How to tell the family the patient has died

Dalzac, LPN, LVN, RN · Jan 3, 2011

At my Hospital the Doc tells the family but they all take the nurse with them. Mostly as a comfort measure because we know the family. We answer nursing question the doc answers what happened questions

JenniferSews · Jan 3, 2011

In LTC I have called. It wasn't terribly unexpected and I broke the news gently but honestly. I did say the patient was checked and sleeping at x hour but when we went to check again they were gone. I felt like if it was my loved one I would take comfort that they were checked on in a reasonable time.

If they are a full code, then we do a full core regardless of how long they may have passed. When the EMTs arrive they take over. Without a doc in the building we have to do everything for a full core.

Belle Epoque · Jan 3, 2011

In LTC the majority of time the death is expected so you shouldn't really have to face any melodramatic reactions.

I've told countless people their loved one has passed on. Just be polite and compassionate. "I'm sorry to call so early but I wanted to let you know your dad passed away peacefully last night" is sufficient. No need to provide any detail unless asked, then be diplomatic and professional, only answer the question asked. It really isn't that bad.

Been there,done that, ASN, RN · Jan 3, 2011

Remember to break the news slowly.

"I am calling to give you some bad news"... pause

"

'I went to check on ( resident) and.... pause,

found them unresponsive"... pause.

You get the idea . It gives the family member time to process the information and makes it a little easier to take.

Good luck, definitely the most difficult thing there is to do.:redpinkhe

PAERRN20 · Jan 3, 2011

If they are a full code, then we do a full core regardless of how long they may have passed. When the EMTs arrive they take over. Without a doc in the building we have to do everything for a full core.

I understand if they are a full code we do everything....but working ER I have had more than one LTC code patient show up who obviously had passed hours ago. Not to start a debate but I am curious if you would still call EMS when the patient is mottled or cyanotic without a pulse, and the arrest was unwitnessed? What if EMS gets there are decides not to transport? How can EMS makes this decision and the RN can't? This is a whole new arena for me, having only worked in a hospital.

loriangel14, RN · Jan 3, 2011

I work in a hospital and I have made the call when a patient has passed. I usally just identify myself and say I am calling from the hospital to let them know that so-and-so passed passed away. I have never called after an unexpected death, they were always palliative patients that were expected to pass shortly but the families didn't happen to be present when it happened.

handyrn · Jan 3, 2011

Some places have laws and agreements with docs that you can call them and they can give verbal time of death orders. I have also seen the EMTs call the coroner and get a death order. If the patient will not be going to the ER and you have death orders they go to the funeral home. The funeral home directors come when you call 24/7 to pick up the deceased.

This has been my experience anyway from living and working in rural areas.

Bruce_Wayne, ASN, RN · Jan 3, 2011

Great thread, I'm learning all kind of stuff in here. I agree with the tip to talk slowly and pause frequently. I think if it were me I'd try to avoid saying stuff like "I'm sorry" because it's intent might be misconstrued. If anything I'd say "my condolences"

Lammy01 · Jan 3, 2011

I work on a medical unit and we constantly have people that die on our ward. I have been instructed to not use the phrases- "passed away" "gone" "unresponsive" or anything that dances around the word dead. We have to say your father has died or is dead because sometimes the other phrases can confuse family members when they are so upset and they may think there is still a chance they are still alive. Also we don't tell patient's families over the phone we ask them if the would kindly come into the hospital and we tell them when they get there unless no one is able to come. most like i sit down with them and tell them that there family member has died and ask them if they need anything and make sure they have support at home.

KaitRN · Jan 3, 2011

I would just like to add, like the others, that most of the time death is imminent in the LTC facility. the pt has been put on hospice care, families have been talked to about changing pt's status to DNR, etc. Once pt's passed I would call the family and break it to them gently, see if they'd like to come view the body, if so do post mortem care, in the meantime call the MD and notify of estimated time of death then call their funeral home choice and the funeral home always picked them up from my LTC facility. I never had to deal with a full code situation at the LTC facility I worked at.. But I would assume if the pt looked like they had been dead for quite some time, you would not send them to the ER. As one Dr. said one time, "you can't treat rigormortis!" lol morbid but true

Belle Epoque · Jan 3, 2011

I understand if they are a full code we do everything....but working ER I have had more than one LTC code patient show up who obviously had passed hours ago. Not to start a debate but I am curious if you would still call EMS when the patient is mottled or cyanotic without a pulse, and the arrest was unwitnessed? What if EMS gets there are decides not to transport? How can EMS makes this decision and the RN can't? This is a whole new arena for me, having only worked in a hospital.

No, EMS would NOT be called if patient is rigor mortis. Why waste that expensive resource? Dead is dead. If you come across a resident who is dead, it doesn't matter at that point whether or not they are full code. In LTC nurses can pronounce death, call the family to advise them of death, ask if they wish to come in and see the deceased, provide post mortem care, call the md to come sign the death cert and then call the funeral home for pick up.

The only difference in protocol is if it's a coroner's case at which time we don't touch or move the body until the coroner has been in and signed the death cert.