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.
My grandmother recently passed and a nurse asked my family a question I had never thought of before, but occasionally asked myself on behalf of my own patients. "What type of person was your grandmother, what did she do, things we would remember about her etc. Made me feel like she really cared as she stood there and listened to every word my family had to say. There r good nurses out there, thank god!
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!
My God! I am so sorry you heard about your sweet baby that way! It's all I can do right now to not cry ... my condolences. What an *******!
Ya know, I do not support what the doctor said WHAT SO EVER. It was very heartless. But I know Critical Care doctors see that happen every day so they are made to become numb to the situation more than less. Of course he should have worded it all differently but in all actuality he probably had no empathy seeing it everyday. My little sister passes of SIDS at the babysitters house. We all rushed to the hospital and the doctor just left her laying there on the table WITHOUT EVEN COVERING HER UP FOR SAKE OF MY MOTHER. Losing someone is the hardest feeling ever. Especially a young child. I think it is horrible how numb some docs actually have become, but that is the sad reality of SOME people.
I too miscarried last year actually. My mother has horrible fertility issues and has caused her tons of heartache over the years. ( I am sure any woman on here who has fertility issues knows what I am talking about.) Well last Feb, my fiance and I found out we were 2 months pregnant. The doctor came in and said " I am not sure weather this is good news or bad news, but you are pregnant, about 2 months" .....then after she talked with my mother fiance and I about how happy everybody was she decided to then say...." but you are losing it!" I NEVER TOOK ANYTHING SO HARD. She could have said it too us when she 1st told us. .......................
"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?
You've never heard of a doctor telling a person that their loved one has died?? What about a patient that dies on the OR table, the nurse has to be the one to tell the family, not the surgeon? Or an ER patient that was brought in and unexpectedly died in the ER? The nurse has to be the one to tell the family?
There have been many times I've called a family and told them their loved one's passed, but this has always been an expected DNR patient.
I think it is very disrespectful to say the word DIED... it is a euphamism that we as nurses are told to avoid! That is why we used sugar coated words such at passed away and expired. Families take them alot less personal. Just saying he she it DIED just puts a horrible cherry on the cake of them no longer having that loved one.
Specializes in Flight, ER, Transport, ICU/Critical Care.
:angel:
I am ALWAYS mindful that what and how I interact with families and survivors will be remembered FOREVER. Whatever life situation they walked in with - will change from the news that I have had to deliver quite often.
What really breaks pieces of me - is that I may not remember all the cases, but they will NEVER forget. I have a few rules.
I may not know the answer to everything - I may not know what is right/wrong - but, I do KNOW what honesty, compassion and kindness will add. I am deliberate and as exact as I can be - I also give them my card/contact info and "if after they have had time and need answers, I'll assist them as best I can - anytime, any question". For this reason - I am brief in the initial notification.
I introduce myself - team.
I tell them how I came to care for their loved ones. I ask what they know and if there are others that should be here (frantic family trying to arrive, clergy, etc).
I then give brief (and kind) description of the incident/illness and the measures taken and finally, I let them know that despite everything - we were unable to ________ and _______ then died. I recognize the nature of the death (sudden, shock, expected, etc). I then give them what they ask for (as much as possible) or I offer for them to spend a few moments alone or I will remain. I offer my sympathy and tell them that I am available to help them should a question arise. I may hug back if hugged - and I have wept with families.
In short - it is a tough duty. I always stop and MAKE CERTAIN that I do it as compassionately as possible.
It is the tough stuff. Be kind, be honest and offer comfort - it is the very LAST part of the care that we provide the patient who died - make it a task that you will be remembered for care you showed - not show any carelessness - ever.
Specializes in Emergency Dept. Trauma. Pediatrics.
To the OP, I cried reading your post, although some might not always see it right away or ever, you have been a great service to them even being the bearer of bad news, you deliver it very gracefully and leaving their family with some peace and the pt with dignity.
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
Leslie, it breaks my heart to read this. I am so sorry for all you have been through.
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!
Same as with Leslie, very sorry for what you have gone through.
Ya know, I do not support what the doctor said WHAT SO EVER. It was very heartless. But I know Critical Care doctors see that happen every day so they are made to become numb to the situation more than less. Of course he should have worded it all differently but in all actuality he probably had no empathy seeing it everyday. My little sister passes of SIDS at the babysitters house. We all rushed to the hospital and the doctor just left her laying there on the table WITHOUT EVEN COVERING HER UP FOR SAKE OF MY MOTHER. Losing someone is the hardest feeling ever. Especially a young child. I think it is horrible how numb some docs actually have become, but that is the sad reality of SOME people.
If one ever gets to the point where it's nothing but another dead person and they look at is as such and can't see their was a person behind the body, they need to exit the profession. The behavior you described is absolutely appalling.
I think it is very disrespectful to say the word DIED... it is a euphamism that we as nurses are told to avoid! That is why we used sugar coated words such at passed away and expired. Families take them alot less personal. Just saying he she it DIED just puts a horrible cherry on the cake of them no longer having that loved one.
I am currently in nursing school, we are taught NOT to sugar coat and to say the person Died because patients end up having a harder time accepting what has happened when you don't. One nurse said Passed on, the family replied "Passed on to where, did they get transferred to another hospital" Another person though it meant their family was stable enough the Doc passed on to a new patient. When someones loved ones are injured or sick and in the hospital they aren't always thinking clearly and can easily mistake what you are saying when you are trying to beat around the bush giving them false hope. You can't really mistake the person has DIED.
Something I would say, don't tell someone so and so had died and walk away, take some time out and be there for them especially if they have no support their and for pete's sake don't ever tell someone while driving in a car or on the phone if the situation was unexpected and the people are local.
"I think it is very disrespectful to say the word DIED..."
I am sorry you find using the word died disrespectful but over many years I have learnt that when relatives are distressed and frightened they can only absorb the bare minimum of information and died leaves no room for doubt. It is a cold hard statement but I think the way it is said matters more.
There is nothing worse than leaving relatives confused or in doubt and many of the gentler terms can create that doubt and I don't think that is fair.
I would however welcome other people's views as I am always willing to learn and change
I think it is very disrespectful to say the word DIED... it is a euphamism that we as nurses are told to avoid! That is why we used sugar coated words such at passed away and expired. Families take them alot less personal. Just saying he she it DIED just puts a horrible cherry on the cake of them no longer having that loved one.
italy, i do understand your reservations.
when we were almost done in school, we had to do a presentation on the specialty we were considering pursuing when we graduated.
i shadowed a hospice nurse for a week.
every pt she saw, she would make a point to fit in the conversation (to the effect of), "you may as well, since you're dying".
i would cringe and feel sickened, since i thought it was horrifically harsh and insensitive.
(so many pts would respond with, "i don't feel like i'm dying"- heartbreaking)
from that point on, i made a conscious decision to stay TRUE to the hospice philosophy, by focusing on their LIFE while preparing for death.
the only times i use "died", is when they have physically DIED.
otherwise, in the shock and devastation of the news, you'd be surprised how many survivors can misunderstand "passed away" or "expired".
you still hear, "what are you saying, what are you telling me?"
when you say "died", there are no misunderstandings.
however, you can still deliver the news in a highly gentle, sensitive manner.
it's not disrespectful at all.
we as a society, just resist death, even when dying.
.thumb.jpg.5aa4d55557c0228e31b94de19666bbbb.jpg){kind=small}
Christina-09RN
10 Posts
My grandmother recently passed and a nurse asked my family a question I had never thought of before, but occasionally asked myself on behalf of my own patients. "What type of person was your grandmother, what did she do, things we would remember about her etc. Made me feel like she really cared as she stood there and listened to every word my family had to say. There r good nurses out there, thank god!