When relatives ask how long will it take for them to die ?

[RN from OZ]

I have been nursing for 10 years and I still cringe when a family member asks "how much longer will it take for them to die "

OR " do you know what time they will pass ? so you can call me and I'll come in and sit with them "

I always tell relatives that we do not know when someone will die .

We can only tell them if a persons condition is unstable or they are getting worse.

But they still ask again......can you tell me when ? how much longer ?

What can you say to these greiving people that will not sound calous ? but also get the message through?

I somtimes think they believe we have a crystal ball. :o

[jemb]

When I was a very new grad in the early '80's, I received a call that my mother was very ill and not expected to survive. She was on the other side of the continent, and I was still scraping by financially recuping from being in school. I called the hospital and asked her nurse if I needed to come right away. (I guess that's a variation on the question of when will it happen.) She very patiently and kindly replied, "It doesn't look good -- probably sooner rather than later -- but the doctor is still working with her. If you haven't seen her recently and want to see her, you should come see her now." Many years later, I still appreciate that reply. Just thought I'd share my experience from the relative's side.

[shannonRN, BSN, RN]

this has got to be the hardest question to answer....i try not to make the decision for the family member. i usually explain that we have no way of knowing exactly when they will pass, but they have to do what they are comfortable with. it doesn't matter what i think. that they need to worry about their physical, emotional, and mental well-being as well as their dying loved one.

some of my coworkers encourage family members to go home for the evening saying that they'll make it until morning. i don't feel comfortable doing that. what if they do pass? just because they have hung in there for the past 3 days when everyone thought they would pass on day 1, doesn't mean that they will last one more.

this is an excellent post...sad, thought provoking, and interesting to see everyone's views.

[micro, RN]

I will ask them what the doctor has told them of the prognosis. In these situations, it is generally in a DNR/comfort care situation. From what the doctor has stated, I will then say my best nursing knowledge what my estimation is. But I also state that there is not cut and dried answer, but assure them that comfort care is and will be done.....continual reinforcement of this.....as well as much time allowing the family to verbalize feelings, etc. If a faith or belief system has been expressed I will make reference to that for the patient and the family. I will gently review the chosen advance directives with them as part of the nursing care to ensure that all are "on the same page". I try to assure them that they may of course stay at the bedside, but that their loved one knows that they are there with them through their love and connection.....It is a tough time for all. It comes with time but it may never get easy talking to patient's family's and patient's at these times.

Nursing is definitely multidisciplined. A good nurse is skilled, astute, flexible in their communication and also has above all a listening ear.

[RN-PA, RN]

I agree-- This is a great thread with thoughtful, caring replies. I spoke with the daughter of a patient last night about her dying mother, to ascertain whether she and her family were aware of the gravity of her mother's condition. (This was my first evening of caring for the patient. Test results hadn't come back yet, but appeared to be a fairly massive CVA-- patient unresponsive and GCS of 6 on my shift.) When I broached the subject, the daughter seemed to understand that her mother was getting close to the end and then proceeded to describe what a wonderful lady this unresponsive patient of mine had been-- Independent, living on her own in her late 80's, a loving and giving grandmother, mother, friend...

Another thing that I tend to mention if I feel it's appropriate is to let family members know-- who are asking about the possible timing of their loved one's death-- that loved ones often die after their families have left them. It's as if the dying person hangs on and feels pulled by their family's desires to stay with them here. It's only when families physically leave the dying person that they "feel free" to die. I know I've witnessed this a number of times and have heard many stories along these lines, too.

[RNinICU]

When I first started practicing, I found this question the most difficult to answer. But now, working in critical care, I hear it more often. I don't always say it's in God's hands, because I have dealt with families who do not have a strong faith, and this answer does not seem to help them. I tell them that I understand why they are asking, and would like to be able to give them an answer, but I cannot. If I know a family has a strong faith, I tell them that God will take them when he is ready. If I am not sure about their faith, I will tell tham that the dying process is beyond our control, and not always well understood. I give them information about the signs we see when death is imminent, and reassure them that if they want to go home, I will call them with any changes. I also tell them that it is alright if they are not there when their loved one passes. Some people feel an obligation to be there, but do not really want to see their loved one die. Reassuring them that they do not have to prove their love by being at the bedside at the time of death seems to help these people. I did have one patient who came in with a massive CVA whose son was in another state. We knew she would not live long, but her son would not make it in time. I sat with her while she died, and had her son on the phone, telling him what was happening. This was the only way he could be there, and it was a way for me to make her death a little easier on him. That was six years ago, and I still get a thank you card from him every year on the anniversary of her death.

[RN-PA, RN]

Originally posted by RNinICU

I did have one patient who came in with a massive CVA whose son was in another state. We knew she would not live long, but her son would not make it in time. I sat with her while she died, and had her son on the phone, telling him what was happening. This was the only way he could be there, and it was a way for me to make her death a little easier on him. That was six years ago, and I still get a thank you card from him every year on the anniversary of her death.

What a beautiful, caring, thoughtful thing you did for that patient's son-- Thank you for sharing; I was very moved by what you did.

[RN from OZ]

Thankyou for all these shared experiences and helpful replies.

I had a very bad shift that day with 3 of my patients terminal and nearing the end.

All of the families had different beliefs and needs,

I was at a loss to try and comfort them all as well as care for my other 4 patients.

The next day I felt much more able to give good advice and comfort to these families using the above advice.

I think the reason families ask this question is out of fear of the unknown, and wanting peace for their relative...they were happiest to hear " We are taking good care of ...... they are pain free and comfortable, you are welcome to stay as long as you like.

Thanks again

RN from Oz

[Jenny P]

I always try to let the family know that they should try to talk with the dying patient; I usually say something to the effect that "if there is anything that you'd like to say to the pt. in private, you may do so now and I will leave you alone if you would like (I also promise to stay right outside the room at this time, so they don't freak out)."

DH and I personally learned from his mother's death that sometimes a person WANTS to be alone when they die: his mother lived for 3 days without a BP (back in the days before non-invasive BP machines) and we were at her bedside continually until 2AM when I told him we should step out for a cup of coffee while the nurses cleaned her up. She died during that 20 minutes, in the 5 minutes that the nurse was out of the room too. Sometimes I share that with families and that helps. Many times I don't share my own personal experiences.

I often encourage families to tell me about their loved one: their likes and loves; their beliefs, hobbies and jobs, whatever, while we are at the bedside. Sometimes it seems to validate that persons' life; and if they die about that time, they look very peaceful when this happens.

I am lucky though in that I work in a CV-ICU that allows me the time to be with families when the patient is dying.

[traumaRUs, MSN, APRN]

My father died July 29th and the hospice cna was with him and called me as he was taking his last breaths (I live 100 miles away) - I will always remember her kindness. I have nothing but respect and admiration for people that choose this kind of work. Its probably one of the reasons I choose to work ER - we deal with death an awful lot, but then there's another pt coming in the door so we have to shift gears and get on with things.