How do you deal with patient grief in outpatient environment?

[FutureRN20190]

I am a fairly new nurse (less than a year) I have been working in the clinic environment straight out of school. For anyone who has worked in a clinic before you know that it is required that the nurses intake the patients and get them ready to see the doctor all in 5-10 minutes.

I have had a couple of instances where a patient will inform me one of their family members has passed away. My nurse instinct says comfort them, listen, be empathetic. However, I am not sure what is the best way to do that in a clinic environment where everything feels rushed.

I do not want to be that robotic nurse, I want my patients to know and feel that I care for them. How do I do that while still getting my job done?

[JKL33]

Hopefully you'll get a variety of good advice with this excellent question.

Personally, I tend to be guided by the existing relationship I have with the individual - whether that's an acquaintance in my personal life or a patient, I may make more of a related/personal comment if it's someone I know fairly well.

I commend your desire to show compassion and my only caution would be that the situations that make us feel like we "should" say something to convey compassion are the very ones that we have to use due caution to not be ridiculous by saying something that is trite and/or insincere. For example: I once had to counsel an orientee when I found her sitting on a (female) patient's bed, stroking the patient's arms and saying "We care very much about you" when the patient was being seen for a psychiatric concern. Her heart was in the right place, but her words and actions were very inappropriate to the situation. We had just met the patient and we'll be leaving in 4 more hours to go home to our families while the patient must continue to face the crisis. So, although the orientee wasn't trying to be insincere, her words were simply false.

I like the guideline of pausing briefly, making good eye contact, and saying something kind that doesn't involve "I". Such as, [pause, give the patient your attention] "Oh, my....you have been through a lot in the last couple of weeks then, haven't you?" This gives them an opening to say more if they wish, but doesn't pressure them to talk, and most importantly there is nothing inappropriate relationship-wise about it, and I don't have to say something that doesn't "ring true."

As far as the time factor, if they are conversing about the situation they mentioned, I eventually (after a couple of minutes) ease into resuming my duties while staying engaged in the conversation. This happens in the ED, where the pressure is on. So these are usually the techniques I use. Like you, I don't want to be ripping off a velcro b/p cuff or hovering a thermometer in front of anyone's mouth waiting for them to finish talking about the loss of their loved one. That's just not compassion.

[Nurse SMS, MSN, RN]

Making assessing their coping part of your nursing assessment and have some resources on hand should the patient desire it, such as outreach pamphlets for support groups or supportive information about the grieving process. Inform their physician of your assessment before they enter the room so they can determine if pharmacological intervention might useful. It can also be therapeutic for one's physician just to ask about how the patient doing since a loved one died. Simply knowing that others care is in and of itself an intervention and patients hold their doctors in high esteem. For the doctor to already know spares them having to bring it up.

Sometimes the best thing you can do is simply let them know that help is out there and that you can assist them in bridging the gap to finding that information when or if they are ever ready or desire it. Also never underestimate the power of a sincere "Oh my goodness. I am so sorry".