6 Strategies to Help you Cope after Losing a Patient

**St. Scholastica**

The best nurses are compassionate and empathetic by nature, so it's no surprise that emotional exhaustion is one of the primary causes of "nurse burnout" - a term used to encompass the physical, mental and emotional fatigue nurses can experience after hardships on the job. This can cause some nurses to disengage, dulling their emotional responses to traumatic encounters.*

"The loss of a patient, no matter the circumstances, never gets easier," shares Angela Puleo, clinical director of Home Health Services at Always Best Care Home Health Cleveland South. "You may feel a sense of relief for the individual who you watched suffering before death, you may experience shock because you just assisted the person to the restroom and had a pleasant conversation, or it may be disbelief because the patient just arrived on your unit and you were not even given a chance to care for them."

As varied as the experiences of losing a patient can be, so too are the recovery processes, which can look different for every nurse. With that in mind, we spoke with a handful of nursing professionals to learn their best tips for overcoming the grief that accompanies such loss. Their advice may help you determine the best coping strategy for you.

6 ways to help you deal with a patient's death

1. Resist the urge to bottle your emotions

"Like many clinicians, I find that I detach myself from the situation at hand within the moment and later process it privately," says Kathy Kump, director of nursing at Ottawa University. For some, however, detaching from the moment can lead to unwanted disengagement.

"Parents and families want to know that you're human," suggests Trish Ringley, neonatal ICU nurse. "I have had parents say it brings them so much comfort, not feeling as if they're all alone in their grief when the people caring for their dying baby are tender and caring, when they are clearly saddened by the grief." She warns against keeping your human emotions locked in, adding that some may actually find it cathartic to express them in the moment.

2. Focus on the patient's loved ones

If you, like Kump, are more productive in grieving on your own after the fact, it can be helpful to turn your focus to the patient's loved ones. "Supporting the family in their time of need gives the nurse a sense of purpose," explains Susan Tromp, practicing BSN in the Medical Intensive Care Unit at Good Samaritan Hospital Medical Center in New York.

One of the cornerstones of holistic nursing practice is looking at the whole person, not just their illness or disease, according to Dr. Julie Anderson, dean of nursing at The College of St. Scholastica in Duluth, Minn. This includes considering the patient's loved ones every step of the way - especially in the event of a patient death.

3. Consider professional or spiritual guidance

"Having pastoral care involved can help the family and the RNs feel a sense of peace that their loved ones are no longer suffering," Tromp offers.

But it's important to note that seeking spiritual guidance doesn't always have to translate to inviting a religious leader to offer assistance. While this may be the most effective option for some, there are other avenues to explore. Kump, for example, has at times wandered into the hospital chapel to simply sit alone and cry.

"Personally, I find meditation during the experience and after the patient's death helps me get a calm sense of perspective about the bigger picture - of life, of my job, of my family and of the families I work with," Ringley says.

If the patient death is unexpected or unusual, nurses may be left with feelings of inadequacy or guilt, Anderson adds. In cases like these, she suggests utilizing the resources made available to you on the job, including a Critical Incident Debriefing Team, nursing peers, the facility's social work department, and chaplaincy.

4. Lean on your coworkers

If anyone can truly identify with the tough emotions of losing a patient, your coworkers can. Not only do they know you personally, but they know the ins and outs of your job. "Turning to coworkers for emotional support is most important because of the mutual understanding of loss that RNs feel," Tromp explains.

Discussing a tough patient loss with your peers can help you externally process the emotions you're feeling - especially if you're not comfortable expressing such emotions in front of a patient's loved ones. "It's incredibly difficult to face death repeatedly while at the same time remaining open to grief and sadness," Ringley adds, touching on the complexity of these emotions and the importance of expressing them to a close confidante. Grief that is suppressed, she says, can end up creating distance between the nurse and future patients.

"Providing nurses with the ability to reflect with their peers after the loss of a patient can not only provide the emotional support necessary to go home and get the needed rest after a tragic loss, but also the ability to clock in for another shift," Puleo says.

5. Find ways to honor the patient in memoriam

For some, simply processing the grief isn't enough. If you're the type who feels the need to do something, it can be helpful to identify ways to physically honor the patient's life. "Find time to respect the memory of the patient," suggests Sara Mosher, owner of Patient+Family Care.

Mosher offers a few ideas: take a moment of silence, find time to be alone and pray, make a donation to a charity in the patient's name or, if invited by the family, opt to attend the patient's memorial services. "One 'living' tribute to someone who has passed is to plant a tree in a place that is meaningful for the individual," Anderson suggests, "such as a favorite park or school."

6. Remind yourself of the passion that drives your profession

One of the most helpful antidotes to the deep levels of grief that can accompany the death of a patient is to remind yourself of the reason you chose to become a nurse in the first place. Focusing on the passion that fuels your professional life each day can help you pick yourself up and move forward.

"One of the most beautiful rewards of being a nurse is to witness the sheer rawness and true vulnerability of the human experience," Kump says. "Each individual has their own unique journey and having the privilege to participate in these incredible moments in a patient's life, from birth to death, is without a doubt one of the most humbling wonderments in a nurse's own life."

"It is truly an honor to provide care to a dying patient. Each experience is unique and changes you as a nurse and an individual in meaningful and positive ways," Anderson adds.

How do you pick yourself back up?

There is no cure-all when it comes to grieving a patient's death. But these tips from veteran nurses may help you cope next time you encounter a tough loss on the job. The most important thing is to figure out what works for you so you can pick yourself back up and continue doing the job you love.

"I think it's safe to say that any person who deals with the delicacy of human life in their career has found that the only way to get through it is to continue to go on and have hope that the next case, the next patient, the next victim they care for will not yield the same results," Kump says.

Do you have your own coping strategies to add to this list? How do you allow yourself time to grieve while still going on to pursue the true passion that drives your nursing career? Share your experiences in the comments below to help build up and strengthen your nursing community!

*Source: National Nurses United article: "Beating the burnout: Nurses struggle with physical, mental and emotional exhaustion at work"

TheCommuter, BSN, RN · Jan 26, 2017

I suppose I am somewhat detached on an emotional level. However, in 11 years of nursing, none of my patients' deaths have affected me that adversely.

I often use intellectualization as a coping mechanism. I also do not become close enough to patients to feel a sense of loss when they die. Moreover, the environments where I have worked (LTC, physical rehab, case management) attract older patients who may already have reached the end of life, so death is not totally unexpected.

On the other hand, the death(s) in my personal life (read: family and friends) are the ones that have an impact on me.

**traumaRUs, MSN, APRN** · Jan 26, 2017

My first pediatric full arrest stays with me to this day - it was in July 1996, I was on orientation in a level one trauma center and we got word that a 4 y/o girl was coming in via EMS in full arrest. My preceptor tapped me on the shoulder and said "we will take this" and off we went to the trauma room. The little girl had been tortured for 90 minutes before dying. To this day, it makes me so very sad to know what that child endured. I won't put any more details out but I remember her name to this day. I spoke with the nurse that was my preceptor recently (we have both moved on to APRN roles) and she too remembers this little one. The paramedic that transported this little girl to our hospital has also moved on to an APRN role and she too remembers this....

It very much affected my practice to this day - it made me more aware of how incredibly frail and fragile we are and how we must always protect our little ones.

We did a critical incident stress debriefing afterwards which really helped us to process this horrendous event. As I was on orientation at the time, I wasn't call to testify at the trial but my preceptor was and she said it was just another insult for her emotions.

Thanks.

6 Strategies to Help you Cope after Losing a Patient

6 ways to help you deal with a patient's death

1. Resist the urge to bottle your emotions

2. Focus on the patient's loved ones

3. Consider professional or spiritual guidance

4. Lean on your coworkers

5. Find ways to honor the patient in memoriam

6. Remind yourself of the passion that drives your profession

How do you pick yourself back up?

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