What Can You Say to the Family When Your Patient Dies?

[tnbutterfly - Mary, BSN]

Your patient has been breathing irregularly for some time now and just drew another gasping, agonal breath. Holding your own breath, you wait…and wait.. for the next breath. But it never comes. It hits you that your patient just died.

You've never had a patient die before, much less witnessed the moment of passing. You are shell-shocked. But soon the family will be here and you need to compose yourself and be professional. Whatever that means.

It's hard to be prepared for the loss of a patient. The family may turn to you for support…...but what can you say? This is hard even for seasoned nurses. But having a few phrases in mind will help.

Read some suggestions from Nurse Beth, our career advice columnist, in her article:

8 Things to Say When Your Patient Dies.

[Nurse/Advocate]

Great article, Beth! Thanks for sharing this, tnbutterfly.

[traumaRUs, MSN, APRN]

Great article. I know from my own experience here are some tips I use:

1. If an infant or small child, offer a rocking chair, wrap the baby/child in a warm blanket.

2. Family presence can't be emphasized enough. If death occurs in the course of a code, allow the family in to the room. You need to have one person who is there ONLY for the family and who can explain what is happening.

3. If the body must be moved to the morgue prior to funeral home pick-up, offer a private room if possible for the family to grieve.

4. Offer to call a chaplain/priest.

5. For especially traumatic deaths, make sure that you care for yourself and other caregivers too. Crisis debriefing should be available.

As an APRN now, I run codes in the outpt environment and I am always cognizant of other pts witnessing a death and discuss the event if the other pts request it (in accordance with HIPAA).

[AJJKRN]

The phrase I generally use for an expected adult death is "I believe that your loved one is no longer with us in body".

[calivianya, BSN, RN]

I still don't know what to say to people. The deaths don't bother me, really - it's rare that I have one sick enough to die that I get to know at all. They're usually sedated, restrained, and have tubes down their mouths, and I don't usually make that personal connection with them. The families are a different story. I sometimes get to know them quite well before their loved one passes.

I just say "I'm sorry this happened," offer a tissue box, ask them if they have any questions, tell them they can have some time with their person, and back out of the room.

If they are not present at the time of death and they intend to come see the patient before the patient goes to the funeral home, I try to go ahead and ask if they are interested in an autopsy so I can clean the patient up before they come to see him/her. Nothing makes a patient look less like themselves than an ETT down the throat, giant ETT holders on the face, NGT, BIS monitor across the forehead, pulse ox attached to the ears... if I can take all of that stuff off before family gets there, get the tape residue off, brush the patient's hair, etc., I feel like they have a better experience. It's hard for a patient to look "peacefully dead" with a million things attached to his/her face.

I think it is very important to remember that some funeral homes don't do the best job at making the dead person look like they're just sleeping. Some make people look fake. That time with the patient at the hospital may be the family's last chance to see them looking like themselves.

[quiltynurse56, LPN, LVN]

While I know that this is geared to deaths in a hospital, in LTC care you get to know the patient and even families. Many family members are usually already there when their loved ones pass and if they, aren't, they arrive very soon. When the family is present, many times we will give them each a hug (if they like), tell them we are sorry and that their loved one was a pleasure to get to know and to care for. We usually let them have as long as they need and offer water, coffee, pop to them if they want.

We all usually need to take a few minutes at some point to cry and compose ourselves when we can get those few minutes, first though is the family and their needs.

[toomuchbaloney]

Sometimes it is okay to indicate that their loved one is now at rest, at peace, with their Lord, reunited with long lost loved ones, etc.

Too often in hospice, the now dead family member had a struggle and suffered through indignities and losses before they crossed that threshhold. In the midst of their loss the family may be receptive or appreciative in the reminder that they are now whole again, dancing with their bride again, or similar.

In my view, the more we know these people personally, the easier it is to know an appropriate thing to say.

Other times our silent empathy and compassion is therapeutic.

[Nurse SMS, MSN, RN]

I tell them I am sorry for their loss. That caring for their loved one was a privilege. That I will never forget them.

[verene, MSN]

I'm still learning how to handle this situation, I'm not sure it is a conversation that will ever be easy to have, but I'm finding the ability to have the conversation is easier now that I've been through patient deaths a few times. I acknowledge their loss, offer any assistance that I can provide, I explain the traditions our facility has for patients who pass away in our care, and ask permission to honor their loved one via this manner, I also ask if they have any additional ways they would like our staff to honor their loved one, and any wishes pertaining to postmortem care we should know about. Many families will ask about "the next steps" and I will explain if they ask, if they are not to this point I usually wait a little while before bringing it up and guiding them through the process. I've found the most important thing is simply to be genuine in my interactions; I may not have the "right" words, I cannot fix their pain, but I can be present, compassionate, listen to their needs, and offer such assistance as I am able.

[Dranger]

I am with Calivianya

Words after death is not my strong suit.

It's not that I am or in shock as I have had hundreds of patient's actively dying or in code type situations. It's just I am really cerebral or mechanical while at work. I do care but the outward show of show of empathy just isn't there with me. Offering a sorry, chaplain or time alone always happens and I do make the the patient presentable for the families but I am just not really a shoulder to cry on type of person and I will never be. I fully make myself available for questions as I like educating but standing their consoling when I don't know the person just doesn't mesh with my personality.

It also doesn't help that I am tasked with coroner forms, funeral home communication and an impending admit in the ED as soon as the patient expires....

[wilsonbl5150]

Hospice nurse checking in. Experience doesn't make it any eaiser. I usually say "I'm sorry, but he/ she is finally at rest." I might offer a prayer , depending on the family. Then I quietly excuse myself.

Also please try to remove any tubes, wires,guides etc the family doesn't want to see all that. Finaly place the head and feet of the bed down if possible. Rigimortis can set in and freeze the body with the head still raised. That makes transportation very difficult.

[Lev, MSN, RN, NP]

Thank you so much for posting this!