New Nurse...Need advice on dealing with death

ira100178 · Jun 29, 2009

yes, counseling is a good way to cope with death and also religion. try to embrace the reality of birth and death...it is normal..and everybody will die eventually...pretty, ugly, rich, poor, educated, uneducated...nobody can escape death..one should only be spiritually ready for it when it comes...in my religion we are reminded of death every service..we sing songs of death and a new life ahead...good luck..

CrufflerJJ, BSN, RN, EMT-P · Jun 29, 2009

Thank you. I think you're probably right. I feel silly being so upset about what happened. Its only been 3 days but I feel like I should be more professional or something. Would it be wrong to send a card to the family or write them a short note? I feel like I need closure or something, but I don't want to cross professional boundaries. I just feel like compared to a hospital the boundaries here are so undefined.

Please don't feel silly about your feelings. Feelings are REAL. You did your best, yet, despite that, your patient died.

I've had friends die in their early 20's, and have had patients die (as a paramedic) from ages 1 through 80-something.

Life happens...death happens.

Yes, maybe in a perfect world, you should be able to totally shut out feelings about your patients. If that happens, though, I think you'd be LESS of a nurse. It's a touchy balancing act, between feeling too much & not feeling enough.

If you continue feelings of "could have, should have, I'm useless & incompetent", PLEASE talk with a trusted coworker or CISD (critical incident stress debriefing) counselor. Having these feelings is not a sign of weakness. It's a sign of humanity.

Caring hurts.

atlangel114 · Aug 30, 2009

Thank yall for your posts. I am a recent grad (May), I have been off orientation 4 days and I am working at a level one trauma center in the Surgery Trauma Intensive Care Unit. I have actively participated in 2 codes. One during my practicum as a student and this one last night. I was the primary nurse and I have to admit that I was terrified...

Since I am a new grad the charge nurse assigned me one of the lower acuity patients... He had a C5-C6 fracture and had been in our unit less than 2 weeks. He was having problems with autonomic dysreflexia (as he was a quad) He had a trach placed Thursday am *so roughly 72 hours prior*

I am the new kid on the block but I can smell a GI bleed from a mile away. His coags and H/H were slightly abnormal. He had dark brown thin residuals from his PEG and the insertion site was weeping serosanginous fluid (a substantial amount) His a-line and TLC were also seeping serosanginous fluid. I made the comment that I thought he may be going into DIC during shift report. His O2 sats were hanging on the low side 91% so I notified respiratory and I suctioned my patient. What I got back was frank blood.

Doc bronched him for a while and his sats steadily dropped. We ordered a stat CXR and it revealed a small pneumo and the doc elected not to place a chest tube right then. Well over the next 30 minutes He was on a peep 22 and 100% FiO2 and his sats were in the 70s. Called the doctor back and he put a chest tube in. Immediately his sats came back up to 100% he was pink, following commands, and just totally with it.

He was a night bath and he was filthy. I spoke to the charge nurse and we felt that he was stable enough to turn. There were NO do not turn orders on the patient.

His T&L were clear but just to be safe I had two other nurses at the bedside to log roll. Sats were BEAUTIFUL when he was on his right side (toward the vent) but when we rocked him slightly to the left to pull the sheets out from underneath him his sats fell from 100% to 88... then to 70.

Doc back at the bedside, rebronched. He saw a massive clot that was blocking the right mainstem. He continued to manipulate the clot without much success. Sats down to 27. Then 18 then pulseless.

Code 1. Chest compressions, bag, Responded to Epi-Atropine-Epi. Epi gtt started Dopamine stared. SVT 160s

Sats 50s Rebronched sats 70s... then fell. Then SBP the HR.

Code 1*2 Epi push, Atropine, Amio- responded. Family called. On there way (staying 2 hours from the hospital)

Rebronch with the attending at bedside. The attending said that the clot was well organized and looked like it had taken days to develop... he assumed that it was a result of of the trach site blood slowly trickling down... (terrible)

Code 1*3 Started at 0617 same as before... ribs cracked during compressions ended at 0645 when the patients family arrived and opted to withdraw care. Gtts and vent off. Asystole in 5 minutes

Now... I feel guilty. I feel confused. Angry at myself. Incompetent. During the codes I was shaking, the charge nurse pushed the drugs. I monitored the vitals and gtts. Could I have done more? Is this my fault? When I saw the family a couple tears slipped down my cheek.

The first thing that his wife said to me was "I am so thankful that you were his nurse. I know that he was well taken care of. He always looked so clean when you had him" (This was only my second night with the patient) She said that she knew that we had done everything that we could. And that she woke up around 0300 to him (my patient) approaching her in a dream to tell her that he was "going home." She also told me that she felt he had waited to pass until his daughter that lived out of town could get there. (She came for the weekend).

I believe in God and Heaven and a life that is better beyond this earth. But I also believe in medicene and the science behind health care. I am just sad and bummed that my patient died.. =(

Pediatric Critical Care Columnist · Aug 30, 2009

A couple of things jump out at me right off the bat...

Since I am a new grad the charge nurse assigned me one of the lower acuity patients... He had a C5-C6 fracture and had been in our unit less than 2 weeks. He was having problems with autonomic dysreflexia (as he was a quad)

Patients with autonomic dysreflexia are not "lower acuity". Autonomic dysreflexia is life-threatening and requires an astute nurse with excellent assessment skills. Not saying that isn't you, but just saying.

He had a trach placed Thursday am *so roughly 72 hours prior* His O2 sats were hanging on the low side 91% so I notified respiratory and I suctioned my patient. What I got back was frank blood. Doc bronched him for a while and his sats steadily dropped. We ordered a stat CXR and it revealed a small pneumo and the doc elected not to place a chest tube right then. Well over the next 30 minutes He was on a peep 22 and 100% FiO2 and his sats were in the 70s. Called the doctor back and he put a chest tube in. Immediately his sats came back up to 100% he was pink, following commands, and just totally with it. He was a night bath... Sats were BEAUTIFUL when he was on his right side (toward the vent) but when we rocked him slightly to the left his sats fell from 100% to 88... then to 70. Doc back at the bedside, rebronched. He saw a massive clot that was blocking the right mainstem. He continued to manipulate the clot without much success.
Rebronch with the attending at bedside. The attending said that the clot was well organized and looked like it had taken days to develop... he assumed that it was a result of of the trach site blood slowly trickling down... (terrible)

So this guy was bronched how many times before the attending came and saw a HUGE, ORGANIZED CLOT in the right mainstem? Whose fault is that?! Of course his sats tanked when you rolled him off his right side. His left lung was doing all the work and then was compressed by him lying on it. How were you to know that, since the doc who did the bronch didn't know that?

Now... I feel guilty. I feel confused. Angry at myself. Incompetent. During the codes I was shaking, the charge nurse pushed the drugs. I monitored the vitals and gtts. Could I have done more? Is this my fault? When I saw the family a couple tears slipped down my cheek.

Everybody shakes in a code situation. You just might not be able to see them doing it. Most times on our unit, the bedside nurse is responsible for monitoring the patient, as you did, providing information to the code team and working with the family. I doubt anyone expected anything more from you. Except maybe you.

The first thing that his wife said to me was "I am so thankful that you were his nurse. I know that he was well taken care of. He always looked so clean when you had him" (This was only my second night with the patient) She said that she knew that we had done everything that we could. And that she woke up around 0300 to him (my patient) approaching her in a dream to tell her that he was "going home." She also told me that she felt he had waited to pass until his daughter that lived out of town could get there. (She came for the weekend).

This is what your patient's wife will remember about you and your care for her husband. She has given you a wonderful gift.

I believe in God and Heaven and a life that is better beyond this earth. But I also believe in medicene and the science behind health care. I am just sad and bummed that my patient died.. =(

We can't save everyone. People die. It's how we're made. This man had everything possible done for him but he knew he was dying and he was ready. Why else would he have visited his wife? It's natural for you to grieve for him and for all the patients who come after him who die. You will go on and you will be a good nurse with a huge well of compassion for those you touch. If you ever lose that you'll lose the essence of why we all do what we do. Hugs.

TemperStripe · Aug 31, 2009

I'm also a new grad (Dec, '08) in a critical care unit. I was the primary nurse when my patient died about two weeks ago. I was very close to his family, and it was a very, very difficult situation. Here's what our palliative care nurse said to me:

Never allow yourself to stop feeling.

I think it's some of the best advice I've received thus far, seriously. If you're not feeling something during these types of situations, maybe you need to reassess your career choice.

That being said, a few things that helped me:

1. Talking to people about it. My mom. My husband. My non-nursing friends. My co-workers. My nurse friends at other hospitals. I realized I needed a lot of validation from a lot of different sources. After I talked about it a lot, I felt much better, like, to the point of being able to sleep again.

2. Crying, really hard, for awhile. I don't get emotional about it now, but I spent a good deal of time crying. I'm not a cryer. I practically had to pull of the road when I drove home that first night.

3. Remembering that the guy is in a better place now. Regardless of your beliefs about what happens after you die, it certainly can't involve anything worse than being in an ICU, right?

The most important thing is to take care of yourself. Be selfish and give yourself whatever you need, if it means talking to what seems like an ungodly number of people, posting on this website for some support, getting a massage, eating a cheeseburger. Whatever. Do it. (In moderation, regarding the cheeseburger. Ha!) You're not good to anyone if you're no good to yourself.

I support you!

Pediatric Critical Care Columnist · Aug 31, 2009

The last of my patients to die on my shift was an infant who had been found not breathing in his bed. He'd been resuscitated and came to our unit where I admitted him. I knew when he arrived that he was already with the angels, but did my job and offered support to the family. We opted for 24 hours of neuroprotective hypothermia after which we'd let him warm passively and see where we were. By early afternoon on day 2 we knew for sure that he wasn't there and we withdrew life-sustaining treatment. For all of that, and allof my many years of experience, I was still very shaken up. I second-guessed every single thing I had said to the parents and other family members and was convinced that I could have done a better job of supporting them. As Caroline said, I talked about it a lot. I took comfort in the belief in me that my friends showered me with and finally began to believe in myself again. Caroline gave good advice.

Tiaj72187RN · Sep 19, 2009

I just want to say thanks to everyone who has replied to this post. Its been almost 3 months exactly since everything happened with my camper. I still carry around the card he had made me before he died in my wallet. I have grown in so many ways through this incident. It is so comforting, however, to know that people have coped in many of the same ways as I did. I felt like I had to talk to so many people right after it happened. I felt stupid, like I was over-reacting, and like people were getting sick of hearing about my problems. I thought I was supposed to be "okay" after day 3. Each day got a little better, I started seeing the event a bit more clearly and realized that truly there was nothing else I could have done.

In August I started working at a hospital on a med/surg unit. I've been here for about a month and I have dealt with death even more frequently now. I still cry when my patients die, certainly not like when that camper died, nothing could compare to that. But when the family is at the bedside of their recently deceased family member, saying their goodbyes, tears rolling down their cheeks, I let a few run down mine. My dad tells me I need to deal with it better, my grandma (who has been an active nurse for 60+ years) tells me I can't be emotionally involved, you have to get over it. Not listening to them is the best thing I could have ever done.

When I stop shedding tears or feeling sadness over death is when I will know it is time to quit this profession.

Thanks again, everyone.

sallyrnrrt, ADN, RN · Sep 19, 2009

I am a new nurse and a critical care intern. I have been training for 5 months and have 1 more month before I am on my own. I am having a difficult time with death. About 5 weeks ago I did chest compressions for the first time on a real person. I do not know her history, she had only been at the hospital for about 20 minutes before the code was called and she was in a different area. She died and it was very difficult for me. When the breathing tube was removed, I swear she was gasping for air. It was all very confusing for me. I didn't understand why everyone was leaving while the patient was gasping for air. There was a de-briefing and I was told that it was natural. I read "On death and dying" by Kuebler-Ross. It didn't help much. I am looking for details on what happens to the body during and right after death.
Now fast forward to a week ago. Another code was called on a pt that I had taken care of the week before. It was a very intense code. Again I did chest compressions. As I was doing them I saw that her lips were blue. Family was in the room and the pt was 21 years old. After the code was called and the time of death was stated there were no dry eyes. I am having a very hard time with this. I know we did everything that we could but I am feeling guilt. What if I had done the compressions better. Are these normal feelings? Does it get any easier? I am looking for advice, any advice. I really appreciate it! Thank you in advance.

OK, in critical care areas, there will be more sudden death, there will be more codes, there will be a ton of abnormal physiology...... it is the nature of critical care, we give intense support for a failed or failing health status of a real human....... they would not be there for just a sore throat. It is sometimes frustrating, but the valent battles for life we fight for patients as in codes etc. do not normally, turn out good, research the stastistics of people arresting in hospitals, and coded, and the outcomes. It is CRITICAL situation, with critical interventions, and frequently critical outcomes.

All that sorta negative stuff being said, for me, and other seasoned critical care nurses it is an area where I can be the most supportive, compassionate, and resourceful , not to mention our awesome critical thinking skills, that even can prevent some of the worse outcomes, we ROCK!! I have never felt better than the emotional and physical support I can give a family member and patient, even when the outcome may not be good. But we can and do have a phenominial contribution..... and girlie sometimes that is pretty fast tract. I am so thankful for the critical care nurse intern development programs of today. It is so much better than when I was "just thrown to the wolves, with far less resources." You will probably be fine and it is evident that you have an compasionate gift. Ok, the gasping or air exchange you felt you observed, after intubation, freq. we hyperventilate the patient during a code, hoping that more freq. and vol of air, will compensate for the comprimised circulation of CPR, not to be crude, but it is crude, sometimes we just have over extended the lungs, and the air will come out, as a baloon like deflation... >> this is a little dramatic

ok, if the young lady was entubated correctly, and compressions were delivered, she could have had a "saddle embolus and no amount of compression or artificial ventilation would oxgenate her, if there was a major rupture in a vessel as the aorta, or heart, you can not oxgenate blood that can not be moved, when there is such loss in integrity of the vascular system...

Hang in there. It Does get better !! And it will seem easirer, only because you are increasing your knowlege, and skills, as you face the varrious Critical Care Issues. we need you, and the families and patients need you, and you need you. :) :yeah:

Propranolol · Sep 21, 2009

hello,

i have been thinking of the same thing lately. i have had 2 patients die that i took care of while in the hospital in the last 2-3 weeks. another on hospice. saw her from when she was diagnosed to her hospice bed. learning about there passing is shocking sometimes. you don't think they are going to die anytime soon and BOOM, they passed away. usually a doctor might let you know what happened to them or someone reads it in the newspaper. especially in the last 1-2 months, i have been more tired and feeling depressed, sort of. anyway, just wanted to let you know, you are not alone. oh, i'm a new grad. started in april. so i know i'm still learning how to deal with certain things and situations. take care.

pcurn2008 · Oct 5, 2009

I am really proud of everyone that has responded to this post and all of the others on this great site. I am the original poster of this message and although I have come a long way, it is still hard to deal with the death of a patient. After going back and re-reading my original message and all of the posts that followed it makes me feel honored to be in such a great profession where we support each other and provide constructive feedback as well as years and years of experience. Where I work, I do not always feel this supported and looked out for. I am also happy to know that my post has helped others dealing with similiar feelings. I have seen many more deaths since I posted this back in Dec 2008. Each one affects me differently and each one helps me grow. Back in Decemeber I tried talking to my mom about how I was feeling (actually I tried talking to just about anyone that would listen! but my mom's response surprised me most). My mom questioned my career choice and asked if I was strong enough to do this. Since that day I have known that I am strong enough to make a positive impact on my patients and their families. I know that is not what she meant. She meant that I shouldn't feel what I was feeling (sad, hopeless, confused, torn, disturbed) and I needed to "get over it". And my response to that is if I ever stop feeling and stop seeing patients as people...I need to get out of Nursing. That is not what nursing is to me. Thank you all so much for the love and support. xoxo

sallyrnrrt, ADN, RN · Oct 5, 2009

I am really proud of everyone that has responded to this post and all of the others on this great site. I am the original poster of this message and although I have come a long way, it is still hard to deal with the death of a patient. After going back and re-reading my original message and all of the posts that followed it makes me feel honored to be in such a great profession where we support each other and provide constructive feedback as well as years and years of experience. Where I work, I do not always feel this supported and looked out for. I am also happy to know that my post has helped others dealing with similiar feelings. I have seen many more deaths since I posted this back in Dec 2008. Each one affects me differently and each one helps me grow. Back in Decemeber I tried talking to my mom about how I was feeling (actually I tried talking to just about anyone that would listen! but my mom's response surprised me most). My mom questioned my career choice and asked if I was strong enough to do this. Since that day I have known that I am strong enough to make a positive impact on my patients and their families. I know that is not what she meant. She meant that I shouldn't feel what I was feeling (sad, hopeless, confused, torn, disturbed) and I needed to "get over it". And my response to that is if I ever stop feeling and stop seeing patients as people...I need to get out of Nursing. That is not what nursing is to me. Thank you all so much for the love and support. xoxo

exactly, I am very proud of you, and WE NEED YOU!!

Propranolol · Oct 5, 2009

I am really proud of everyone that has responded to this post and all of the others on this great site. I am the original poster of this message and although I have come a long way, it is still hard to deal with the death of a patient. After going back and re-reading my original message and all of the posts that followed it makes me feel honored to be in such a great profession where we support each other and provide constructive feedback as well as years and years of experience. Where I work, I do not always feel this supported and looked out for. I am also happy to know that my post has helped others dealing with similiar feelings. I have seen many more deaths since I posted this back in Dec 2008. Each one affects me differently and each one helps me grow. Back in Decemeber I tried talking to my mom about how I was feeling (actually I tried talking to just about anyone that would listen! but my mom's response surprised me most). My mom questioned my career choice and asked if I was strong enough to do this. Since that day I have known that I am strong enough to make a positive impact on my patients and their families. I know that is not what she meant. She meant that I shouldn't feel what I was feeling (sad, hopeless, confused, torn, disturbed) and I needed to "get over it". And my response to that is if I ever stop feeling and stop seeing patients as people...I need to get out of Nursing. That is not what nursing is to me. Thank you all so much for the love and support. xoxo

well said. :up: