How to tell the family the patient has died

[PAERRN20]

Sorry for such a blunt title but this is a question I have been pondering since accepting a new assignment. I will be working in long term care, and haven't had a day on the floor yet. However, I do work in the ER now and whenever a patient dies, the MD talks to the family, so I never have to be the first one to break the news.

Obviously I would not come out and say the patient died so bluntly. I am more worried about how to respond when the family asks questions. For example, what if I don't know the exact time of death? Do I say the patient was soundly sleeping at 0300, but on rounds at 0500 the patient had passed away? What if they are a full code and they obviously gone? Sorry for such questions but this has got me a little nervous!

[Cat_RN, ASN, BSN, RN]

Per our facility policy, we HAVE to 'code' anybody we find without a pulse/not breathing if they are not a DNR. Doesn't matter if they are stone cold, technically we have to call 911 and provide 'CPR'. (I'm sure EMS is not understanding most of the time but hey, it's policy and I'm not going to get fired because EMS doesn't like it). Ridiculous. I know. When someone dies at the facility who is a full code, a sheriff also comes. I've never had a coroner's case. I've had people who die, but most of the time it's expected. I've never found anybody cold.

When I call, the family knows usually before they answer the phone. (I work nights). I've never had anybody freak out, although there was a family who came and would.not.leave. for HOURS. Pretty much the whole shift. (I thought we had a policy stating no more than 3 hours after death but the pt's nurse didn't enforce it).

[casi, ASN, RN]

I've always been told that if you find them dead, cold, in rigor, and they are a full code start cpr and call ems. Silly I know, but there are too many sue happy families out there. In my area one of the nursing homes is getting sued because staff started CPR on a full code, but the family told them to stop so they did. Now the family is claiming that they never told the staff to stop and they didn't follow orders.

[evolvingrn, BSN, RN]

I tell people their loved ones have died on a regular basis both in person and on the phone. I am a hospice nurse so i also pronounce the deaths. Generally on the phone I say my name is so and so and i am a nurse at +++++++++++ I'm really sorry to inform you that your mother passed away a few minutes ago......i then pause and wait for their reaction and respond to that reaction supportively. If your at my facility you know that death is a possibility because while many are there for symptom mgt we frequently contact family and keep them in the loop of changes if we think they are actually going to pass away, we do occassionally have and 'out of nowhere' death. but even when a loved one has been actively dying family generally are still a little shell shocked and cry. I given them a little time to react then i offer the support we have available. I give them the opportunity to come in and see their loved one and tell them what the next steps are. Many choose not to come in, then i fill out my paperwork , and release the body to the funeral home.

[CT Pixie, BSN, RN]

Full code in our LTC facility is exactly that regardless of whether or not the pt is obviously dead. We start CPR and continue until EMS arrives and takes over, I have never had a case where EMS decides not to transport an obviously "gone" patient. Our volunteer EMS understands that all the facilities in our area have the same policy and goes with the flow.

I actually had to make my "I'm calling to let you know..." call not long ago. I've lucked out and had none pass on my shift in the time I've been a nurse. I did as the other poster said..Hello Ms Jones, this is Pixie you're mom/dad/granny's nurse..pause....I'm sorry to have to call....pause... (etc).

[CT Pixie, BSN, RN]

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.

Yes, LTC nurses can pronouce death (only the RN and with the doc and family signing off)..we do have DNR residents who the family has not signed off that an RN can pronouce, in which case the body is left until the doctor comes in to pronounce). However, although some States might allow it, an LTC nurse in Connecticut facilities cannot pronouce death on a full code patient. The only medical person who CAN pronouce death on a full code resident is a doctor.

[nerdtonurse?, BSN, RN]

I've had to do too many middle of the night phone calls. Often, I can tell a patient's getting bad, and we get the family in house, or at least on the way and knowing the patient's not doing well. I've also been asked to call family by the family that was present at the death. What I usually do is this:

"Is this John Smith? Sir, I'm Nerd, a nurse at XYZ hospital, and I'm calling about Sally Sue, a patient at our facility. I'm sorry to tell you that Ms. Sue died a few minutes ago. We were with her at the time, and she died peacefully and without pain." Answer their questions, and you may have to tell them the same thing a few times, or they may pass the phone to 2 or 3 people for you to tell them what happened as well. My patients always die "peacefully and without pain" even if they weren't. People don't need to know that someone had a massive seizure due to an evolving CVA, or were begging you to save them 20 minutes before they stopped breathing. That's the little things we have to live with; telling the family won't make things better for them.

Never, EVER tell anyone "she was calling for you as she died" or reflect on how bad the patient was prior to death "she's not suffering anymore." Even if you feel like the person you're calling should've been there, there's no point in trying to make them feel worse about not being there. Some people can't stand to be there, some people can't stand NOT to be there. You can be on the receiving end of a lot of emotion, and remember that it's okay if you're upset, too; I've cried with families before, especially our frequent fliers. We get attached.

Just be patient, and try to get your coworkers to keep an eye on your other patients; someone always wants a bedpan, or a glass of juice, or another blanket in the middle of a code...

[rkitty198, BSN, RN]

You say what the charge nurse I work with says:

Your (fill in blank) has expired....

Like their loved one is a carton of old milk.

I hate that she puts it that way.

I think that as long as you dont say that you are going to be fine.

[clumsy penguin]

If you are working in an ER... and a patient is "mottled or cyanotic" and doesn't not have a pulse why would you even think to call EMS?

EMS have more independence when it comes to their orders than an RN does... however an RN is kind of the ringleader in a hospital setting. They have to be independent and have standing orders in the filed because there are no MDs.... standing orders are what they look to.

I guess I am wondering why you are asking if you should call EMS if the patient is already in the ER...

If you're an RN you should be the one to code/ not code per their wishes

[Nascar nurse, ASN, RN]

If you are working in an ER... and a patient is "mottled or cyanotic" and doesn't not have a pulse why would you even think to call EMS?

EMS have more independence when it comes to their orders than an RN does... however an RN is kind of the ringleader in a hospital setting. They have to be independent and have standing orders in the filed because there are no MDs.... standing orders are what they look to.

I guess I am wondering why you are asking if you should call EMS if the patient is already in the ER...

If you're an RN you should be the one to code/ not code per their wishes

Hint..go back to the beginning and reread the post. This nurse is currently in ER BUT is planning to work in LTC and is asking about the protocols IN THAT ENVIRONMENT.

[clumsy penguin]

Thank you for correcting me! I misread the post

[brownbook]

I have called, and told families in person, that their loved one has died. As lammy01 stated please don't use terms like passed, expired, didn't make it, etc., just say dead or died. Of course it is shocking but they don't go through the few seconds, that can seem like an eternity, of crazy hope or confusion of what does that mean where did they go?

[Simba&NalasMom, LPN]

I would imagine that would vary widely by state. It's my understanding that here in OR, licensed nurses must get a verbal pronouncement from the MD unless the resident is on hospice.

If the resident is a full code, he must be coded, period.