LTC, DEATH AND DYING

mustangsheba · May 25, 2001

Sandi, dear: It doesn't get easier, but I think we get better at assisting families with the process. I can still do this after almost 20 years because I know that what I do and say somehow helps the loved ones left behind to get through. Providing patient comfort is of primary importance to the family (and to me!) We can assist the family in understanding what is happening. Sometimes it's hard for families to honor the desires of the patient as expressed in their advance directive, and we can help them to work through that. Just being there as a presence that presumably knows what to do is comforting. I've stated before, I consider taking care of the dying an act of love and respect, a gift we can give the patient and family. I don't mean that to sound noble. It's a Karma thing for me. When we reach the point where it no longer touches our hearts, we need to do something else. You are doing a great job. Everything is as it should be. Best wishes. And well said, Oramar.

chrn · May 26, 2001

You have to really care about people to feel that kind of pain. How incredibly fortunate for that resident and the family to have a nurse willing to give of herself so much. I've been there. I once sat and read to my hospice patient from a book of Jewish prayers. I remember crying so hard I could barely get the words out. But I was doing what was the most comforting thing for a dying man and I will never forget him. Take care and continue to let those special people touch your life...you've got a lot of love to give.

duckie · May 26, 2001

Sandi, I wish I could tell you that it gets easier to deal with but it doesn't. I too am a LTC nurse. So far this year I have lost 14 residents from my unit. I have two more that I expect to go any time. I always make two priorities. The first is the resident. When they draw their final breath upon this earth, I want them to feel surrounded by love and compassion. I do everything in my power to assure them that their final days will be pain free. I feel they deserve this. I have a positively wonderful staff of CNA's and when we have a resident that we know has only a short time left, we begin a ritual. Someone is in the room every 15 minutes. The CNA's are assigned in 15 minute intervals and they go in faithfully. I also go in at least hourly, more if possible. My staff is wonderfully compassionate and attached to our residents so when I say that we are on "terminal care" they never complain, they just start the routine. What this involves is checking the resident, doing oral care or giving fluids if tolerated, position changes to ensure comfort and if they feel the resident is in pain, they let me know and I take it from there. This also gives us frequent chances to interact with the family and provide for their needs as well. We provide free meals, snacks, beverages, anything they need. We frequently call our Chaplains and all of my staff are on hand to give love, assurances and TLC and most of all the knowledge that we love them too. I have had many families tell me if they have their choice, when it's their time to die, they want to die on our hall. I accept that as quite a compliment in such as sad time. I still cry, I hold the family in my arms and I also mourne the loss. I had someone tell me once that it wasn't professional for the nurse to cry. Well I guess I'm not a pro yet, after 20 years, I still cannot harden my heart to their pain and loss. I don't want to. When I lost my Gramma, I remember how very comforting it felt as the staff that cared for her came into the room with us and cryed. Many of them kissed her good bye. I knew she was loved, you could feel it and that makes the loss so much easier to deal with. Always be yourself and keep doing what you do. One thing I have done to help me deal with the frequent deaths is to start a memorial book for myself. After 6 years in this facility, I have 127 names in my memorial book. When someone dies I write their name in the book and I write down what it was that made them special, their unique traits that made them different. Every once in a while we pull my book out and we talk about the residents we have lost. We feel sadness at their loss but we can remember them fondly and even laugh at some of the things they did. As long as someone remembers, then they continue to live on in our hearts. If I cannot do what I do now, I will retire. While dealing with death so constantly is painful, it is also a special time to make a difference. All we can do is try, and pray what we feel in our hearts comes through to those in need. Do not be discouraged my dear, keep leaving a part of yourself with those who have needed you. I believe that sharing someones death is the final gift of love. God bless and keep you!

sandigapeachlpn · May 26, 2001

I really am sad this morning after watching yet another Resident die before my eyes. The family was in the room, I had not received report yet and was called to the room by my CNA because the Eve nurse was away from the station. The family was in the room and I had no idea that my resident was in such distress. By the time I initiated as many comfort measures as possible, paged the Dr. to obtain orders, etc, on walking back into the room to assure the family, she took her last breath. I have watched many residents die but it is so hard for me because I know these residents for so long and they become so close. Many of my residents have no family and I am their only visitor or stimulation, company or surrogate family. To make matters worse the granddaughter looked at me before I left the room, with such admiration stated " How can you do this all the time? " I almost broke down in tears. It is so hard to start the day with a death. I keep thinking about the way her face looked when I noted that she wasn't breathing anymore. I know that she had no quality of life any longer, CHF finally caught up and won. But she was so special, a retired CNA and she touched my life with hers.

Any words of wisdom from veterans. I have been a nurse for only five years.

PaulaP · May 27, 2001

Sandi-

I have been in long term care for 13 years and a nurse for 22. It doesn't get any easier to deal with someone's passing, especially in long term care because the residents are just like family! I take comfort in knowing that I do everything I can to the best of my ability when taking care of a resident. At our facility the staff takes turns in staying with a resident whose death is imminent so that no one dies alone if possible. Hang in there and bless you for being so caring!

Heather27 · Jun 12, 2001

No...it never gets "easier"...God forbid that there ever be a day when I don't feel sad at the passing of a resident. HOWEVER...I always remind myself that this is what I DO..this is what I CHOSE. I may be the last contact that person has on this mortal coil, so it's my responsibility to see that their passing is one of comfort and dignity and love and compassion. I, too, cry with families...reminisce with them...tell them that it's OK. Not professional? Then I don't ever want to be "professional".

Peace

tinkertoys · Jun 15, 2001

QUOTE:

Heather27

No...it never gets "easier"...God forbid that there ever be a day when I don't feel sad at the passing of a resident. HOWEVER...I always remind myself that this is what I DO..this is what I CHOSE. I may be the last contact that person has on this mortal coil, so it's my responsibility to see that their passing is one of comfort and dignity and love and compassion. I, too, cry with families...reminisce with them...tell them that it's OK. Not professional? Then I don't ever want to be "professional".

Amen, Heather27!

halfpint · Jun 18, 2001

I have been a LTC nurse for 16 yrs. The death and dying of my patients is no easier now than the first time. But I get satisfaction from knowing that I have tried to make them happy and comfortable in their last days, and I feel thats why God let me become a nurse.

lavahawaii · Jun 18, 2001

Originally posted by sandigapeachlpn:
I really am sad this morning after watching yet another Resident die before my eyes. The family was in the room, I had not received report yet and was called to the room by my CNA because the Eve nurse was away from the station. The family was in the room and I had no idea that my resident was in such distress. By the time I initiated as many comfort measures as possible, paged the Dr. to obtain orders, etc, on walking back into the room to assure the family, she took her last breath. I have watched many residents die but it is so hard for me because I know these residents for so long and they become so close. Many of my residents have no family and I am their only visitor or stimulation, company or surrogate family. To make matters worse the granddaughter looked at me before I left the room, with such admiration stated " How can you do this all the time? " I almost broke down in tears. It is so hard to start the day with a death. I keep thinking about the way her face looked when I noted that she wasn't breathing anymore. I know that she had no quality of life any longer, CHF finally caught up and won. But she was so special, a retired CNA and she touched my life with hers.
Any words of wisdom from veterans. I have been a nurse for only five years.

Aloha Sandy,

As our other collegues have answered, it doesn't get easier. But it seems as the years go by we seem to care more about our profession. I have been in critical care/ER/Dialysis and now Long Term Care Educator for the past 23 years. Take comfort that you have also touched that person's life with your compassion and empathy. It is good to see that 5 years of nursing has not calloused your feelings.

tinkertoys · Jul 2, 2001

I just found out that one of my patients died today. She had been one of mine since her admission 3 years ago, shortly after I got my license. She had Myasthenia Gravis, had a trach, and used a ventilator (only at nite until recently). She was a very alert, intelligent lady, knew as much about her vent as we did, and was very particular about her care. She had never married, but she was from a large family, and they were very close. She was very active in Center activities, and kept us up on all the latest news. Over the last few months, she began to have one URI after another (usually MRSA, so she was on isolation a lot), and her quality of life really began to decline. Her family began to stay with her, due to her declining condition, and she recently became pretty much dependant on the vent. She even began to talk at times about turning off the vent, because she so tired, and felt that her time had come. This afternoon, she went to sleep, and didn't wake up. She had family with her, so she wasn't alone, which I was thankful for. I'm thankful that her suffering is finally over, and that she went peacefully, without pain. We did all that we could for her. I know that. but she has been a big part of my life for 3 years now, and I will miss her terribly.

One of our new LPN's asked me the other night if you ever got used to your patients dying. No, you don't. (Or rather, if you do, you need to find another line of work.) Somehow, you learn to separate your personal feelings enough to do what you need to do. It's OK to get angry over losing the battle, or to mourn the loss of someone you've grown close to...as long as it doesn't interfere with the care you are giving to your patients.

I know I'm rambling. I apologize... I try to talk with my husband about this, but he doesn't get it. I know that all of you would. Thanks for listening.

darby · Jul 2, 2001

Originally posted by sandigapeachlpn
I really am sad this morning after watching yet another Resident die before my eyes. The family was in the room, I had not received report yet and was called to the room by my CNA because the Eve nurse was away from the station. The family was in the room and I had no idea that my resident was in such distress. By the time I initiated as many comfort measures as possible, paged the Dr. to obtain orders, etc, on walking back into the room to assure the family, she took her last breath. I have watched many residents die but it is so hard for me because I know these residents for so long and they become so close. Many of my residents have no family and I am their only visitor or stimulation, company or surrogate family. To make matters worse the granddaughter looked at me before I left the room, with such admiration stated " How can you do this all the time? " I almost broke down in tears. It is so hard to start the day with a death. GOD BLESS ALL OF YOU,i have been a nurse 30 years now,we are special and how many times have i heard those words,how can you do this,well too many to remember but i know i helped the many all over the world with love,thanks nurse ,we all need you,dont ever stop caring.darby