death in LTC

River&MountainRN, ADN, RN · Jun 4, 2018

Have you worked in healthcare prior to becoming an RN? As cold as it sounds, you will get better with handling death yourself, as well as being able to help others through it, the longer you've been in the profession.

Just think of how you'd want to be notified: with kindness and compassion. Spare them the gory details; I'm not saying outright lie, but cushion the truth if it was a more difficult death than just passing in sleep. More or less, you develop a sort-of sixth sense to whether someone is close to passing (between clinical signs and just your gut)...if that's the case, make sure you are especially attentive to their comfort, cleanliness, and are rounding on them more often (*try* to be there when they pass or have an aide there, both for their comfort and the family's---especially if the family can't be there. It makes the "was she/he alone when it happened" a lot easier to answer honestly).

Most times, the family knows it's coming. They've either been notified of a decline in status and anticipate the death from afar or are so closely involved that they have someone sitting with their loved one. Most times, they'll "know" when they pick up the phone and it's you, if it's something that's been anticipated. Most times, the funeral home arrangements will have been made and discussed in advance. Usually there will be someone who wants to come in and view the body/say goodbye---make sure their loved one is cleaned up nicely before the family gets there. I've seen transport to the funeral home handled one of two ways: either you have an estimated timeline of when people want to come in to say goodbye to the deceased and you can tell the funeral home to wait that long and then come for pickup, or you just wait until everyone has had their time and said it's ok.

NutmeggeRN, BSN · Jun 4, 2018

Usually (not always) death is not a surprise in LTC. If the patient is failing, it is always wise to make sure the family or DMPOA is advised so they can come in if possible. That being said, death happens, (often in 3's). Always make sure you have the facts and you cannot beat around the bush. Use compassion and think about what you you want to hear. Hopefully, if anticipated, everything was done to make their transition easy and that they were comfortable. Hopefully someone was with them so you can tell a family member they were not alone, especially if the family cannot get there. Not always the case, but if you can, make sure that happens. If reasonable give them the option to be there before, during and after. We always set up a coffee and snack service for the family on a cart.

It is never fun but it does get easier.

CapeCodMermaid, RN · Jun 6, 2018

So...you should tell them in a kind manner and ask them if they want to come see Grandma before you send her to the funeral parlor. You need an MD order to release the body, at least in Massachusetts. Honestly, I'd like to say it gets easier, but I've been in LTC/SNF for 25+ years and I still tear up when certain residents die.

amoLucia · Jun 20, 2018

This might be a little late, but you might want to try a bit of role-playing with an experienced nurse you feel does a good job with telephone calls.

It would be a safe way to get a chance to try out your 'prepared-ness'. And let your nurse assoc really 'pull out the stops' as she does her role-play part.

I'm a fan of role-play and situations like this could also help new nurses improve the 'doctor notification' phone calls as well as any other family phone calls, like for falls or sudden change in conditions.

And you can also exchange roles to get a rounded experience.

lumbarpain, ADN, RN · Jun 21, 2018

first if you are very familiar with your patients family or significant others....then it relieves you in a way......what I do is if a patient is starting to fail , or I FEEL like something is going to occur..no matter what it is..I always want a good report from the last nurse..then I check the previous days nurses noted...a to see if there is AL shifts to see if there was anything any nurse missed giving me on report..IT DOES HAPPEN....and ask the last shift if the family or significant others are aware of the change of status of the resident ...so everyone is prepared ...sometimes people can just APPEAR like they will pass away and make a complete come back....Vitals can fool you too..I have found that patients can just pass away even when their vitals were looking good...so good research on the residents status will put you in a complete state of calm in a way...

Breaking the news is a very tough thing to do......if the family is expecting the worst...then they are a bit prepared for the news......if the family is distant and non emotional..which they can be at times...then it wont be hard saying what you have to say..but its always good to be empathetic.....we all feel terrible when a favorite patient passes....but this is life unfortunately....starting the conversation is hard.....saying" I am so sorry Ms Smith...your Mom had passed away a few minutes ago...she was comfortable and went peacefully. I hope this helps.