Suggestions for Coping with Pt. Death

jerseyRN · 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.
Wow, my thoughts exactly, beautifully stated. Thanks.

mollie · Dec 19, 2004

I don't agree that having problems with how to deal with death disqualifies one as a hospice nurse. We are all going to die some day and we must come to terms with how to deal with it. If caregivers, nurses, ect, find rituals helpful as a coping skill, that is excellent. If the nurses and staff want to gather around a dying patient and honor his passing, this is humanity at its best. And then to be able to leave and continue on with other tasks at hand shows very healthy coping mechanisms in place. It is a gift to be able to "feel" both the good and the bad. And to embrace anothers heartache and then to let it go. This is what this forum is helping me do. Finding how others cope, being able to share doubts and fears without fear of being judged as not good enough, is what I need from fellow nurses and for the most part what I find here.

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

Katillac, RN · Dec 19, 2004

I don't agree that having problems with how to deal with death disqualifies one as a hospice nurse. We are all going to die some day and we must come to terms with how to deal with it. If caregivers, nurses, ect, find rituals helpful as a coping skill, that is excellent. If the nurses and staff want to gather around a dying patient and honor his passing, this is humanity at its best. And then to be able to leave and continue on with other tasks at hand shows very healthy coping mechanisms in place. It is a gift to be able to "feel" both the good and the bad. And to embrace anothers heartache and then to let it go. This is what this forum is helping me do. Finding how others cope, being able to share doubts and fears without fear of being judged as not good enough, is what I need from fellow nurses and for the most part what I find here.

Mollie,

Fortunately, there is room for us to approach our practice as hospice nurses in many ways. Some of us grieve when our patients die, some don't. Some have rituals they enter into for closure and other reasons, for some these aren't necessary. For some, having helped facilitate a peaceful death is sufficient to effect closure, for others it's not the case. None of those differences should prevent us from being good hospice nurses.

Now this is referring ONLY TO ME, and not meant to imply anyone else should be or feel differently, but when I no longer feel a sense of loss (which I then grieve) when my patients die, I will take a look at how and why my emotional investment has changed. The grief I feel isn't a problem, it's something I work through, and when I having difficulty resolving my grief I talk with one of our wonderful social workers, our spiritual care coordinator or the bereavement coordinator.

Some of the deaths which I have struggled to come to terms with have been, from a clinical perspective, peaceful, but for me that isn't always enough to cause me to immediately let go of my attachment. I'm not perfect, and sometimes my struggle is about the way in which I have reacted to the situation, for example, working to continue to provide good care to a patient who had a history of abusing his family and was abusive to hospice staff as well. When my patients are young, especially with young families, I often do anticipatory grieving with the patient as the loss of promise and future are processed. I complete that work after the patient's death. But that's just my way of dealing with it, again, not meant to imply others should be like me.

I hope you'll be able to take advantage of the wide variety of opinions and techniques offered here. Some folks are very passionate about their views, and I hope that doesn't make you see the forums as any less valuable as a resource.

lvngme · Dec 22, 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

The Hospice company I work for have a Nurse Support Group meeting every week or every other week so the nurses can discuss these issues. They also have a memorial for the families of the deceased pts. every six months, the newly deceased, and the nurses are encouraged to attend and meet with those family members. Hopes this helps.

zacsmimi · Jan 5, 2005

Hospice recently contracted with my LTC facility, and I have had the opportunity to watch these wonderful people work, and learn from them... I have been thinking about joining them myself.

Over this Christmas break, we have lost 8 patients. I pronounced 6 of them. This is also the first anniversary of my boyfriends mom's death, and I was very very involved in that process - and it was the first death I ever experienced of someone close to me.

Yesterday the patient didnt pass well. I cant really explain it, but spiritually something was just not right. No family there... I sat with this 99 year old woman, kept her as comfortable as I could, reassured her...she struggled. I know I did all I could for her. I wasnt particularly close to her. I know she was estranged from her family - who knows why, and I dont really think I care... I dont really feel loss... sorry she suffered, but she was oh so ready to die.

After she passed, I found myself feeling hollow. Disconnected. Overwhelmed. I then proceeded to work a double shift.

Today Im wandering around at home in my bathrobe and can't seem to focus.

There are 2 funerals today. I feel like I should go but I dont want to.

Hospice is planning a coping thing for us since the loss has been so great in such a short time, and I will go... but Im looking for help to cope now.

How do I recharge? And, God forbid - how do I deal if anyone else passes this week? (We have a flu outbreak on my floor)...

Meanwhile, my own folks are in their 80s and moms health isnt great.. I need to be as prepared as I can be... and I feel less and less able to deal with HER...

I thought I was good at this. I AM good at this. I know I make a difference. I know I can touch famililes and patients and I am comfortable doing that. This feeling of being lost is a new one and confuses me. Can anyone shed some light on this?

Ashera, LPN · Jan 5, 2005

i thought i was good at this. i am good at this. i know i make a difference. i know i can touch famililes and patients and i am comfortable doing that. this feeling of being lost is a new one and confuses me. can anyone shed some light on this?

you are good at this! you touched a life at the most intimate time - and with this 99 year old...you were able to be with her when no one else was there, and she chose that time to let go. for her to let you share that part - paid you an incredible compliment. her struggle - or what did not seem to go right - was her's alone - but you shared your being there and that was a gift you gave her.

i know what you are feeling - and i'm not sure i can define it - i was there over new year's/eve and day - when we had 4 deaths in a row. some were easy - some left me feeling empty and drained and oh-so-tired. like i was depleted of energy and had not been refilled. i recognize this in myself as needing to disconnect for a short while. long sleep does it for me - you are tired, to say the least. acknowledge this - you need to do something for you - not for anyone else. you need to recharge - and it won't take long - but don't be a hero and charge right back in. distance yourself a bit emotionally if you have to be physically there again - it will all come back and you will continue to do what you do best - and that is touch the lives of those special people that let you close enough to be a part of their ending. it's a gift you have.

about your parents - everyday when i'm at work - and i have a pt die that is close to my mom's age - it hits me in different ways. i get irritated sometimes with her when she is not taking as good a care as she can - when i have a pt die decades younger than her. and sometimes it makes me realize how little we know about 'when' death will happen. but it will - and does. when that time comes for my mom - i will be her daughter and turn off the nurse part. i will let others do that. it won't be easy - and i think as nurses we 'feel' differently than others - but you will do fine then too.

i think the key is to feel what you are feeling - acknowledge that you hurt - you get tired - you get angry - and because you are able to experience all these emotions - know that it makes you a better nurse. you accept that you are human -

i rambled on here - sorry - but know that you have a bunch of nurses here that are sending you warm hugs and thanking you for caring enough to really feel - and that you are very special!

zacsmimi · Jan 7, 2005

i thought i was good at this. i am good at this. i know i make a difference. i know i can touch famililes and patients and i am comfortable doing that. this feeling of being lost is a new one and confuses me. can anyone shed some light on this?

you are good at this! you touched a life at the most intimate time - and with this 99 year old...you were able to be with her when no one else was there, and she chose that time to let go. for her to let you share that part - paid you an incredible compliment. her struggle - or what did not seem to go right - was her's alone - but you shared your being there and that was a gift you gave her.

i know what you are feeling - and i'm not sure i can define it - i was there over new year's/eve and day - when we had 4 deaths in a row. some were easy - some left me feeling empty and drained and oh-so-tired. like i was depleted of energy and had not been refilled. i recognize this in myself as needing to disconnect for a short while. long sleep does it for me - you are tired, to say the least. acknowledge this - you need to do something for you - not for anyone else. you need to recharge - and it won't take long - but don't be a hero and charge right back in. distance yourself a bit emotionally if you have to be physically there again - it will all come back and you will continue to do what you do best - and that is touch the lives of those special people that let you close enough to be a part of their ending. it's a gift you have.

about your parents - everyday when i'm at work - and i have a pt die that is close to my mom's age - it hits me in different ways. i get irritated sometimes with her when she is not taking as good a care as she can - when i have a pt die decades younger than her. and sometimes it makes me realize how little we know about 'when' death will happen. but it will - and does. when that time comes for my mom - i will be her daughter and turn off the nurse part. i will let others do that. it won't be easy - and i think as nurses we 'feel' differently than others - but you will do fine then too.

i think the key is to feel what you are feeling - acknowledge that you hurt - you get tired - you get angry - and because you are able to experience all these emotions - know that it makes you a better nurse. you accept that you are human -

i rambled on here - sorry - but know that you have a bunch of nurses here that are sending you warm hugs and thanking you for caring enough to really feel - and that you are very special!

thank you thank you thank you