Throughout nursing school we learn how they can die from various illnesses, but I only had one lecture on hospice that talked about death and grief. We deal so much in death so it is strange nursing school doesn’t spend more time on how to understand our role with dying patients and how to cope with their deaths. Even if you have had a loved one pass away, patient deaths affect you differently. Here is what complicated patient deaths and what we should tell nurses to better prepare them:
What Complicates It
- Nurse-Patient Dynamic
Nurse-patient relationships are built the second we walk in the door to establish trust for the rest of the shift. It’s a deep connection but one that ends when we go home. When we have that relationship dynamic cut short by patient death, it’s a weird mix of grieving while being strong for someone who is essentially a stranger that we know a lot about.
- Ownership
When I am assigned a patient, they are MY patient. As the primary nurse I am legally responsible for their care. But it also opens the door for guilt, self-doubt, and grief when patients die even when it is completely out of my control.
- Family Vs None
Nurses balance complicated family dynamics all the time and in normal circumstances there is a big gap between the patient’s needs and their family’s. When a patient is dying, the family unit almost becomes an additional patient and that gap is narrowed.
For me, it’s almost harder when they do not have family. I never want to see anyone die alone. I check on them more frequently because I’m determined to make sure they are comfortable and so they will not die alone.
- We See Behind the Curtain
After the heart stops and the family says goodbye, we start the behind-the-scenes work to prepare them for the morgue. There are phone calls, faxes, and paperwork to do. We see the skin color fade and feel their warmth slip away as we do post-mortem care. Our brains slowly transition them from patient to object because the reality of having to physically place your patient who is in a body bag into the morgue freezer yourself is hard.
How Nurses Can Better Prepare
- Build the Relationship
Even though you know death is imminent and your relationship will end, build it. That gives the patient and their family confidence that you will provide the utmost care for them even beyond their last breath.
Be with them. Laugh with them. Grieve with them.
- Hold It Loosely
It might seem contradictory to tell you to make a deep connection and then to hold it loosely, but I assure you it’s not. Emotions should not be turned on and off like a switch. Instead nurses must balance the ability to be emotionally present with keeping the relationship separate from yourself. If you hold too tightly to a relationship that has finite boundaries, it is easy to get lost in the grief instead of being a nurse who grieves.
- Make the Time
Time is a precious commodity for a nurse. Many feel like they do not have time to process grief of a patient. Nurses do not have time to do a lot of things, but we prioritize our tasks to be as efficient as possible.
Death is one of those moments where we need to prioritize ourselves in order to have a long, satisfying career as a nurse. Take a moment to step aside. Cry (if needed), vent, and refocus after a patient death can help keep the patient-nurse dynamic balanced. It takes strength to be vulnerable and allow yourself to process the things we see.
Some of my most bittersweet experiences as a nurse has been with my dying patients and their families. I see it as an honor to care for people in their last moments on earth— to show them compassion, love, and grace beyond their last breath. It is not easy and sometimes there are never “right words” to say, but sometimes after you say, “I am sorry for your loss,” the absence of words is better. Bring in water or coffee and look out for their basic needs in the moment. Give them time to grieve in private. If the family wants, allow them to participate in the postmortem care to the point that they are comfortable. I had a mother who lost her young adult daughter and it brought her great comfort to still be a mother by helping me bathe her daughter one last time. Gently guide family through the logistical process moving forward by providing resources for mortuaries. Be gracious if they do not have all the answers for arrangements right away. They will be asked a lot of questions and it is extremely hard to make sound decisions in the wake of loss.
