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.
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.
It's not saying the word "died" that puts the "horrible cherry on top"...it's the fact that the patient DID die.
I don't understand how "died" is a euphemism? Other terms, such as passed away, expired, etc, are euphemisms. "Died" is factual, and people can misinterpret any other word/phrasing used.
I feel sorry for the loss you posted about...but am not understanding this particular post.
I see everybodys points on this thread. I do see the professional point of needing to say DIED for the sake of not sugar coating. I guess I just think of all the things that have been said to me when I have lost someone and I dont take it well. For instance, when the chaplan comes to the room if the family likes a prayer afterwards, they do not say " God please take John Doe into your hands since he is dead" they say please take them into your hands since he has passed. I do see how it can be confusing, but it depends on who you are talking to. Thanks for the responses though.
I see everybodys points on this thread. I do see the professional point of needing to say DIED for the sake of not sugar coating. I guess I just think of all the things that have been said to me when I have lost someone and I dont take it well. For instance, when the chaplan comes to the room if the family likes a prayer afterwards, they do not say " God please take John Doe into your hands since he is dead" they say please take them into your hands since he has passed. I do see how it can be confusing, but it depends on who you are talking to. Thanks for the responses though.
I think praying together after the fact is different than hearing the news for the first time...
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!
I have another:
My dad passed away almost a year ago (it will be one year March 13th; today (9th) is his birthday. Anyway, it was totally unexpected. His neighbor found him and called the police (I spoke to him a few days prior, his neighbors noticed he wasnt doing his routine things). The cops called me and told me over the phone while I was home alone with my kids! This is not proper procedure , at least in NJ. My husband is a police officer, and he said the police were supposed to contact my towns cops and send a car over , then they are supposed to stay with the person until other family arrive. They had my name, my husband said all they had to do was put my name in the system and find my address.
Dont ever tell anyone over the phone, if it can be absolutely avoided, that a loved one has passed.
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 think expired is the worst. It sounds like a human being has an expiry date and I have heard of complaints from a lot of family members regarding that.
I think expired is the worst. It sounds like a human being has an expiry date and I have heard of complaints from a lot of family members regarding that.
oh my gosh, i agree.
"expired" makes it sound like a person has gone bad, just like a carton of milk.
Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.
Unquestionably, In my 35+yrs as an RN BSN,MSN, I have never taking the task of informing the relatives of a patient that has expired, here in US or in my native country Madrid,Spain. In addition, I strongly believe that is the doctors duty to inform this unpleasant news. However, I would accompany the doctor to provide moral support to the relatives.:redbeathe
I will never forget my first clinical rotation in Kerrville, TX where a wise nurse succinctly and professionally told a family of an unexpectedly and quickly deteriorating patient, "Everybody wants to go to heaven, but nobody wants to get on the bus." I could tell this facilitated preparation on the grieving process for the family. The patient passed a few days later.
Specializes in Ortho, Oncology, Med/Surg, Critical Care.
I'm actually crying while reading this o_0,
I work a surgical/oncology floor at my local hospital. We get a lot of frequent flyers and sometimes they're not doing so well and they pass away while under our care. The toughest part for me has always been when the family is waiting by the patient's side for them to pass away. And then comes that moment when they call you into the room and say, "I think s/he's gone." Then it's time to get another nurse and verify that they are, in fact, no longer with us. Then come the tears, and the hugs, and having to call doctors and the supervisor and the organ donor people [i hate doing that *_*] so we can "release the body to the morgue".
Also on our floor, if a patient in ICU is made a DNR and off the vent, etc. they send the patient to our floor either until they pass or are sent to a hospice care center. Nine times out of ten, they die within 12 hours or less. The lucky ones get out to the hospice center which I think is nicer for the family. I mean, who wants to associate a hospital as a place where mom/dad died? I know that sounds harsh, but I'm thinking of the family.
To be honest, it's easier to tell someone over the phone. I'm a pretty strong person, but having to face the family and tell them that their loved one is gone, or when they call me into the room to tell me that the patient isn't breathing and I have to get another nurse to go with me to be absolutely certain, it really makes me sad. I know this sounds harsh, but it's easier for me so that I don't have to see their reactions, I can just listen to it. I hate either way having to tell someone that their loved one is gone.
There are times, however, when the death is unexpected and let me tell you the worst case I ever had:
I work the night shift [7p-7a] and at around 11p, the ER calls and tells me that they have a patient coming to me until she can be seen by hospice and sent to the hospice care center. Patient was a healthy 52 year old with no prior history that was found on the floor by her husband unresponsive. They called 911, she coded in the ambulance and in the ER and they intubated her. The family decided to make her a DNR because there was no hope for her to survive [i think she had an aneurysm I can't really remember]. She got to our floor and we made her and the family as comfortable as possible [husband and daughter were at the bedside] and around 2am the family calls me and says, "Lisa I think she's gone." So I got my charge nurse with me and we checked her and she was gone. The daughter was hysterical "No Mom! Don't go, it's not fair!" The husband was crying, but I think he was trying to stay strong for his daughter. We let them say their goodbyes, hugged them and they thanked us, then they left. I will never forget that night. This was almost 2 years ago.
Sorry that this reply is so long, but I felt the need to say it.
Here, (in Colorado at least), an RN can pronounce death, so I have a hard time reading some of the comments that discuss how "the doctors do it," as an RN you have to remember that you are a participant in the process.
I've been fortunate to never be placed in this situation (with reactions of anger towards staff), so I thank the OP for the topic because sometimes I need to be reminded of all the different sides when this happens. I just wanted to remind everyone that by being an RN, you have a place by your profession to discuss death with patients and their families (whether the pt has already died or is about to). "How you say it" also includes saying it in the first place: often times we just side step or don't say these things because we are afraid we are going to be opening a can of worms (in this "get in and get out" world); but actually bringing it up (out into the open) is often therapeutic and patient's families are (not always but often) appreciative of the nurse using their knowledge about the dying process (since we do see it a little more that the public, let alone how it is often different than what people see on tv) and sharing. Death is often so abrupt in patient's families' eyes (even when it's been anticipated for some time) that any info helps them to feel like they have a grasp (or more of a grasp) on their situation. While the family might not be vocal or in the mood for communicating with each other about "the death," any attention the nurse can give is remembered by that family and even the little discussions about death can actually facilitate the family discussing amongst themselves or with the pt (if they are still alive). In my opinion, you are better off discussing death than not discussing it and the family feels like they got the cold shoulder.
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cherrybreeze, ADN, RN
1,405 Posts
It's not saying the word "died" that puts the "horrible cherry on top"...it's the fact that the patient DID die.
I don't understand how "died" is a euphemism? Other terms, such as passed away, expired, etc, are euphemisms. "Died" is factual, and people can misinterpret any other word/phrasing used.
I feel sorry for the loss you posted about...but am not understanding this particular post.