Whether a nurse's first experience with the death of a patient is during their time as a student or as a nurse, the experience comes with responsibilities and emotions. It is an honor to bear witness to and provide dignity at death. Preparation for the experience is useful. Let's look at post-mortem care, care of the family, and care of the nurse.
Providing post-mortem care
Immediate post-mortem care follows hospital policy, but typically involves a set of standard interventions. Death is pronounced by a physician, practitioner, or specific healthcare personnel.
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Alyssa Miller's "A Silent Calling"[/caption]
The nurse documents :
- Date, Time, Observations
- Actions, including any resuscitation efforts
- Name of anyone notified
- Disposition of belongings
- Where the patient is moved (funeral home name, medical examiner)
The nurse performs:
- Cleaning the patient
- Ensuring belongings are accounted for
- Removing devices, such as indwelling catheters
- Leaving or placing identification in at least two areas (toe, outside of body bag, armband)
*Please note that any death following unusual or suspicious circumstances will have different protocols, which typically involves very little other than notifying the medical examiner, and devices must be left in place.
Caring for the family
Comforting the family often falls to the nurse. In your initial interactions with family and friends, please try to avoid phrases such as "passed" that make death seem less real and phrases such as "expired" that indicate the patient was maybe a carton of milk. There is no reason to avoid use of the terms "death", "died", or "dying".
Avoid telling the family that you "understand", that you recently lost a pet, or that you know someone who recently experienced a death. Do not be nervous, and do not ramble. It is 100% okay to say that you do not know what to say.
You will feel at a loss for words because words are inadequate for such intense times in a person's life. This is totally normal. Remain composed and compassionate, perhaps take a few deep breaths.
A simple offer of self is warranted: "Take all the time you need. I am here for you. Is there anyone else I can call? How can I best help you right now?" If you desire, offer a hug or to say a prayer. Offer pastoral care services. Offer a short list of details regarding next steps, such as the need to call the funeral home.
If the family is lingering or becoming disruptively emotional, it may be helpful to redirect with a question that requires thinking and joyful reflection. "He once told me that he served in the armed forces. Which branch was it again? Was his rank colonel?" Then the nurse can redirect the family toward closure surrounding the immediate death.
Taking care of yourself
I will never forget the first death I experienced in nursing shoes. I was a first semester BSN student in a long-term care facility. My patient was an older adult woman dying from bladder cancer. She really needed no care and had no symptoms. She also had no family present. I spent my two days turning her, cleaning her, and reading to her. The next week, she was gone. I asked the charge nurse if she had died. In reply, I got "oh, how sweet, you caaarrreed." I was furious, but it let me know who I was NOT as a nurse.
Old advice included to distance yourself from the patient. The reality is that avoidance of feelings is not a functional response, and it is difficult to give good care from a "distance". In the midst of physical care of the patient and comforting the family, the nurse still must unpack his or her own feelings and thoughts to reduce personal stress. It is only human.
The first step is recognizing that death really is not avoidable. Allow yourself time to respect that a person's life is lost and to personally grieve, if needed. You will have to find what works for you. For some nurses, a very logical, the-next-patient-needs-me approach works well. For some nurses, yoga, prayer, or even a vacation may be needed.
As an oncology and hospice nurse, it was customary for the unit to grieve for long-term patients together. Sometimes we might hold a an event- a worthy tribute to a life we treasured. Talking with colleagues is a very useful tactic.
However, I once found myself in a situation of prolonged grief for a patient I had cared for over many months. She was the last in a long line of such deaths for me. Recognizing that it was not reasonable to experience such grief, I dealt with the experience (seek psychiatric assistance if needed!) and determined to handle it better in the future.
What that meant for me is this: When a patient dies, I place their memories in a mental box. When I want to remember these people who became dear to me, I pull out this mental box of memories and sift through them just as someone might look through a physical box of old pictures, reminicissing.
Whatever your strategy, just know that it is our part of our daily work to hold the hands of those who die, and using adaptive and successful coping is essential to continuing bedside nursing.
Image of patient in bed by Alyssa L Miller "A Silent Calling"