Debriefing after death

Double-Helix, BSN, RN · Mar 20, 2016

Debriefings after death are, in my experience, common but not prevalent. They can take place the same day or in the days following the patient's death. They often center around the care the patient received, how the code was run (if there was one), where we might improve, and it provided a place for staff to vent, share memories, or get support. But setting up such a debriefing can feel awkward to those who aren't familiar with them, and it doesn't surprise me at all that a maternity ward, which probably rarely experiences a patient death, doesn't have a formal system for a debriefing. I have never heard of a facility that had a policy for the DON to inform the entire nursing staff when a patient's death has occurred or share details of the death, particularly in a case where a systems or practice error did not contribute to the death. In regard to your third point, as a staff nurse who cared for the patient a couple days before his death, there is no reason for you to write any additional notes. Any assessments or notes from that shift should have been documented that day. Adding anything to the record now would be flagged as a late entry, and any personal notes you might make would not hold up in the event of an investigation unless it was supported by the medical record. Given that the diagnosis was a congenital abnormality incompatible with life, I doubt this is anything you have to worry about.

I'm sorry you lost a patient. It is never a good feeling, especially one unexpected and so young. As an associate manager on the unit, you could speak to your manager about whether opportunities for staff debriefing or grief counseling are needed in the event of another patient's death. However it's important to note the purpose of funerals is to bring closure to the family and friends of the patient. Staff should only attend if they are invited, and many families choose to keep those services private and do not wish to share funeral information with the hospital staff. If your hospital offers employee assistance resources for these kids of situations, I would suggest seeking support there if you feel the need.

MunoRN, RN · Mar 20, 2016

I understand feeling shaken up after the death of a newborn you've cared for, but I think your expectations might be excessive. The first red flag is that you've said you wish you had known so you could attend the funeral, which raises concerns about boundaries with patients. As for the charting, there should be absolutely no difference in your charting depending on whether or not the baby died suddenly the next day. And while HIPAA doesn't prevent your manager from informing you of the death, many facility policies are much more strict than HIPAA, and sharing patient info that isn't pertinent to ongoing quality control may be against facility rules.

KelRN215, BSN, RN · Mar 20, 2016

I've never worked somewhere that wouldn't have notified me in the above situation.

When I worked in the hospital, many of our pedi oncology patients died. If they died on the floor, the people working that shift always called the patient's primary RNs to let them know. When they died at home/on hospice, an email went out notifying us of their deaths. Two of my favorite patients ever died on Friday night shifts when I wasn't working. In both cases, my colleagues notified me that night.

When I worked in home care, if the patient's parents didn't tell me when they died, the hospital always called to let me know. The same applies at my current job. If the patient dies in the hospital, I find out but if they die at home, someone from Case Management will call me.

I don't see any boundary issues with attending a patient's funeral or wake. I have attended many over my 9 years as a pediatric nurse.

city midwife · Mar 20, 2016

To clarify -I have written plenty of notes that day so thats covered. As a midwife often staff are invited to funerals, it's not unusual but yes it is entirely up to the family.

Our policy is to notify all staff that cared for that family and the issue with no formal debriefing has already come up in the form of staff questioning our paediatricians' practice when that is not their fault.

Thanks for all the comments

nutella, MSN, RN · Mar 20, 2016

To clarify -I have written plenty of notes that day so thats covered. As a midwife often staff are invited to funerals, it's not unusual but yes it is entirely up to the family.
Our policy is to notify all staff that cared for that family and the issue with no formal debriefing has already come up in the form of staff questioning our paediatricians' practice when that is not their fault.
Thanks for all the comments

In my line of work death and dying is "normal" - having said that - there can be instances when coworkers like to debrief.

But I also like to point out that you may want to look at your strong reaction and reflect on that. Perhaps there is something you want to discuss with a therapist rather than your coworkers.

Some while ago I worked for an agency (hospice and palliative care) and one of the nurses was very stressed over the high amount of younger patients that were dying. Furthermore she questioned the way they died. Long story short - the employer had a psychologist come in to have a discussion about coping and the tenor was that as nurses we need to be able to cope with such events as part of our job and life.

Although hospice nurses attend funerals at times, which is not seen as a boundary crossing, it still bears the question if it is attending for the family, for the nurse to have closure, or both.

calivianya, BSN, RN · Mar 20, 2016

I don't work with children, so maybe there's a difference, but I've never had a debriefing after a death, and we have at least a few a week and sometimes a few a day. Some of them had been with us for weeks or months before they died and we got to know them and/or their families well. I wouldn't attend a patient funeral, either, but that's just me.

in the US, it would be a privacy law violation for your employer to tell you personal details about a patient that you were no longer taking care of, but I'm guessing you're not from the US so I don't know if it's against the law in your country or not.

LVN fresno · Mar 29, 2016

I agree there should be a debriefing after the death of a patient. There was a patient that died many years ago when I was working on an oncology ward. I had developed a close relationship with the patient and the family. The death was not expected and i was off for a few days I was not notified and not given the ability to attend the funeral. I never forgot the patient and it did have a lasting effect on me.

TheLadyR · Mar 29, 2016

I work adult cardiac intensive care. I worked two years on a cardiovascular floor prior to moving. On the floor, I was fortunate enough to get critical patients addressed before it turned into a code. When I moved to the ICU, I experienced my first patient death. The family withdrew care.

One week later, I ended up having a panic attack over a paper I was writing. I had no idea why I was experiencing anxiety; after all, it was just a small paper. It wasn't until I talked to my charge nurse that she addressed a debriefing. Afterwards, I realized that I had so many feelings towards my patient's death that I had never addressed.

Debriefing, in my experience, is incredibly important and a necessity. We get close to our patients and protective of them- it's only natural to develop a bond.

I hope that you find peace.