Final Moments

[firstyearstudent]

Recently a patient died who was DNR. I have two questions.

1) This patients husband was really emoting and shaking her when she was in her death throes and it appeared to me that she was in more distress because of it. Should I have stepped in?

2) When this woman was moments away from death and her mom was at the bedside, I just stood by unobtrusively in the room while she passed away. But I felt it was a private moment. Should I have left the room?

How do you handle these types of situations?

[Shopgirl1]

Hi there,

Boy, talk about difficult situations! The first question, thats a tough one. People deal with the grief in different ways, and maybe his way of letting go was by acting in the manner. However, in your clinical judgement if you thought that he was causing her pain, then it might have been wise to provide him with emotional support, and perhaps explain that this IS a very difficult time shaking his wife may cause her more pain. Then again, its difficult to say what is right and what is wrong because death is such a ethical subject.

Your other question, I think you did the right thing by staying in the room. I always think that it is a comfort for the family to let them know that I am there for them in their darkest hour. After the inital death, then I think it's appropiate to leave the room and let the family be with the body.

Regardless, I am sure that you did the right thing in both of those situations. No death is an easy experience, and I have been in healthcare for 5 years and each is unique. Each has a learning oppertunity hidden somewhere.

Hope this helps!

[Beary-nice]

Death is a tough subject, everyone deals with it differently.

I remember a resident I had cared for many years ago. It was Christmas day and his wife had just been in to see him and then left to go spend time with some of the children. Granted, the guy had been status quo all morning, he went unresponsive at the lunch table. He was a DNR, full of cancer, COPD you name it. He died. I remember calling his wife who had just been there about an hour before to tell her that he had suddenly taken a turn for the worse and that she had better come back. She returned and I went with her and explained to her what had happened and that he had died. She entered the room where we had him on the bed. She began shaking him and yelling "You can't be dead!" over and over. She then proceeded to throw her body on his and said you can't go. She then proceeded to roll off the bed onto the floor and rolled and kicked and screamed.

I would have maybe intervened in your case when the husband was creating more pain for the patient. I think you did right just standing quietly. Sometimes just your presence can speak volumes.

[leslie :-D]

in answer to #1, whenever you see your pt in distress, then yes, it's time to step in.

i often put my hands on their arms and gently guide them back.

once they're away from the pt, my hand remains on their arm/shoulder.

sometimes i take the family member's hand and place it on the dying pt.

and yes, it was perfectly appropriate for you to be present.

a nurse is needed there to answer questions when anxieties resurface.

after the pt has died, i give them time alone, telling them i'll be at such and such a place, and will be back in a few minutes.

death is uncomfortable for most involved.

it sounds like you were extremely respectful.

great job.

leslie