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.
The Charge Nurse has already indicated she wants the body sent to the funeral home and the room cleaned ASAP because there’s another patient in the ED who needs the bed.
You want to spend time with the husband and daughter who are just now getting off the elevator. But you also have a hard IV stick on another patient who needs a blood transfusion, and your post-op knee patient needs her pain med.
You aren’t prepared for the loss of a patient and all the accompanying emotions. How could you be ? It’s not a test you’ve ever studied for.
Often nurses are the first persons a family member turns to at point of loss. It’s a privilege and an honor to bear witness at the time of death, but it can cause feelings of inadequacy.
You Can’t Fix It
You can’t fix this by changing a dressing, or providing patient education. In fact, you can’t fix this. At all.
You cannot take their pain away, no matter what you say or do.
It’s awkward and your feelings are jangled because the husband and daughter are tearing up and you are all standing around the corpse and you, too, are shell shocked but you haven’t finished your med pass. Feeling inadequate, you proffer a box of kleenex. Thankfully, they accept your offer and take a Kleenex.
Manage Your Feelings
If you are an empathetic person, you are feeling the loss along with the family. People who are empathetic make great nurses, but feel more acutely. You must control your emotions and remain composed, but genuine and responsive.
Does that mean you can’t shed a tear? Shedding a tear is fine, but not out and out crying, because then the focus is on you and your feelings.
Besides, you don’t have time to fully experience your feelings. If you start crying, can you stop? What if you start crying but you’re an ugly crier and your eyes sting the rest of the day and your nose is red ?
Concentrate on your breathing, bite your lip, distract yourself. Take a deep breath.
What You Can Say
A simple “I’m sorry for your loss” when said in a heartfelt manner, is meaningful.
Ask what they need. “Is there anyone I can call for you?” “Would you like some chairs and time alone for a few minutes ?”
Acknowledge their feelings. “I know how much you loved her” (if you know this to be true).
“I can’t imagine what this must be like for you” Because you can’t.
If you are comfortable, ask if you can give them a hug. “Can I give you a hug?” A human touch can be immensely comforting.
From Emotional to Cognitive
After a certain amount of time, you may need to move the family away from the bedside and from the emotional realm to the cognitive realm.
How do you move some one along when they are in crisis and emotional? You don’t.
You re-focus them from the emotional to the cognitive. You do this by asking a question. Ask about their loved one.
“She always talked about her herb garden”
“She was a teacher, right? Did she teach here in town ?”
This type of question will instantly switch their brain to the cognitive side as they answer you. They are now in the realm of dates and facts. From this place, you can move things forward that must take place, and bring closure to the hospital situation.
Self-Care: Debrief and Process
Realize you have to process that your patient died at some point.
It’s traumatic to watch another human being die. It is not sufficient to say “I just have to pull myself up by my bootstraps and keep going”.
Emotions will come out one way or another. You might burst out crying at a Lifetime movie, or over react in some other situation. Processing means talking out loud to a supportive person. Hearing your own words out loud. Saying them. You owe it to yourself to debrief as soon as you are able.
NurseEyeroll Kati Kleber talks about this beautifully in her article “I wish I could cry with you, but I can’t”.
You can compartmentalize your feelings as a coping mechanism, but be careful. Putting the experience aside doesn’t mean it’s been dealt with.
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.
What has helped you when your patient died? What ways have you found to respond to families? I’d love to hear.
I recently had a Shared Death Experience that you must read. I’m still humbled and in awe.
Until next time friend,
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You can also come visit me at Ask Nurse Beth career column at allnurses.com for all kinds of entertaining and informative career questions and answers, and to submit your own question 🙂