What to Say When Your Patient Dies

Ashley was stunned. Her patient George had just died and been pronounced. It was her first time to lose a patient and it felt unreal. He had taken one last, huge breath in...and then nothing. It was as if he just stopped. Stopped being. All around her, noisy activity went on as usual. Lunch trays were being delivered. A patient was being wheeled down to Xray. How could everyone act so normal? Ashley felt anything but normal.

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What to Say When Your Patient Dies

Before Ashley could begin to regroup, she glanced down the hallway towards the elevators.

Stepping off the elevator was George's elderly wife, Elaine. George and Elaine had been married 46 years. Ashley felt trapped and panicky. She was the nurse, but what was she supposed to say? This had certainly never been on any test in school.

Ashley knew how to fix plenty of things - a beeping infusion pump, a low serum magnesium level- but Elaine's crumpled face? She couldn't fix this. She couldn't get busy and make her patient comfortable. She had never felt so unprepared and didn't even know what to do with her hands as Elaine walked towards her.

Provide Comfort

It's always OK to say a simple, heartfelt "I'm so sorry". Don't worry as long as you are genuine. Common phrases like "I'm so sorry for your loss" carry more weight and meaning in these situations, and are comforting. At the same time, be comfortable with not saying anything. Be present and follow the family's lead.

Practical Help

Nurses are good at providing material comfort. Offer Kleenex if needed, or a glass of water.

"What can I get for you?”

"Is there anyone I can call for you?”

"Would you like some time alone?”

" I can get some more chairs in here for you".

Ask permission to give a hug if you are comfortable with hugging. Offer to contact their pastor or the hospital's pastor. A blanket from the warmer placed around the shoulders can also be a comfort.

Acknowledge their feelings "I know how much you loved him" (if you know this to be true) "I can't imagine what this must be like for you".

Manage Your Feelings

At some point you may feel like crying. Nurses who are empathetic will feel the grief along with the family. It's OK to shed a tear, but it's important to manage your emotions. Out and out crying is not OK, because then it becomes about you. To keep yourself from crying when you don't want to, bite your lip, or do a quick math problem in your head.

Help Them Move Forward

At some point you may need to move the process along without rushing the family. Your other patients and duties are still there, and the bed may well be needed for another patient.

The key here is to gently move the family from the emotional realm to the cognitive realm.

How do you this? When someone is in crisis and in an emotional state, you can refocus them by asking a question. "George said he loved being a coach. Was it basketball that he coached?” or "He was a golfer, right? Did he play much?” The person will immediately switch to the cognitive side of their brain and answer you.

It's insensitive to switch gears on someone who is in an emotional state, but once they are in a cognitive state, you can begin to bring closure. They are now in the realm of dates and facts. Ask them if they have chosen a mortuary, or whatever else you need to do, such as gather belongings. Find out if they are waiting on any other family members.

Self-Care: Debrief and Process

It's traumatic to watch another human being die, and it can be a loss if you cared for them or became attached.

When you're at work, you need to put your feelings on hold in order to function and remain professional. It's OK to compartmentalize your feelings as a coping mechanism, but be careful. Putting the experience aside doesn't mean it's been dealt with. Emotions have a way of coming out one way or another. You might burst out crying at a Hallmark movie, or over react in some other situation.

But eventually the experience needs to be processed. You owe it to yourself to debrief as soon as you are able.

Processing usually means talking about it to a supportive person. Putting your feelings into spoken words helps you name what happened and begin to heal from the trauma. Practical tip- when you get home after your shift, take a shower. Stripping off your scrubs and letting water run over you symbolically cleanses and refreshes.

Note: If you have unresolved grief issues of your own, get help so you can better help others without your needs taking precedence.

Nurses are often the first person a family member turns to at point of loss. It's a privilege to bear witness at the time of death, and it's an honor to comfort and help the family.

What have you learned to say or do when your patient dies?

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Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

Nurse Beth works in acute care and is the career guru at the Ask Nurse Beth career advice column. She has an award-winning blog, nursecode.com Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

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This is literally what happened to me this morning. I work in home care, and had a patient who was in palliative care in a nursing home, and the family called to let me know the patient had passed during the night. This is a patient I had for 3 1/2 years. I find that you can never go wrong with saying” I’m so sorry “.

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Specializes in LTC, assisted living, med-surg, psych.

I have always felt it a privilege to be at the bedside when someone passes. It's a sacred moment to me, and I say a quick and silent prayer over the patient before the duties which must be done get underway. A sincere "I'm so sorry for your loss", "is there anything I can do for you?" and the occasional hug give the family some comfort while maintaining professionalism. I never completely broke down at a death---not even my husband's---but there were times I'd sob in the car after work. Some deaths simply hurt more than others, especially in long-term care, oncology, hospice and dialysis. We nurses more or less "get used to" seeing people take their last breath, and we learn to control our emotions...but I still believe that if a nurse can't feel at least something when a patient dies, it's time to consider whether or not to continue in the profession.

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10 hours ago, VivaLasViejas said:

I have always felt it a privilege to be at the bedside when someone passes. It's a sacred moment to me, and I say a quick and silent prayer over the patient before the duties which must be done get underway. A sincere "I'm so sorry for your loss", "is there anything I can do for you?" and the occasional hug give the family some comfort while maintaining professionalism. I never completely broke down at a death---not even my husband's---but there were times I'd sob in the car after work. Some deaths simply hurt more than others, especially in long-term care, oncology, hospice and dialysis. We nurses more or less "get used to" seeing people take their last breath, and we learn to control our emotions...but I still believe that if a nurse can't feel at least something when a patient dies, it's time to consider whether or not to continue in the profession.

I would love to have you as my nurse when my time is near. You are compassionate, professional, and still respectful of patients and their families. This the role model that all healthcare professionals should follow.

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On 3/29/2019 at 9:37 AM, Nurse Beth said:

At the same time, be comfortable with not saying anything. Be present and follow the family’s lead

Most important thing.

Anything you say that is either rote, pressured (anxious), or interruptive has the potential of seeming very cold or just being inappropriate in other ways.

Try not to intrude on people's expressions of grief or their moments of saying their good-byes.

I learned to limit words and go-with-the-flow, over time. For example, at an unexpected death the family member arrived and as I was escorting them and approaching the room I asked, "Would you like me to come in with you or wait out here?" I saw a look of "who cares?"/confusion pass over their face before they said, "I don't care..."/"whatever you usually do...". Even though my question was meant to be caring, it was unnecessary. I realized in that moment it was (for that person) a needless question when their mind was somewhere else (the devastation and disbelief of being about to view their dead beloved family member).

The same is true with offering a bunch of physical comforts right in the thick of things. You can just make a box of tissues available instead of running around creating a relative havoc by asking 5 questions about their preferences and trying to make everything perfect. If/when you happen to see another nurse doing this, it becomes apparent that it is unnecessary/inappropriate.

Anyway....just a few thoughts.

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I've often reflected upon our medical culture's views of death and dying and thought some of them just odd. Not that death (especially premature) isn't tragic and sad, but it is an expected life event, not a failure. I realize that some families don't want to lose a loved one, but these extreme, life-sustaining measures that we subject our patients to just boggle my mind. I've always maintained that there are worse things in this life than dying and languishing my last days on earth in an unfamiliar hospital ward ranks right up there in my book. Then there is the funeral industry but that's a whole other story.

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On 3/29/2019 at 5:12 PM, VivaLasViejas said:

I have always felt it a privilege to be at the bedside when someone passes. It's a sacred moment to me, and I say a quick and silent prayer over the patient before the duties which must be done get underway. A sincere "I'm so sorry for your loss", "is there anything I can do for you?"

This.....a thousand times....this.

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Specializes in Critical Care.

And call your OPO within in hour, as they may have the opportunity to be a tissue donor.

And for you ICU peeps, call when clinical triggers are met or family first starts to make statements implying they may go.the palliative extubation route, not when their hand is on the tube.

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Specializes in Nephrology, Cardiology, ER, ICU.

Because I care for chronically ill pts with a shortened life expectancy I do a lot of end of life counseling and hospice referral.

I find that sometimes silence works well. For instance, when I'm dealing with giving the news of an expectant death, I try to go at the conversation slowly and allow some silence so the family can process the info I'm trying to give.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

As a Parish Nurse, I have had the privilege of being with patients and their family members as they near the end of death, take their last breath, and provide comfort to the family afterword. No matter how many times I do this, I feel blessed to be a part of these intimate moments. Many times being present and offering a gentle hug or touch on the shoulder speaks louder than any words. Dealing with grieving families is not a one-size-fits-all approach. It's important to be aware of the body language and take your cues from that.

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It’s not a one size fits all when comforting family either. As each person handles grief and dying differently, you have to feel them out. I’ve been present for a lot of death. Some sudden, some not. Some people want to be comforted and others don’t. I always learn I need to pick up on those signals.

It can be very difficult for nurses to deal with a lot of death in a short period of time. It’s why self care is so important for us. So we can mentally and emotionally be there for the next family that needs us.

The last few weeks I personally have done numerous weans and codes. The stress of it all is becoming apparent. I have vacation coming up next week and I’m looking forward to the break. Time with family is much needed!!!

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