Patient died...

[samiam4]

I'm a nursing student in my 3rd semester and my pt died the other day. I have anxiety, chest pains, and a horrible stomach ache after finding out my patient died. It is my worst nightmare.

I had clinical on Tuesday and I found out on Thursday (kind of) that he died. We usually get the same patient's when we go into clinical. My teacher said "you have two new patients today" and my stomach dropped. My instructor didn't say if my pt passed away or not. So I said "ok."

So I went on with my day looked up my current patient's info and saw my pt. from tuesday still on the pt. list for the floor. About an hour later his name disappeared. The nurse that had the pt. with me on Tuesday came in to work at 7am and went up to the night nurses on the floor and said "What happend?!" I just had this feeling something happened to MY pt. from tuesday.

My pt.'s room from Tuesday was being cleaned by the custodial people. His bed was empty and made. I just knew it was him that something happened. I didn't get to talk to anyone about it and didn't ask what happened b/c I didn't want to be the nosey nursing student. When I had the pt. it was on tuesday and it was a very busy day with med passes. I felt that, on tuesday, I did not provide the best care for him. I know that I'm a student but, I feel like what if it was something that I DID or DID NOT do that contributed to his death early Thursday morning?!

I have a hard time prioritizing my care and I'm still learning....I had clinical on Tuesday the pt. died early Thursday morning. I'm guessing something happened in his sleep? When I had him as a pt on tuesday morning he was doing great, in good spirits, laughing and joking. A very happy man in his late 80's. He was in the hospital for Poss. pneumonia, SOB and had an extensive history for CHF, pulmonary hypertension, diabetes etc. When getting report from the nurse on tues she told me his O2 would desat into the 60's overnight but would be better 80's-90's during the day when awake (and it was)...

I don't know why I feel like what if it was something I did that caused him to die...I feel like I can't accept him dying and I don't know why my instructor didn't tell me what happend...I feel like I want to throw up. Any advice? Comfort words and experiences people can share? Should I talk to my instructor even though she doesn't know that I know about the patient passing? Help...I feel like I should quit nursing school........

[NCRNMDM, ASN, RN]

First, let me say that I'm sorry to hear you've had this experience for the first time. If you continue in nursing, however, this certainly won't be the last time you experience this. Caring for a patient, and then having that patient die, is never an easy thing. As you care for the patient, you develop an emotional bond with him/her. You want to see the patient get well, you want to see him/her be discharged home, and you hope that the care you're providing will help him/her achieve these goals.

Sometimes, unfortunately, we find ourselves caring for patients who are too sick to achieve these goals. Based on the information you gave about your patient, it seems that this was one of those times. Your patient had an extensive past medical history, preexisting respiratory issues, and his already precarious state was complicated by pneumonia. Your patient's sats deteriorated to the 60s at night, and rose to the 80s-90s range during the day. A sat in the 80s isn't good, but a sat of 60 is certainly cause for alarm. It is obvious that his respiratory system was severely compromised, and that his condition wasn't compatible with continued life.

Also keep in mind that you weren't the only person who cared for this patient. Nurses with much more experience than you saw and cared for this patient. It was not a mistake, oversight, or error on your part that killed this man. It was an already unstable state, a complicated past medical history, and a case of pneumonia that led to his death. I'm sure that all the nurses involved in this man's care did everything possible in an attempt to cure his pneumonia and restore his previous level of health. Unfortunately, he was too sick, and nothing could be done to save his life.

As a fellow nursing student who recently had a patient die, I know how you feel. My patient had lung cancer that had metastasized to her brain. She also had ruptured diverticulitis and peritonitis. She had undergone several surgical procedures. The first night I cared for her, she was alert and oriented, lucid, and able to carry on a conversation. It was slightly obvious that she had a brain tumor, but she wasn't experiencing any acute distress. Her vitals were fairly stable, her fever had come down, and she appeared to be responding well to her medications and treatments. She was eating a regular diet and was in good spirits.

The next night I wasn't there. I came back the next night, and everything had changed. My patient was obtunded and basically aphasic. Any attempts she made to speak came out as slurred syllables rather than comprehensible words. She had periods where she was responsive only to painful stimuli. She did not recognize me or the other student who had helped me care for her only two nights before. She was hypertensive (she was trending about 170/85) and tachycardic. Her respirations were labored, irregular, and she was tachypneic.

I, along with the other student, provided all the care we could. I restarted an IV, we gave her a bath, we applied lotion, we turned and positioned her every two hours, we cared for her radiation burns, and tried to make her comfortable. When we left at the end of the night, we knew she wouldn't live much longer. Our assumptions were true, and she died several days later.

When I went home that night, I begin to wonder if I could have done anything else. Could I have provided better care? Could my assessment have been more thorough? Did I miss something that could have somehow improved her condition? The answer to all of those questions is no. There was nothing I could do to help heal this patient. She was terminal, and she didn't have long left on this earth. My partner and I provided the best things we could have for this patient: we treated her with respect and dignity, we made her as comfortable as possible, and we sat in the room with her, talking to her and holding her hand. We knew she wasn't going to live much longer, and we didn't want her to be afraid or alone.

The same things are true for you. You did all you could for your patient. You gave him the care he deserved, you treated him as a human being, you showed him respect, and you did your best. At the end of the day, that's what nursing is. Nursing isn't curing every patient, nursing isn't successfully treating every condition. Nursing is providing care for the patient's physical, spiritual, and emotional needs. Nursing is holding the hand of the dying patient. Nursing is comforting the family member of a deceased patient. Nursing is giving that much-needed dose of pain medicine. Nursing is easing a patient's fears.

During your clinical day, I am sure you did these sorts of things. I am sure your patient knew that you cared for him, that you were there for him, and I am sure he trusted you to provide him with the best care possible. Just because he didn't live doesn't mean that you aren't a good student, or that you won't be a good nurse. He was a sick man, and he is no longer suffering. Rest easy with the knowledge that you provided the best care you could.