Suggestions for Coping with Pt. Death

hospicenurse · Nov 2, 2004

I am a nursing student participating in a group project researching ways nursing staff/health care professionals deal with the loss of a patient. Are there any rituals you participate in as a unit or individually to acknowledge the death of a patient? How does participating in a ritual help you cope with the death of a patient more easily? I would appreciate any input!
Thanks, Alissa

At my hospice we are given the freedom to attend the funeral if we wish. I find that there are select patient's whose funerals I want to attend - usually those who I feel especially close to. Also, we often make a followup bereavement visit to families, but again, this is voluntary not mandatory. Sometimes just a followup phone call is the most appropriate action. I consider all of these things part of the ritual of death. They help me first of all by allowing me to say goodbye - letting go. They also help me because it has a great impact on the family - allows them to express appreciation/say goodbye/clear up any misunderstandings, etc. This is vital not only for their grief process, but for goodwill created for myself and my agency. I work in the small community where I was born and raised - and if things don't go well, my Mom might just get a phone call (in case you are wondering I'm 50, Mom & Dad in their 70's, but do things ever change? :chuckle )

leslie :-D · Nov 2, 2004

i don't have any rituals.

if there are consistent problems dealing with a patient's death and you are a hospice nurse, then i would reconsider another specialty.

i have attended several wakes/funerals of my patients but do not consider it ritualistic.

i do have 'rituals', or better put, my own consistent methods of ensuring a peaceful death; if it is peaceful then there are no problems.

if it is not peaceful, then by golly, you think long and hard on what can be done the next time to prevent an undesirable passing.

i remember one time as a student nurse, i witnessed a bunch of staff standing around a patient's bed (they didn't even know him but word spread that death was imminent) all holding hands as his death approached.

to this day i still have ambivalent feelings about what i witnessed. perhaps they thought that to be a ritual to be used so the pt would not be alone (no family around); on the other hand i found it to be forced and unnatural. as soon as he died, they quickly left and did their thing.

i hope i'm understanding your question.....

leslie

hospicenurse · Nov 3, 2004

i have attended several wakes/funerals of my patients but do not consider it ritualistic.
i do have 'rituals', or better put, my own consistent methods of ensuring a peaceful death; if it is peaceful then there are no problems.
i hope i'm understanding your question.....
leslie

I may not have understood the questions either. On rereading it seems it's more about how the nurses cope, and my responses are more about what I do for families, not for myself.

On a personal level I always thought I had no need to follow up with 99% of my families. I felt satisfied that my job was done well and I seldom had the need to talk with them after the patient dies. But what I have found over the years is that caregivers have a strong need to touch base with "their nurse" one more time, especially if I didn't pronounce. They need to tell the story of what happened. They need to hear that they did the right thing. They need to hear that the last dose of morphine, or turning him over, or slipping in that last sip of water wasn't the thing that killed him. They need to thank me and all of the staff. They need to say goodbye. This, I believe, is a part of the ritual of death. Or maybe better said they are the rituals that start the process of grief. Funerals and memorials or any kind of gathering of friends/family are another part of the ritual. I take part in them when time allows - they aren't a priority for me. Being non-theistic, I don't get any solace or spiritual comfort from the ceremony, nor do I need any. I make an appearance and sign the book like most people do at funerals.

I have changed since I became a hospice nurse, and some of that change has helped me to cope with constant exposure to death and grief. First of all, I became the best hospice nurse I could be - there are no do-overs, as we all know. I nurtured my instinct to protect my personal time and space - I don't take calls on my time off, no one gets my home number. I gave myself plenty of free time - fortunately easy to do since I don't have small children or lots of social activities. I am an introvert by nature, so I need to veg out to regain energy. I know myself well, and I take care of myself. I hold myself accountable for what I do. It works for me.

And....I realized over time, just in the past couple of years, that the followup I do with families also helps me. It's my job to help them through the death, and I find my job is complete once we have said goodbye and I know they are on the next part of their journey. I report off to the bereavement coordinator, and then I feel the sense of closure that, apparently, I need.

Gail

leslie :-D · Nov 3, 2004

hi gail,

perhaps rituals is the wrong terminology.

when i go to wakes or funerals (usually wakes), it is soley out of respect for the family; i stay 10 minutes and leave....but it means the world for them to see your face. and it's not for all patients but being a hospice nurse for close to 9 yrs, i've had my share.

and absolutely, our free time is our own; until you walk in our shoes, the potential for burnout is incredibly high.

and lastly, closure for all involved is most important which to this day, i have problems with if the patient did not pass peacefully.

i wish i could just rationalize that they no longer suffer but there are those lingering visuals of those you just couldn't help.

you sound like a wonderful nurse.

leslie

Katillac, RN · Nov 5, 2004

I am a nursing student participating in a group project researching ways nursing staff/health care professionals deal with the loss of a patient. Are there any rituals you participate in as a unit or individually to acknowledge the death of a patient? How does participating in a ritual help you cope with the death of a patient more easily? I would appreciate any input!
Thanks, Alissa

My hospice holds periodic simple memorial services, to which all staff are invited. Staff stand and one by one the names of the deceased are said aloud, and after each name is spoken a beautiful gong is struck and we light a candle and float it in a bowl of water. Then we simply sit and share memories. This ritual is very important to me at times, not so important at others.

I find the idea that hospice nurses should have no consistent "problems" dealing with patient deaths strange. I grieve the death of my patients as I grieve other losses, sometimes more and sometimes less. When the day comes that I don't feel a need to mark the life and passing of these folks in some special way, THAT'S when I'll reconsider my specialty, because it will mean to me that my heart is no longer in my work.

leslie :-D · Nov 5, 2004

I find the idea that hospice nurses should have no consistent "problems" dealing with patient deaths strange. I grieve the death of my patients as I grieve other losses, sometimes more and sometimes less. When the day comes that I don't feel a need to mark the life and passing of these folks in some special way, THAT'S when I'll reconsider my specialty, because it will mean to me that my heart is no longer in my work.

obviously you're referencing my remark so please allow me to expound.

my entire being as a hospice nurse is to ensure that my patients pass peacefully physically, mentally, spiritually, emotionally. if i have accomplished that, then no, i do not grieve. perhaps it's a reflection of my own spirituality. furthermore, i do feel saddened (sometimes) but that is not the same as grieving. i also do not agree that grieving 'marks the life and passing of these folks'. to be able to transition a person from here to there without pain or fear is what i consider to be one of the more major accomplishments and something i hold extremely close to my heart.

leslie

DMB FAN2 · Nov 6, 2004

I have been a Hospice Nurse for 5 years now. In our Hospice, we are able to attend the funeral of our patients if we wish. I do not attend every funeral- I find it to be too hard on my spirit.....but if I have a pt that I have become close to, or a family that I felt closer to, I will attend for my own closure. In my heart, I feel that my goodbye has been already said to that pt before they died- because often I am there at the last few hours of life, and I quietly say my goodbyes then.....

And as for the subject of the painless, non-suffering deaths- we wish that they could all go that way- but the reality is that there will be some that no matter what we do, or what drugs we use, or spiritual help we get, that will die in pain and suffer......that is the very hardest thing to bear....and to forget.

:kiss

leslie :-D · Nov 6, 2004

And as for the subject of the painless, non-suffering deaths- we wish that they could all go that way- but the reality is that there will be some that no matter what we do, or what drugs we use, or spiritual help we get, that will die in pain and suffer......that is the very hardest thing to bear....and to forget.
:kiss

my sentiments exactly.

those are the ones that you grieve and struggle with, and that linger....

for some reason there are always those patients that no interventions help. and that's why i'm all for heavy heavy sedation for these types.

leslie

jerseyRN · Nov 7, 2004

my sentiments exactly.
those are the ones that you grieve and struggle with, and that linger....
for some reason there are always those patients that no interventions help. and that's why i'm all for heavy heavy sedation for these types.
leslie

And even with heavy sedation, sometimes, some people, no matter what do, have hard deaths. And you're right, these are the cases that you replay in your head when you lie in bed at night. It's these experiences that remind us how little control we really have in this life. Maybe that's why these cases so distress us.

Anyway, about rituals to cope with loss: Sometimes going to the wake helps. Saying goodbye to the family is sometimes the hardest part for me, though a necessary part of the process. There's a few families I've stayed in touch with long after the death with an occasional call or card.

Also helpful is having colleagues to talk to.

DMB FAN2 · Nov 7, 2004

Yes Leslie......I do agree with you....I had a young man, in his early 40's who died a terrible death of colon Ca.....and this was very hard for me, it was this time of the year too....and when the leaves change it reminds me of him every time.....I left his home crying so many times in the car......he had such horrible symptoms...no matter what I tried... poor guy had a very hard death:crying2:

He will always be in my heart....on the night he was dying...his mother called the on call nurse...and asked specifically for me to come.....so I went to do the post mortem care for them....at least he was finally out of pain

I am sorry to ramble on...but this helps me somehow.....thanks for listening :kiss

Ashera, LPN · Dec 4, 2004

to be able to transition a person from here to there without pain or fear is what i consider to be one of the more major accomplishments and something i hold extremely close to my heart.

leslie

You are oh-so-right, Leslie. People ask me how I can do this type of nursing? I answer "How can I not?" It is who I am - and I love it. No, it is not always - if ever - 'easy' to do any type of nursing - Nursing is hard work - but to be part of this most special part of someone's life - to help getting them, as you put - from here to there - and to have some effect on easing their pain, either physical, emotional or spiritual - then I've done a good job - and I acknowledge that to myself. I am quiet - I am respectful of my ability - and I take a deep breath and go right back in. I receive far more than I give. For me - it's just about being human and touching another. It's just life - and I think it is beautiful to be able to share. I sometimes need some quiet and reflective 'me' time - to regain focus - but I do not grieve. I celebrate the fact I was somehow able to help. Obviously there are those deaths that are horrible no matter what we do. But we keep doing the best we can. And in that, we can know we make a difference.