death and dying

We've had an increase in palliative patients admitted to my unit over the last few years. From ICU and the community.

The best thing is to try not to become overly involved. You are there to provide care and comfort measures (usually to the patient and the family). You don't know the patient well enough to become attached. We've had patients come in and die before we even finished the admission paperwork and other linger for weeks. Those are the hard ones. Walking into work and wondering if you will have the patient again, when they've been asking why they won't die.

Just remember to introduce yourself to the patient and the family when entering the room. When care is being given you are within your rights to ask the family to step away.

I've brought cups of tea, juice, etc to the family at the bedside. I've sat with their family member while they go get something to eat (nobody should ever die alone in my mind).

When the time comes, "I'm sorry for your loss" usually is the words I say. I've held widows and ducked a punch from a brother.

It doesn't get easier to deal with. But over times it no longer feels personal.

that's the reality of ICU nursing. sometimes the goal is NOT to get the patient better. some are just unfixable. the patient as well as their family are under your care now. introduce yourself. ask if they have any questions about what's going on or what to expect. touch is a powerful tool. a hand on their shoulder, a touch on their hand keeps the human element real for them. most people have not gone through that process before. they need guidance. they need to be assured that they are loving the person enough to let them go....this is essential when withdrawing care. making sure they have chairs close to the bed, their loved ones hand outside the covers so the family can hold it. when death is immeninet, i often go into the room and let the family know it is time to tell them they love them. if this becomes prolonged (heart rates of 20 for 10 minutes or more, a gasping resp once a minute or so) i instruct the family to assure the patient that they will be ok, it's ok to leave. sometimes patients just need to 'hear' that. it's a very emotional time for everyone. i quietly stand in the doorway, giving the family privacy, yet being there. when asystole finally occurs and the doc is not present (i try to give the docs enough warning so they can be present) i quietly approach the patient, listen to his chest, turn to the spouse, daughter, son and confirm that the patient has died. depending on their reaction an "i'm sorry" might be in order at that point. again, touch is important. even if i don't 'know' the patient, no family leaves without a hug. not a wimpy one, a genuine hug. it's amazing how many total strangers will grasp onto that and hug you tightly back. i always tell them that we are here for them, if they have questions or need to talk after the shock wears off. i've never had any takers on that, but they are usually grateful for the offer. some have come back months later telling us how much that meant to them. it's not easy but you've done this before, unfortunately sometimes, too many times. you are the expert and must quietly convey confidence, caring and concern. there is no shame in letting a patient's family see tears in your eyes, especially if you've taken care of them for a long time. they are comforted by it. it conveys a sense that you really cared for their loved one and share in their grief. some nurses are just better at the death process than others. it takes practice and not something you really want to get good at but you do. that's not to say you will ever get used to it. there are times i'd rather be any place but there but like always, you do what you have to do. i've been strong for families only to break down and cry after they left. your co-workers are there to support you. let them.

hope this helps. if you ever want to talk, don't hesitate to message me. :icon_hug:

When I worked the ER you did not have time to get to know your patients and it was something that you learned to deal with. I never did get use to the children though. Even after 12 years I still cried. I work with mainly Oncology patients now and it is completely different. I get to know these patients and their families and it is much harder on me. Everyone (nurses, patients and families) have their own way of dealing with death and dying. I think the most important thing is to let them know you care.

When I started as a nurse two years ago I'd experienced two deaths in my family, so death was not my area of expertise. The first death was my grandmother who was 48 years old and I was 8 years old and living with her when I found her dead in the morning, the second was my mother 5 years ago this August to a Norco/alcohol overdose, she was 49 years old. The first facility that I worked at had deaths, but I was not the patients nurse. I would stand outside the door while they were taking their lasts breaths and look at them through the door then after death I would still just stand there, pretrified to touch. Later on, I had one of my residents die. For some reason an inner strength came over me and I was able to be in the room, comfort the family (mostly just by being there), I could touch the resident and say nice closing comments and somehow it has gotten a little easier. Let the family lead, if they are religious, follow their lead. I'm spiritual, not religious, but I comfort through their lead. If they talk to God, I comfort with kind words of heaven, etc. If they do not speak of God, still just listen, if you cannot say anything, just make sure they have everything they need and let them know you are there for any of their needs. I've learned in a short time, the dead don't hurt, it's the living that need you. The dying need your help sometimes for comfort to pass, but after that you are there for the family. When in doubt, don't say anything, just listen and be there to comfort. I think maybe if someone ( a nurse) has unresolved issues with death, it's harder to deal with. I know until I was the one the family was looking at for help, I could've of not done it. We are nurses, we are jacks of all trades, and unfortunately or fortunately we are involved in this thing called death. It can be a beautiful thing(depending on the situation, elderly who have lived a long, full life) or it can be tragic thing (youth, babies, or just plain to young). I'm going to my other grandma's funeral on friday and today we had a private family viewing prior to her cremation. I was with her at the hospital all w/e and it , was sad, yet beautiful. She lived a long, full life, brought lots of joy to everyone around her, and the memories of her will be beautiful. She's not suffering from cancer anymore, we here on earth will suffer for our loss, but that shall pass slowly. Because I was the nurse in the family everyone looked to me for answers and reassurance, just like at work and sometimes, I just said nothing and listened, and sometimes I just held my grandma's hand and said nothing, or just hugged a family member, exactly as I do at work. Sorry so long, but death is very fresh in my head right now and I could go on and on. I wish you the best in coming to some type of peace in the death of your patients. And by the way it's okay to cry with the family. Remember you are human and to see anyone suffer, effects all of us.

As I sit here at this moment, the death and dying issue now applies to a Director of Nursing who greatly influenced my life. She had a double mastectomy followed by chemo. She was told she was cleared of cancer. Recently, she was told that it had metastasized to her lungs and liver. She never smoked cigarettes. While I know that has nothing to do with metastasis I am so deeply saddened at this moment that I do not know what to do with myself. She started out with this certain facility way back when and took it from a dungeon to what I believe is the finest of nursing homes in the state. She is the backbone - the heartbeat if you will of it all. Sometimes one does not know if they are saying the right thing or doing the right thing. All I know is her time on Earth appears to be limited from the way she spoke to me today and my sadness overcomes me.

Having seen what happens to people after certain catastrophic events, such as stroke, acute MI, anoxia, I have lost my fer of death, and actually now sometimes view it, for such patients, as a better outcome than surviving.

I worked in LTC, where a lot of your survivors would end up. It isn't a merciful way to spend one's last years, IMHO.

Realize that you made a difference to them in their final time.

:)

I really don't know. But I know how you feel. I used to work Pedi..I loved Pedi until in 2 weeks 2 patients very close to the nursing staff passed away. I guess its just as hard with adults. After that experience though I learned to keep more of a professional distance, but its still hard losing a patient.

Having seen so much suffering, I see death in many instances as a release from suffering, and something to be thankful for. When caring for the dying patient, I remember that I am caring for their entire family as they go through this experience. Treat the patient and their family with dignity, always keep the patient's comfort at the top of your mind and foremost in your actions, and don't be afraid to explain what is happening to the family members as it occurs. Often, the processes that occur during death are frightening to family members, and if you explain that this is a normal part of the dying process, it probably looks/sounds worse to the family members than it does to the dying person, etc., this can help them to cope with it a bit better. I like to make sure that they know that since the sense of hearing is the last one to go, that even if their loved one is unresponsive, they can still probably hear, and can still feel comforted by the presence of their loved ones.

You truly have been through a ton for such a "young" nurse. I think the way you handle death is wonderful. I should know, I have been a hospice nurse for close to 20 years, and actually became a nurse for hospice. Almost all of my experience has been with death and dying. It has come naturally for me, but it has come by experience for you. I am sorry you have lost people so young in your life. May you live a long life, so that you can go on to comfort those around you. You are obviously doing a wonderful job. Please continue! You may wish to consider a career in hospice with your gift of comfort. God bless!

Nancy,

You are absolutely correct. Hearing is our first sense in the womb, and the last sense to leave us when we are dying. Thank you for letting your families know that their loved one can hear them, even if they cannot respond. As a hospice nurse I tell families to tell their loved one anything they want them to know. Many times it is for the loved ones benefit to let go of past hurts, regrets, etc. It can also help the patient to let go. Many times people need permission to die. I have seen too many "hang on" or linger, until their loved ones tell them it's OKAY to go. Thank you for spreading the word. God bless!