When choosing a profession such as nursing to venture into, people are usually aware of the fact that they will be surrounded by sickness and death. While it’s understood that taking care of people with contagious diseases, and deadly viruses is literally the job, no one could’ve foreseen the plague that would come upon humankind just 3 years ago.
I think it’s also safe to say that the majority of people truly have no idea what they are about to get themselves into when entering healthcare. In reality, people usually find out the hard truth about losing a patient is much more than just a notion.
In the span of my career, I’ve worked in a range of healthcare roles from skilled nursing to hospice, to emergency room. Without a doubt, I’d have to say that those are the top 3 departments for me, where I’ve witnessed the majority of patients passing away. In skilled nursing facilities, it was usually due to natural causes. In the hospice setting, in most cases it was to be somewhat expected, as the patient was kept as comfortable as possible. The emergency room had the most traumatic and unexpected accounts of death.
Now, is there something to be said about that? Does the manner in which a patient expires have an effect on the nurse caring for them? Well, I suppose it depends entirely on the individual. What about the age of the patient? Many nurses have admitted that it is far more traumatic to see a pediatric patient die, than say an 82-year-old grandma of six, regardless of the nature of death.
Why? Are we conditioned as a society to believe that the 82-year-old has already lived a good, long life? Does age play a factor in how we cope with death? Do we assume that because she may have lived a long number of years, that her life was fulfilled? That she was happy? Should we be any less distraught over her passing, because we feel that she’s lived long enough? If we can come to terms with it in our mind, should the family have done so as well? Do we as healthcare professionals tell ourselves that there is no reason to be sad? The truth is, no matter how long she lived or whether she lived her life to the fullest, she will still be missed. Her death will not have any less of an impact on her family and friends. Surely, you can agree that they will still feel an immense amount of pain with their loss.
Now what about us, the healthcare workers? In particular, the nurses. Nurses are the first point of contact for all patients. They are the doctor’s eyes and ears. Doctors rely very heavily on the skills, training, and assessments, of the nurses, to update them about any important issues. Nurses are there, at the bedside 24/7. They are there when the patient’s families come to visit. They feed, bathe, and dress them. Nurses are more often the ones who are listening to all the stories from times past.
With that understanding, it’s reasonable to expect nurses may at times find themselves becoming emotionally attached, or invested. That patient has now become like family to them. In a situation where death is certain, a nurse may find themselves heartbroken. Perhaps they’ve spent the last several months bonding with this patient. It’s true that some nursing specialties see higher incidents of death than others. For the nurses working in those units, how do they manage? Does it ever get any easier? Perhaps you are a new nurse, and you’ve recently experienced your first patient death. How did you handle it? Did you cry? Were you able to hold back your tears? Did you second guess yourself, thinking you could’ve done more? The truth is, most of us are guilty of one or more of the above-mentioned questions. So, the real question is, can your nursing colleagues teach you how to handle the death of a patient? I believe so. Let’s examine this further.
Your patient passes away. How do you feel?
The first thing here is to acknowledge your true feelings.
One thing I’ve personally witnessed in my 13-year-long career is this “I have to be tough and suck it up” persona. Many people have been led to believe, or even told, that if you show any ounce of emotion while on the job, it is unprofessional. Some nurses believe that showing sadness in front of the family would upset them. Well, let me tell you something; you are not doing anything wrong. Considering the circumstances, grieving with the loved ones of a patient is perfectly normal and acceptable. Hiding your feelings doesn’t make you a better nurse. Perhaps, some may recommend stepping outside the room, walking down the hall, or getting some fresh air outside while they let out their emotions and this is perfectly fine too.
It’s okay to vent. Find someone, a fellow coworker, to talk to.
Talking to one of your colleagues can do wonders for you. This is especially true if you find yourself struggling with this matter. Hearing from other nurses in your specialty can be helpful in reassuring you that these things do happen. If they are experienced, they may be able to review your care and provide a briefing of sorts to discuss your nursing care that was provided and how it relates to that patient’s level of care. Sometimes being told, “you did everything you could, there was nothing else that would’ve saved them” is exactly what we need to hear. As a nurse, you have to remember that it has less to do with you, and everything to do with the disease process that patient was going through. If spirituality is important to you, perhaps speaking with the facility chaplain, or seeking out your own spiritual leaders may lend some comfort to you during this time.
Seek out others who cared for them. Talk to the family.
It is possible that speaking with the family of the departed can also be a source of comfort as well. There may be stories or funny jokes that you may have shared with the patient that they are not aware of. It is also likely that the patient may have informed their family about the wonderful care that you provided to them. Being provided with that sort of feedback can prove to be very encouraging, as well as comforting.
Find a way to decompress after work.
Some people find that healthy hobbies such as walking, running, or other forms of exercise allow them to blow off some steam. Exercise is indeed a common way that many people use to rid themselves of any pent-up anger.
Take some time off.
Maybe this is getting to be a bit much for you. But “they’ll be short if I call in. I don’t want to let my team down”. Have you ever thought like that? Please understand that staffing issues are not your primary concern as a staff nurse. Your mental and emotional health is worth more than any job. You can not be expected to continuously pour into others, while neglecting your own emotional and mental health. Yes, some nurses have become so desensitized to death and trauma, that they can witness a person pass away, and proceed onto the next task as if nothing has happened. Does this make them a bad person? Of course not! After all, many times nurses are not provided with the time and space throughout the shift to process what has just happened to a patient. If you are finding that you do not yet possess the ability to do this, don’t worry. You many never develop that ability. There is nothing wrong with you if you don’t. This doesn’t mean that you are overly sensitive or weak. You are simply human. That is the same compassion that is required to be a great nurse front the start. Some facilities even have what is referred to as “mental health days” in addition to PTO. If an experience has become too taxing for you, step back and take a day or two.
Address any unresolved traumas.
At this point, if you find that this is happening on a reoccurring basis, like every time a patient expires, it may not hurt to seek the help of a counselor or therapist. Don’t be afraid to take a deeper look into your emotions. Was the passing of this person truly rough on you or is it a trigger to some other emotion that you have yet to resolve in your figurative heart? Does this event remind you of something similar that may have taken place in your life?
Seek out others who are struggling like you. Join a support group.
Usually, these groups are reserved for the families, however you may find that there is some benefit to be had by linking up with others who are also struggling with death. Death can indeed be a scary and a confusing time for all involved. Most people don’t understand why it happens. Sometimes the sadness can be too much for a person to endure. Finding others who have the same problem and seeing how they are managing it can be beneficial. Lenity Light Hospice of Texas has support resources such as these to guide you through your grieving process for both families and staff members. You may find that their coping methods may be perfect for you.
Put your thoughts into words. Keep a journal.
This is an easy method for expressing yourself. Not everyone feels comfortable enough to speak with a co-worker. Perhaps you haven’t worked at that facility for very long or you just don’t feel close enough to the staff there. That is perfectly fine. Keeping written record of your moods, feelings, and thoughts concerning a patient death may be helpful. No matter how personal you believe your writings are, despite your best efforts to keep these documents private, there may be prying eyes nearby, never put identifiable patient information into your journals.
Take care of yourself.
It goes without saying that eating well and getting adequate rest are essential in being able to function properly and think clearly. We all know that not getting enough sleep can lead to increased levels of stress, irritability, and restlessness. These, coupled with lack of sleep, can cause negative emotions to be amplified if not kept in check.
Unhealthy and non-productive things to avoid
Finding ways to “self-medicate”.
Some people, rather than deal with pain or acknowledge it, they’d rather escape it. In this case, alcohol can become a crutch. Now, your average nurse that has had a pretty tough day may treat themselves to a glass of wine, especially when they are not returning to work the next day. However, one must make sure to not consume alcohol in dangerous quantities. Trying to essentially “numb” the pain is not going to change the outcome of any situation or erase the hurt feelings. Learning how to process those emotions in a healthy way is what’s best for long-term emotional growth.
Self-Isolation
Purposely trying to stay away from others may be more damaging than you realize. Quiet time alone may give a person time to gather their composure, but extended periods of isolation can eventually lead to irrational decisions triggered by temporary emotions. Don’t do it.
Everyone grieves in their own way. Nurses are definitely no different. Many people are actually not used to seeing nurse’s display any sort of emotions. It’s as if we are considered to be robots that can take endless amounts of emotional distress without complaint. No. This is not who we are.
We are all kind, caring, and empathetic people who understand, on some level or another, what it feels like to lose someone you truly care about. Everything that happens in those hospitals and facilities affects us too. If you are struggling with the loss of a patient(s), you don’t need to suffer in silence. Speak up about how you are feeling. You might be surprised that someone else may feel the same way you do.