Grief - how can we avoid it as nurses loosing a patient?

Long Term Care Columnist / Guide · Mar 26, 2015

It's different every time we lose a patient. Some deaths are harder to bear than others. Obviously we can't burst into hysterics when a patient we care about dies, we have to remain professional. It's OK to let a few tears fall, especially in response to the family's grief, but we must remain calm and in control.

That being said, there have been plenty of times I've gone into the bathroom or gotten into my car at the end of the shift and bawled my eyes out. There is nothing wrong with feeling sad after a patient passes on. In fact, my position has always been that if a nurse can't feel, it's time to get out and go do something else. Just remember that when a patient dies, it's not about you or how you feel---it's about the patient and his/her loved ones.

DisneyNurseGal, BSN, RN · Mar 26, 2015

I don't think you should try to avoid grief, to me that is akin to burying your feelings. Death is a part of life and we need to deal with it.

I work on an oncology unit, so I see my fair share of death and suffering. There are certain families that we get closer to than others. To say not to "get too attached", is not a normal part of the human experience. It is in our nature to form attachments. Recently, we had patient who was diagnosed with terminal brain cancer, and was never stable enough to leave the hospital. The family was so loving, caring and genuine, that our whole floor came to adore this family. I was the nurse when he passed on his 29th day since diagnosis, and the wife was sleeping on the couch. I had to wake her up and tell her that he was gone, and I just sat there with her as she cried, and I cried with her. That night, a respectful stream of floor staff came into pay their last respects to his wife. Sometimes you can not help it. People will touch your life in ways you can not expect. I am a better nurse for having cared for this family and helping them in their time grief.

That being said, that is the rare case. When someone passes I will usually shed a tear (especially if I have to make the notification), and in some cases cry my way home. To me the most important part is that you have a health relationship with the concept of death, don't dwell on it, but deal with the emotions behind it.

Gooselady, BSN, RN · Mar 26, 2015

Grief isn't something we ought to avoid, or try to avoid. That leads to burn out and compassion fatigue and all those pitfalls of nursing as a career.

I don't know how to describe it . . . but the first couple of deaths were the hardest. Then, some kind of invisible boundary started coming up when my patient died, so I could be there for the family, hug them and help them cope, without my OWN empathic response to cry with them, or cry with them for all the people I've lost. I don't know how it happened, just that it did.

My last hospital job was working on an oncology floor and we prided ourselves in our excellent comfort/end-of-life care. So instead of just feeling the grief of loss, there was the sense that I made this person's passage -- one we'll all take ourselves -- better, easier and with positive memories for the surviving family. Overall, taking care of the dying became something I loved about the job.

Now, I'm taking care of two little boys, one of whom is so fragile, and not expected to make it to adulthood (or adolescence, I sometimes wonder). I can't quite 'imagine' coping with his death in the professional calmness I had with the adults. Now that I'm thinking about it, goodbye, back into denial I go

There is a precious 'gift' that can't be described when you take care of the dying. It is not a 'silver lining'. It is sacred. If you are religious, employ your faith. For me, about as unreligious as it gets, I still have a deep sense of the sacred, and it is particularly 'present' when caring for the dying.

If you feel panicky about it, that's OK. You aren't alone. Just be brave for the family and the patient, and something rather remarkable will start happening inside you . . .

Coffee Nurse, BSN, RN · Mar 26, 2015

There is a precious 'gift' that can't be described when you take care of the dying. It is not a 'silver lining'. It is sacred. If you are religious, employ your faith. For me, about as unreligious as it gets, I still have a deep sense of the sacred, and it is particularly 'present' when caring for the dying.

This, exactly this. I once spent an entire night shift holding a dying baby, rocking him and singing him lullabies, so that his exhausted parents could get a few hours of sleep. You've perfectly described the feeling that was in that room - I don't subscribe to the idea of nurses as "angels," but I truly felt like I was doing sacred work that night. It was a gift and an honor to be with that little one and I will remember him as long as I live.

Anna Flaxis, BSN, RN · Mar 26, 2015

Losing.

You don't avoid grief. While you can't go around sobbing all day while at work, you can take a moment to allow yourself to cry in the bathroom or something, then come back out ready to be the sensitive, caring person helping a patient and their family through this transition.

heron, ASN, RN · Mar 26, 2015

What are ways to avoid grief when loosing a patient?
What are your tips or what do you usually do?
I know we can't get too attached, self awareness, what else?

Short form: you don't. I, personally, believe that it's hardwired into our brains as a way of coping with loss. Trying not to feel it is pathological. The other posters' comments here are right on target.

RNNPICU, BSN, RN · Mar 26, 2015

I agree. Grief is not something you can avoid. Being there with the family and supporting them, crying are all okay. The key is once you leave the room and go on to the next task, pt, etc, you have to be able to continue on.

Once you leave work, have things that you like to do, especially on a difficult day or sad day. Exercise, cook a good meal, have a glass of nice wine, read a good book. Importance is self care for when you go home.

I do get "attached" to a certain point with my pts. It is hard not to, however, when I go home, I am home and in my world. I definitely have cried with families, but was able to maintain composure and move about my day and care for my other patients.

As nurses we build relationships with our families, feel sad, happy, for them. When I go home, I don't really talk about work that much because I want to enjoy my time at home. Exercising and cooking yummy meals is what helps me debrief.