Whether your first experience with the death of a patient occurs during your time as a student or as a nurse, it comes with responsibilities and emotions. It is an honor to bear witness to and provide dignity at death. Preparing for the experience is useful.
Providing Postmortem Care
Immediate postmortem care follows hospital policy and typically involves a set of standard interventions. Death is pronounced by a physician, practitioner, or specific healthcare personnel.
The nurse documents the following:
- 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 the following:
- 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 has different protocols, which typically involve 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 words such as passed, which make death seem less real, or expired, which liken the patient to a container of milk. There is no reason to avoid 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% OK 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 people’s lives. This is normal. Remain composed and compassionate, and perhaps take a few deep breaths.
A simple offer of yourself 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 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. The charge nurse replied condescendingly, “Oh, how sweet, you cared.” I was furious, but it let me know who I was not as a nurse.
Old advice I’d been given was to distance yourself from the patient. The reality is that avoiding your 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, nurses still must unpack their 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 has been 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 others, yoga, prayer, or even a vacation may be needed.
When I was 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.
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, reminiscing.
Whatever your strategy, just know that it is 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.
About the Author
Catherine Cantrell, MSN, RN, is a nursing content strategist, teacher, and writer at Higher Learning Technologies and has worked in oncology, pulmonology, progressive care, intensive care, med/surg, step-down, and hospice.