to take what you've learned and move on.
Your hospital did a good thing by offering the stress debriefing and pastoral care. And you were smart to make use of them. Keep seeing the counselor for as long as you need.
Antepartumnurse
15 Posts
No reason according to the hospital administration but it always feels like you could of/should of done more.