So, when a patient says "I'm going to die"...

[blackIrish]

This got me thinking-from the superstition thread-

I ALWAYS believe them. But, what do you say?

I was with one patient quickly circling the drain- V-tach, torsades, and back again a few times. She was telling us "I am dying" and another nurse there was saying "NO your not, quit saying that" Almost in an condescending voice. And guess what- I think she was going to die. We transferred her out of there ASAP and I don't know what became of her.

But, what is the best thing to say? Or should you say anything?

[coffeeaddict, LPN, LVN]

I always ask what makes them think that? Sometimes it is because of a fear they need to voice or possible something they over heard us say. It helps to know why they are thinking that. Often they are right, but I work a ICU so yes they are pretty sick. To make myself feel better, I tell them that we are doing everything we can for them.

[leslie :-D]

often, the pts are correct in their assessments....but nevertheless, those type statements are generally made out of fear.

it depends on the acuity of any given situation: whether the statement is made when one is crashing or is it a more gradual downfall that invites reflection?

if it's acute and urgent, i usually tell them not to give up, "as we are not giving up on you".

if it's stated in a more casual tone but one of simple observation, i will pursue with "what makes you think that"/"tell me why you feel this way". this type of conversation can open up many windows, re: current code status or even hospice.

leslie

[Megsd, BSN, RN]

I have always been told that when a patient says they're going to die, to listen carefully because they are usually right. I have only experienced this type of patient assertion one time. I was a home health aide in an assisted living facility doing PM care with a very very anxious lady with some degree of dementia and expressive aphasia. She had been going into the nursing office all day and having the nurses take her pulse because she swore she was going to die. When I was with her she refused to put on her pajamas and slippers because she's going to die. I asked her why she felt that way, but she was unable to tell me why (lots of stuttering/stammering). She crawled into bed, I told the nurse that she thinks she's going to die, the nurse told me she'd keep an eye on her.

I went home that night and worried about her and wondered if she'd really be dead when I got to work the next morning. I had dreams about her dying. It was really over the top of me, I'll admit, but I was really worried!

I got to work the next morning and walked past the breakfast room, and there she was, happy as could be, chatting with the other residents.

She's still alive.

So... I dunno.

[RN BSN 2009]

Yes... I've found that if you say "Tell me..." to patients, sometimes they have a good reason to say why they are feeling that way. You never know if they were overhearing a doctor, but he was talking about another patient. Who knows!

[blackIrish]

Thanks for the replies. I know it is something we all experience.

I think I mean though-like when WE know it doesn't look good. They are scared and hell, so are we.

What can you/do you say to help comfort them? I don't want to lie and say "Oh, you'll be fine"

I think I like the "We're doing everything we can for you" response.

Thanks again and keep 'em coming!

[mom4josh]

I work on an oncology floor, and we also get hospice patients, so we have our share of dying patients here. A while back there was a man with cancer but we thought he had a fair amount of time left. One day, out of the blue, he said he was going to die that night. He called his family and everyone came from all over to see him and he said good-bye to everyone. His VS were good, so we just thought he was scared. About 1 a.m., however, the nurse came out and said that he had died... just like he said. We learned that night to always believe the patient. When they say that, it's usually a good time to find out if they want to be DNR!

[Soup Turtle]

I have always been told that when a patient says they're going to die, to listen carefully because they are usually right. I have only experienced this type of patient assertion one time. I was a home health aide in an assisted living facility doing PM care with a very very anxious lady with some degree of dementia and expressive aphasia. She had been going into the nursing office all day and having the nurses take her pulse because she swore she was going to die. When I was with her she refused to put on her pajamas and slippers because she's going to die. I asked her why she felt that way, but she was unable to tell me why (lots of stuttering/stammering). She crawled into bed, I told the nurse that she thinks she's going to die, the nurse told me she'd keep an eye on her.

I went home that night and worried about her and wondered if she'd really be dead when I got to work the next morning. I had dreams about her dying. It was really over the top of me, I'll admit, but I was really worried!

I got to work the next morning and walked past the breakfast room, and there she was, happy as could be, chatting with the other residents.

She's still alive.

So... I dunno.

:lol2: That's not the ending I was expecting!

[TazziRN, RN]

Depends on the situation. I've had pts come in rolling in pain and agitation because of traumatic bleeding somewhere: AAA, severe injury, etc. I mean, yelling and screaming "Oh my God, this hurts!! Help me!!" and so forth. Then they suddenly became calm and said "I'm going to die." Those pts make me jump and move even faster than I had been and I make sure the doc's right there with me, because those are the ones who really are about to die. I've only seen one of those pts survive.

The others ask/say it out of fear. Depending on the situation I will either ask them why they think that, or tell them I'm doing everything I can to prevent it.

[nurseangel47]

I've noted during many years of nursing to also believe those patients. They will usually present with feeling of "impending doom"....or at least that is what they referred to it during my course as a nursing student many many moons ago. Yes, I always listen to those pts. They mostly get a calm overtone after the initial panic is overcome. Always listen to your patient. Things go on inside of their bodies that even vital signs and monitoring equipment do not reveal until it is too late to save them...

[TazziRN, RN]

I've noted during many years of nursing to also believe those patients. They will usually present with feeling of "impending doom

I never thought I was going to die but I did have this kind of feeling when I was pregnant. I had an appt for a prenatal check and I was agitated. My doc kept asking me what was wrong and all I could tell him was "I just don't feel right. I don't know why." I spent the remainder of my pregnancy on bedrest with PIH. I had no symptoms that I knew of, I just didn't feel "right". Thank God I had a doc who listened to me rather than brushing me off.