I had my first patient pass away early this morning. She was older, a DNR/DNI who had a recent change in her medical condition (w/i a couple days) and passed away without any struggle. This wasn't the first patient that I saw pass on, just the first one that was my own. The companion at the bedside called the family prior to the patient's death, when her condition was considerably worsening. She told them to come in and that was all they were left with. When the MD was paged, she came in, did her exam, called it, and told me to page her when the family arrived so she could tell them the news.
I straightened everything up by the bedside to make the patient look as peaceful as possible and I went to chart while waiting for the family, etc. So, in time, the family arrived, obviously upset, and I'm so intent on calling the doctor that I don't address the family, who walk right past me and into the room. So now, the patient's family's walking into the room, not knowing the patient passed away, and, me, (as flustered as ever with the companion calling me over) am torn between talking to the family and calling the MD, goes to my SUPERVISOR, who tells me to stop them from going in.
I walk into the room, and the children (who are now grown adults) are standing there, and they just look at me, and all I can say is I'm sorry. I didn't know what else to say, or how much to say. They asked me when it happened, and I told them the time and if they wanted to step outside and wait for the doctor, they could. But they chose to be alone with my patient. All I could think that this wasn't my place... not actually knowing whether it was or wasn't. That I was handling this horribly. That I had to tell somebody that their mom had died, and I couldn't figure out if this was part of nursing or whether I passed into the MD's realm.
I cried hysterically the whole way home and to bed, thinking that the way I handled the situation made it worse for the family (who, by the way, had not given me any inclination that they were angry at the way things were being handled).
I handled it the way I did, I can't go back now. Has anybody had similar experiences where they had to step up and face the families with difficult news?
Feb 5, '07
You did a great job.
When I worked night shift the MD wasn't available, so I often had to make the call. Here two RNs can pronounce a patient. I would only make the call if it was an expected death from a DNR patient.
Feb 5, '07
I'm with Tweety. Sure, when you think back on a situation like this, you come up with all kinds of things you could have done differently, but really, there was nothing wrong with letting the family have time alone with their loved one. It's not like they didn't know that she was dying, and I doubt they expected anyone to try and keep her breathing until they got there. I don't think you broke any 'rules' by being honest with them in answering their questions.
I often make myself scarce when a patient is nearing death so the family can say the things they need to say to the patient and to each other without a stranger hanging around. I'm never far away, mind you, in case there is anything I can do for them. Seems to me that's what you did. Good job!
Feb 5, '07
It sounds like it was an uncertain situation and you were trying to do what you thought was right. Don't let it get to you, and learn from it moving forward so that you are better prepared with how to address it if/when this might happen again.
Feb 10, '07
I deal with death of patients quite often on my floor and I can say you did what any reasonable person would have done in your position.
We will always have the "not so perfect" situation and we do the best we can in that situation with what information is available to us at the time.
Feb 10, '07
Last semester, I had one prof tell us that if we ever had to tell a family that their loved one has died, to actually tell it to them straight. She said when she was a new nurse in the ER, she went to tell a family for the first time that their mother "Has gone to a better place." and the whole family let out a sigh of relief, and joy.....then asked if they could go up to the ICU to see her now. She said she felt terrible when she actually had to backtrack and explain that Mom was actually dead.....not in ICU.
Feb 10, '07
Yeah, euphemisms don't really help anyone but the speaker. It's always better to use the words died and dead, because there's no way to misinterpret that. It sounds harsh, but death is harsh.
Feb 11, '07
Thanks guys, you've given me more confidence in myself with future situations like that. I think I had myself so convinced that it's the doctor's role to tell the family -- not my own, that I was too scared to address them directly before they walked into the room. I'm beginning to realize though, that nothing in this field is black and white.