Telling relatives the patient has died

[snoopy29]

Most shifts I have to tell unexpecting relatives that their loved ones have died. I believe that what we say and how we say it will potentially stay with those family members long after we have forgotten the patient so I would be really interested to hear any ideas as to how other nurses break the news, particularly when it's unexpected.

I always take a deep breath before I go into the room and remind myself that what I say is probably going to change the lives of the people waiting nervously in the room. Working in the emergency department the first time I will meet then is the time I will be giving the news. Sometimes I go in with a doctor, sometimes on my own. I always introduce myself and apologise for meeting them in the circumstances. I make sure I know my patients name - I know how awful that sounds but when an arrested patient arrives arrives in the ED they will be handed over as "59 year old male" followed by clinical information.

I check who I have in the room then I don't prevaricate I say "I'm afraid I have some really sad news for you, as you know Peter was very sick and despite our efforts he has died" Our doctors (in their one hour session on breaking news , bless them !!!!) get taught to empathy build by asking what has happened today but I don't do this as you see hope building in their eyes as they assume that the doctor would not be interested in taking a history if their relative was still alive. I always use the word died - not expired, or passed on. One new doctor I went in with said to the family of a young patient who had come off his motorbike that he had "gone to another room" the poor relatives mistakenly thought he meant he had gone to ICU so as you can imaging that took some untelling.

Then I expect the unexpected!!! think I have seen every emotional response going. Anger is common, at me, the pt for dying and at other relatives. Denial - one poor lady who had been married for many years just could not comprehend the bigness of what we were saying and kept repeating every few minutes "I'm sorry nurse why are we here, and has anyone seen my husband" It only really sunk in when I took her to see her husband. I have had relatives that refuse to accept the pt is dead and see them breathing and moving. I usually get them to touch there relative and when they feel the coldness it starts to sink in. I have had relatives that have sagged with relief telling me that the pt has been unwell or in pain for many years. I sometimes see acceptance and this always moves me - the 90year old man married for 50 plus years who says tears rolling down his cheeks "I knew she had gone, nurse what am I going to do without her"

If I am asked I will always say unless it is a blatant lie that I believe that their relative did not suffer and their death was peaceful.

If they ask me if I think their is an afterlife then I tend to ask them what they believe then says "then there's your answer."

I explain exactly why the police will attend and give them practical information backed up with written information and telephone numbers.

I make sure I answer or have the doctor answer any questions the family have. I would love to say that I have the luxury of time to sit with the family until they are ready to leave but the reality is that in the short time I am with the family work will have built up but I always make sure they know were to find me.

I would like to be able to have a few minutes to collect myself before I face the shop floor but it doesn't work like that and I still struggle coming away from distraught relatives to be confronted by Mr I've had far to much alcohol and am going to shout until someone fixes my poorly finger!!!

Please do not think I post the above as an example of how to break bad news my reason for posting is that I think it is a really important area for nurses and I would welcome other nurses tips and guidance.

[Tweety, BSN, RN]

Awesome.

It must be different here in the states because here MDs are the one's to tell family of unexpected deaths, in the ER, the OR or the floor.

If the death is expected, such as comfort measures for a dying patient, then I don't mind breaking the news. Otherwises, it's not really my job. I'll support them after the MD talks to them.

[LACA, BSN, LPN, RN]

When my grandmother passed away, the nurse called my mom's cell phone and said "Pull over to the side of the road. I'm calling to tell you that your mother has expired." REALLY? I wasn't aware that my grandmother was a carton of milk.

Another "gem"-- when my 11 week old son died, the ER doctor told me (AND I QUOTE) "There's no heartbeat, he's dead. If you want to leave him on the machines forever, you'll be the mother of a vegetable, But that's your call."

DESPISE that man with everything in me.

My son remained on lifesupport for 5 days, then we unhooked him and he passed away.

Those are classic examples of what NOT to say!

[MiahMSN, MSN, RN]

JessicaA, that is horrible. How heartless and tactless of both the nurse and especially the doctor. I'm sorry for your loss.

[HmarieD]

Awesome.

"It must be different here in the states because here MDs are the one's to tell family of unexpected deaths, in the ER, the OR or the floor."

I have never heard this. I have, unfortunately, been the bearer of this bad news on more than one occasion. Can you substantiate that?

[leslie :-D]

i always use the word died - not expired, or passed on.

i agree with this, and think it very important to use the word "died".

as americans, we tend to try and sugarcoat it by using other substitutes, but there isn't anything remotely as realistic, as "died".

if i am asked i will always say unless it is a blatant lie that i believe that their relative did not suffer and their death was peaceful.

even if it is a blatant lie, why not tell them they didn't suffer, that they died peacefully?

the only times i don't tell families that, is if there were witnesses that family may eventually talk to.

if they ask me if i think their is an afterlife then i tend to ask them what they believe then says "then there's your answer."

families ask me this all the time, and i can't help but respond with a resounding "oh, yes!"

i tell them that as a hospice nurse, i have witnessed so much spectacular phenomenon, that i could never believe otherwise.

even if they are staunch atheists, they cannot help but be comforted by my (genuine, heartfelt) response.

good thread, snoopy.

leslie

[PostOpPrincess, BSN, RN]

You have a good heart.

You definitely have your calling; keep it up.

[tiredstudentmom]

If one of my family members died, I would be HONORED to have you as their nurse...you have a lot of empathy and compassion for others, even if you can't always help the patients. Kudos to you! It's good to know that there are still people like you in the world.

[LACA, BSN, LPN, RN]

JessicaA, that is horrible. How heartless and tactless of both the nurse and especially the doctor. I'm sorry for your loss.

As for the nurse in my grandmother's case--I think she was telling my mom in the way she thought best...it just didn't seem that way at the time.

As for the doctor in my son's case--he was a heartless, terrible man. I have no respect for him and I will go to my grave with ill feelings towards him. He took a horrible time in my life and made it much worse.

As the OP said, how you tell a family WILL stick with them the rest of their lives. And they will dwell on it forever. When my oldest son was stillborn at 23 weeks, the doctor in that case was warm, compassionate, and did everything she could for us.

When my youngest son died at 11 weeks old, the doctor made it even worse.

How you tell someone makes a HUGE difference.

[leslie :-D]

As the OP said, how you tell a family WILL stick with them the rest of their lives. And they will dwell on it forever. When my oldest son was stillborn at 23 weeks, the doctor in that case was warm, compassionate, and did everything she could for us.

one time, i miscarried when i was 24 wks pregnant.

i knew i had miscarried, but the nurse came in (smacking her gum, btw) and casually said, "did you know you had a boy?"

whether she was right or wrong in telling me, i was horrified and cried even harder.

and when my 6yo dtr was killed, she had lived until she got to the hospital.

the er doctor came out and told me, "your dtr died...but i think that's a good thing. consider it a blessing".

he then quietly muttered, 'i'm sorry' and walked out.

survivors need to see that we drs and nurses, grieve with them, for their loss.

it's what connects us as humans.

leslie

[Maeggles]

I don't understand how these 'professionals' could be so callous! I could understand not knowing what to say, but really?

And to the OP, thanks for this thread. As a nursing student, I love hearing the right things to say.

[snoopy29]

if i am asked i will always say unless it is a blatant lie that i believe that their relative did not suffer and their death was peaceful.

even if it is a blatant lie, why not tell them they didn't suffer, that they died peacefully?

the only times i don't tell families that, is if there were witnesses that family may eventually talk to.

the only time i won't lie is if i think i am going to be caught out and then lose the families trust. very rarely when some people die they suffer at the end and still look like they are suffering in death. i know that when the family come to see their relative they are going to see that suffering so i would not feel able to say they did not suffer, what i would say is that that they died without pain, not alone and just went to sleep. that said as a hospice nurse leslie you will be so much more experienced and knowledgable than me so i absulutely take on board what you say and really thankyou for your words.

jessicaa my heart really goes out to you but i wanted to say thankyou it must have opened old wounds to post about your horrific experience but it's because of people like you being brave enough to share that we learn.