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.
Who is to say it's a lie? Do you know for a fact their isn't?
actually, no one knows with 100% certainty.:)
however, i couldn't ever work in hospice as long as i have, without closely examining my beliefs, and examining everything i have personally witnessed or experienced.
so when a pt/family asks me what my beliefs are, i speak 100% from my heart.
Specializes in Plastics. General Surgery. ITU. Oncology.
These are difficult situations to deal with and there is no absolute right or wrong way to address them.
As a nurse on an Oncology unit I can both pronounce and register death and often have the sad task of informing the family. I do prefer to use frank and unambiguous language in doing this. The family are distressed enough whatever terms are used. Euphemism is not helpful.
I never use religious language. The beleifs of the family are their own and I do not intrude.
Specializes in Emergency Dept. Trauma. Pediatrics.
actually, no one knows with 100% certainty.:)
however, i couldn't ever work in hospice as long as i have, without closely examining my beliefs, and examining everything i have personally witnessed or experienced.
so when a pt/family asks me what my beliefs are, i speak 100% from my heart.
and to me, that is my truth.
leslie
I agree, that is why I was asking the other poster how they can say you're lying. How would they know you are lying unless they are posting from the after life LOL
Oh, Leslie, sorry for your losses, and sorry you encountered such an emotionally inept doc at such a sad time. Personally, no matter what the loss, I find no comfort in, "It's a blessing." No matter the circumstances, I can't imagine it ever feels that way to the next of kin hearing of the death for the first time.
When I was 18, I was hospitalized in traction for severe lower lumbar strain. My young adolescent's room was across the hall from the critical care unit in a small hospital. I received a plant with 2 red carnations in it from my mom and dad. Then my brother came in and said they had to bring my dad in to ER again-several MI's in 2 years. My mom, brother and older sister left my room. Then a nurse came in and asked if I wanted to "go thank my dad for the flowers". When I went into CCU, I saw mom, brother and sister kneeling on the floor next to my dad's bed, all crying. I ran to my BIL in the hall screaming he didn't make it!!!
Whenever I had to call a family member,especially in LTC, I would tell them that their parent had taken a turn for the worse. Then when they arrived, I would tell them that they had passed away very peacefully after I had talked with them.
I am a nursing student doing a postional paper for my role development class. I was hoping someone could let me know about their the education they got while in nursing school about death and dying. How much education did you get, was there any role playing involved, what year in school did they approach the matter?
Specializes in Med/surg, ER/ED,rehab ,nursing home.
I did not receive any education of any sort on death and dying. That was many years ago. What I did get was advice from more senior nurses on how to talk with the family, especially by phone. Todays family members are more informed. Unless it is a sudden unexpected death, you will probably find yourself being asked " Has Momma died?" . I alway answer truthfully to that question. Usually I have taken care of that family and their Momma several days and have gotten to know them.
We had a small segment about death in our book, but that's it. We didn't do role-playing. However, you must be honest and use the word "died" to help the family grasp the reality of situation so they can start the grief process. Saying words like, "passed, resting peacefully", etc. is found to delay the grieving.
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leslie :-D
11,191 Posts
actually, no one knows with 100% certainty.:)
however, i couldn't ever work in hospice as long as i have, without closely examining my beliefs, and examining everything i have personally witnessed or experienced.
so when a pt/family asks me what my beliefs are, i speak 100% from my heart.
and to me, that is my truth.
leslie