As a healthcare professional, you realized before you entered the nursing profession that at various times in your career some of your patients will die. Many students and nursing students understand this on a cognitive level, but the emotional impact of losing a patient for the first time often takes them by surprise. In addition, different factors related to the nature of the death and the characteristics of the patient affects the impact of a patient’s death on a nurse. Many young nurses find it helpful to know what other nurses and medical professionals experienced when one of their patients died and how they cope with the loss.
Common Reactions to the Loss of a Patient
Many nurses report their initial thoughts and emotions related to a patient’s death depends upon the age of the patient. When an elderly adult who has suffered with a chronic illness, a nurse, as well as the family, often takes comfort in the fact the individual had a long life and the patient’s suffering has ended. While the nurse is likely to feel sad, the grief associated with the loss is typically uncomplicated.
Nurses who work in emergency departments and intensive care units often have a very different experience. When an otherwise healthy adult arrive in the emergency room as a result of trauma and the medical team is not successful in their attempt to save the patient’s life, the nurse either faces a barrage of emotions or may actually feel numb. Additionally, as part of the medical team, may face the anger of family who just learned their loved one has died. While most veteran ER and ICU nurses have built healthy emotional defenses for times when grieving families lash out in anger, most novice nurses have not developed this coping mechanism.
Regardless of their level of experience, the death of a child tends to be emotionally wrenching for all medical professionals. Some of the common thoughts and feelings include:
- A child is not supposed to die. Children are at the beginning of their lives, not the end.
- Someone must have done something wrong that lead to the child’s death.
- The child is an innocent, so s (he) did not deserve to die.
- The child was helpless, so s (he) could not do anything to prevent this from happening.
While a certain degree of self-blame happens when any patient dies unexpectedly, nurses and other medical professionals find they second-guess their actions more often when a child is involved. Most preceptors work with the nurses on their teams to debrief, or review, the nurse’s actions before, during, and after a patient’s death, especially when the patient is a child.
The Nurse’s Responsibilities to the Patient and Family
One of the ways to cope with the death of a patient is to know that you have done everything possible to care for the individual and his or her family. In a hospital setting or nursing home setting, sometimes the family is not able to be present during the patient’s final moments. In your role as a nursing professional, kindness, compassion, empathy, and genuineness are even more crucial elements of care than they are under normal circumstances.
If the patient is conscious, s(he) make ask you to tell family members certain messages, ask you to pray with them, hold hands, or just listen as s(he) shares sensitive memories. Most nurses, when possible, fulfill these final requests and relax some of the more stringent protocols that may hamper making human connection with the patient. For example, the nurse may opt not to wear a mask that covers her face or not to wear latex gloves in order to share a human face and touch with the patient. Of course, the nurse needs to pass any messages to family members and fulfill any promises made to the patient.
When families lose a loved one, even when the death is expected, they tend to fall into crisis. While conveying empathy, the nurse needs to make sure the family has a support system in place, which may include a member of the clergy, friends, and extended family members. Since the patient’s loved one are likely overwhelmed with emotions, any directions you need to give to them need to be short and concrete. In some cases, you may need to prepare the family to view the body. Additionally, if you are the only one in the room with the patient at the time of death, the family will likely ask you questions about what happened with the patient. Veteran nurses report that it is very important you reassure them that the patient did not die alone. When sharing information about the patient, using good judgment is vital as not to add to the family’s grief.
Taking Care of Yourself
Sometimes young nursing professionals are surprised that they experience very little feeling at the time of their patient’s death and they are caught off guard when they are flooded with grief afterward. In either case, you need to do your best to maintain your composure when you are with the patient’s family. Again, you need to balance being genuine with acting as a professional.
Typically, your preceptor will review the patient’s case with you, which is referred to as a debriefing. This experienced nursing professional can help you sort through your thoughts and feelings about the loss of your patient. In the rare event that your advisor informs you about things that you might have done differently, avoid becoming defensive or falling into self-pity. Often what may seem clear with hindsight may be very nuanced during the actual situation.
Some nurses attempt to work their grief out of their system by taking extra shifts. This strategy tends to be counterproductive because it not only leads to exhaustion but eventually the painful emotions need to be addressed. This is the time to maintain a healthy diet, exercise, try to get enough sleep, and reach out to other nursing professionals.
While dealing with a patient’s death is never easy, as you gain experience, you will be able to handle your own reactions in the most constructive manner possible.