Role of Hospice RN at a death.

tewdles, RN · Apr 19, 2013

I feel I could be more helpful to families when their loved one dies then I am. I would love some insight on what others say and talk about with families, when attending a death.
I am new to Hospice, and a quiet person. I want to do my best for the families and still be me. Hearing some experiences would be helpful, thank you if you can spare a moment.:):)

Your calm presence, "in the moment" with the grieving family members is sometimes all they need. Listen to them, find themes in their comments to use to guide them toward a celebration of the life they just shared, the victory in that particular peaceful death, and their excellent (although not easy) care.

Invite them to help you prepare their loved one for the journey out of the home, and as you take care of the "details" that surround a death in the community...with empathy, compassion, and professionalism...this will help them in the days to come.

Quiet and kind can be enormous assets in these situations.

Long Term Care Columnist / Guide · Apr 19, 2013

I agree with tewdles. Attending a death can be an emotional minefield, so communication is often best when we use few words, or even when we use no words at all.

A hug. A comforting hand holding that of the bereaved person. A moment of respectful silence and a bowed head while the family prays for their departed loved one. An offer of a Kleenex and a listening ear. Even a few tears.

All of these small gestures communicate caring far better than the most eloquent homilies or the most accurate scientific explanations. About a year ago, I was at the bedside of a man who had just passed away at our assisted living facility; his poor little wife---now newly widowed---was terribly upset that his eyes wouldn't stay closed and asked me why he was staring at the ceiling like that. She didn't need the biological details, she needed reassurance......so I told her I thought he had seen something beautiful as he was taken to Heaven.

She's never forgotten that, even though her dementia has advanced since then, and sometimes she brings a flower or a sweet when she comes by my office. We nurses have so many opportunities to assist patients and their families in end-of-life situations, and it's almost always best when we do it with as little fanfare as possible. Good luck to you, OP....I think you're probably far more helpful than you realize. :yes:

martymoose, BSN, RN · Apr 19, 2013

[quote=VivaLasViejas;7287692She didn't need the biological details, she needed reassurance......so I told her I thought he had seen something beautiful as he was taken to Heaven.

Gosh, That's beautiful thing to say at that moment!

weemsp · Apr 19, 2013

Being the bedside nurse before, during and after at pt death is a memorable experience for the bereaved families and spouses.

One thing, in-particular, that I know comforts family at these times is being reassured that their loved one is not in any pain, discomfort or distress. As we all know, sometimes the " mechanical" happenings as a pt slips away can be rather unsettling...the Chenes stokes, mottling, vocal wimpers, etc...

More often than not, the families have concerns whether these things are normal and is there something we should be doing.

I gently and softly explain that they are feeling no pain...and this is just the human body's way of letting go. ( obviously, I choose my words carefully and with consideration for the family's spiritual needs, etc.

I am always sure to give them privacy, if it's an entire family grieving...but if it's a lonely spouse or only child...I try to be present as often as they appear to need. A quiet prayer...if that's their need...a thoughtful word of encouragement...or just sitting with them in silence.

You will find your own method...whatever is true to you...and your patient/ families.

God bless you for the work you do!! It takes a truly gifted, caring and special person to work in hospice...so I send you hugs from abroad!!

olioxenfree · Apr 19, 2013

My grandmother recently passed: unexpectedly, not hospice. The bereavement counselor actually answered the phone while sitting with us and told the caller "I'm sitting with the family of a code right now, I'll have to call you back." She wasn't a "code" she was my grandmother! Needless to say, don't do that. Be real and respectful with the family; listen, and give them time to come to terms in their own way. Outside of those things, the proper things to say or do is not that important.

lhflanurseNP, APRN · Apr 19, 2013

I took a class on death and dying and here are some really good tools that might help:

Book: Final Gifts by Callanan and Kelly (1997) Maggie Callanan | Biography |The Official Site

Video: Death: A Personal Understanding 1999 directed by Derman. There are several clips that can help (Resource: Death: A Personal Understanding).

redmielita · Apr 19, 2013

This might seem basic, but know what the patient's name is/preferred to be called, and use that when speaking about them to the family. A dear friend of mine passed away, and while her given name was "Susan" everyone called her "Susie" and she was never referred to as Susan. The grief counselor kept referring over and over again to "Susan". I know we were all rather sensitive at the time, but it felt jarring and as if he hadn't done his homework with regards to our friend the patient.

evolvingrn, BSN, RN · Apr 20, 2013

I see the role as both of a comforter but also a coordinator/educator. I worked inpatient hospice. so people were often numb and they had 'no clue' what came next/ my role was to help them have a clear picture of what we were going to do over the next hour clean the body , discuss if there was family that wanted to come in . ...if they wanted a chaplain. call the funeral home. It seem silly because we know the procedure and most families had chosen a funeral home ect........but a lot of families are stressing and trying to remember what they have to do. they were often so relieved to calmly review what the next step were and what i was doing and just know that for tonight, they got a few minutes to just greive. the funeral homes we worked with also did a great job even in the middle of the night of coming in and sitting down and talking with them. During this time people often reflect on their loved one and i listened. Sometimes If i had a chance to interact with the deceased i would mention something i had appreciated about them, whether it be their humor or their strength.

seanynjboy, BSN · Apr 20, 2013

I just wanted to say that I really enjoyed reading this thread. I worked in Hospice as a secretary before I became a nurse and I worked with some amazing people and had a really good 3 week hospice rotation. I definitely see working in hospice in my future.