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.
Specializes in Med/surg, ER/ED,rehab ,nursing home.
I usually have to tell the family, having worked the night shift and being charge nurse at times. If it is a code that is done, it has always been the doctor who breaks the news. If it is a doctor the family has known, I have seen hugs by that doctor. Each situation is different. The few times I have had to call the family in the middle of the night (med surg unit) I just ask them to come in. If they ask if the person died, then I tell them of the death. My first time I had to do this I phoned the niece (who was a retired nurse) if she wanted us to send her deceased aunt to the nursing home. OUCH....OMG. She understood thankfully, that I was asking her if she wanted her sent to the mortuary. I had taken care of several of her family over the years. Still I felt bad that I made such a mistake. One relief supervisor said the same thing once. SO I am not the only one who made a slip of the tongue. If a family needs hugs, I give them, if they need time and privacy I do that, too. I do not think that there is any way to do this that will be perfect for every situation.
I agree that our words have a huge impact. Thirty years ago I was in the ER waiting room with my grandmother when the doctor came in and making reference to my grandfather, said, "He's gone." I vividly remember my hopeful grandmother standing up and asking, "Where did he go?" We seem to remember things like that for a lifetime.
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.
Not to bump an older post, but I just have to say - wow! How in the world did you manage to keep your composure? I was choking up just reading that!
Also wanted to offer my condolences to those who have lost their relatives, children, parents. :hug:
Tweety-I think the poster who asked for clarification on whether a nurse tells the family that there relative has died has a point. I worked night shift very recently on a med surg floor and we WERE NOT allowed to tell a patient's family that the patient had died. Sometimes this entailed a phone call in the night to the attending who then had to call the family. We were told it was not in our scope of practice, but maybe it was the hospital. Either way, the docs never pushed it back on us. I didn't even know it was different in any other state, but I guess it is!
You never know when this responsibility may be thrust upon you. Some hospitals have no official policy and whichever staff was the one to call is usually the one to tell the family... but not always.
If a physician calls time of death but is known to be coorifice with families, you may be appointed to give the family the news.
As many know (thanks to some members outing me frequently) I am not a nurse, my background is not medical. However, I have worked with disaster relief and have coordinated efforts with medical professionals for emergency response clinics and mobile tent hospitals in developing nations. I have worked with activities following Katrina, the massive earthquake in Pakistan and even the 2006 assault on Lebanon by Israel.
*I* got pushed out the door to deliver the news to families on occasion simply because I was the one "in charge."
It is never easy and you should be careful to EMPATHIZE with the family, not SYMPATHIZE with them.
The difference? Empathizing means that you understand WHAT they are feeling and are compassionate to that degree.
Sympathizing means that you FEEL AS THE PERSON FEELS and that can be devastating for all involved.
There has to be a moderate degree of emotional detachment so that you can be a point of stability for the family in that critical moment.
I've had to do it a dozen times... it never gets easy... and it never should.
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'm sorry.. totally inappropriate.. but when I read this line in your post... I heard John Cleese's voice... and then it went on with the whole "Dead Parrot" sketch.
Specializes in Ortho, Oncology, Med/Surg, Critical Care.
Not to bump an older post, but I just have to say - wow! How in the world did you manage to keep your composure? I was choking up just reading that!
I'm not sure how I kept my composure around the family. I did cry for a bit afterwards, before I called the doctor to tell him she had died. For me it was awful because I'm not much older than the daughter was and it made me think of how I would feel if I lost my mom so suddenly. After I left work that morning, I called my mom to tell her how much I loved her and it took everything in me not to cry on the phone because I didn't want her to worry.
It has always being difficult for me to inform the relatives when their loved ones has passed on...I remember when I was still a student and I was with the registered nurse in a room when she had to inform the family...Their father had passed on and the children and their mother just broke down uncontrollably and the mother fainted...That broke my heart to see such a reaction considering that it was my first exposure...I went out and into another empty room sat there and cried too...They loved their father...She loved her husband dearly...when I went back, I found the nurse holding the children and hugging them tighlty the mother had to be taken to the resuscitation room...I joined in to hold and hugged...felt like we are one big family in a moment of sadness...That day, I learnt how to be sensitive, empathetic when a nurse has to break news such as this to the family/relatives...
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bradleau
146 Posts
I usually have to tell the family, having worked the night shift and being charge nurse at times. If it is a code that is done, it has always been the doctor who breaks the news. If it is a doctor the family has known, I have seen hugs by that doctor. Each situation is different. The few times I have had to call the family in the middle of the night (med surg unit) I just ask them to come in. If they ask if the person died, then I tell them of the death. My first time I had to do this I phoned the niece (who was a retired nurse) if she wanted us to send her deceased aunt to the nursing home. OUCH....OMG. She understood thankfully, that I was asking her if she wanted her sent to the mortuary. I had taken care of several of her family over the years. Still I felt bad that I made such a mistake. One relief supervisor said the same thing once. SO I am not the only one who made a slip of the tongue. If a family needs hugs, I give them, if they need time and privacy I do that, too. I do not think that there is any way to do this that will be perfect for every situation.