Nursing Notes

February 23, 2011

Good Grief: Nurses Cope With Patient Deaths

Filed under: Nursing — Shirley @ 12:12 am
Tags: , , , ,

Here’s an article from Nurse.com that talks about the effect a patient’s death can have on you as a nurse.  We all understand that death is a part of living; we are taught what to do for the recently departed; we are taught how to help those in the last moments of living; we gladly stand up and hold the hand of our patient as that last breath is taken.  It’s part of who we are and what we do as nurses.  The problem, though, stems from the humanity we all share.  We are each touched and scarred by a patient’s death.  We cannot help but be.

Please read this article and initiate similar discussions with your peers.  Until we start processing these events, we can not begin to move on.  All of us need to feel free to turn to our peers to discuss this topic because there really is no one else who can understand.

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Rowena Orosco, RN, BSN, had been working at Johns Hopkins Bayview Burn Center in Baltimore for three years when a family with seven children was brought to the hospital after a fire destroyed their home. The one survivor, a 7-year-old girl, was transferred to the burn center with burns over 70% of her body. As the medical team worked desperately to save the girl, Orosco sat with her, crying and holding her hand as she died. This moment haunts the nurse 15 years later.

“I got through that day, but after that I thought about quitting,” Orosco says. Instead she attended a debriefing, exchanged many tearful hugs with colleagues in the halls, talked a lot with a co-worker and kept working. “You kind of put your emotions aside because there are other patients waiting for you.”

Nursing students might learn how to help family members grieve, but seldom learn how to deal with their own feelings of sadness or loss. Research about how nurses cope with patient death is scarce and mostly anecdotal. But what studies there are suggest nurses go through a unique grieving process when patients die, and how they manage this process is important to their well-being.

Only Human

“We feel that when people die, it doesn’t affect our care, which is absolutely ludicrous because we’re human, too,” says Tina Brunelli, RN, CSN, MSN, ANP-C, a nurse practitioner with Novant Health in Kentucky. Brunelli, who has worked in oncology, hospice and critical care, wrote a concept analysis as a graduate student, published in Nursing Forum in 2005, about how nurses cope with patient death.

Stifling personal emotions about patient death has been equated with professionalism for nurses and physicians. “These fields evolved from the military and there are still feelings of, ‘Suck it up and move on,’” says Robert S. McKelvey, MD, a professor of psychiatry at Oregon Health and Science University, Portland, who wrote a book titled, “When a Child Dies: How Pediatric Physicians and Nurses Cope.”

But in interviews with nurses and physicians about the subject, McKelvey found “nurses, on the whole, did a better job [of coping]. They were more open to talking about these things than their physician colleagues.” Those who allow themselves to go through a grieving process seem to be healthier, McKelvey says. Those who hold it in, he says, “pay a price by not being able to deal with their feelings at the time and place.” They may feel reluctant to get close to other patients, have difficulty with personal relationships or have trouble sleeping or eating properly.

How a nurse responds to a first death — and whether he or she is supported by colleagues and supervisors — seems to affect how that nurse reacts to future losses, says Lisa Gerow, RN, MSN, a doctoral candidate at the University of Kansas, Kansas City, and associate professor of nursing at Tulsa (Okla.) Community College. She is the lead author on a report, published in the February 2010 Journal of Nursing Scholarship, which uses interviews with 11 nurses to describe the grieving process after a patient dies.

Nurses may be especially at risk for problems in coping with patient death if they believe they had some responsibility for it or didn’t do enough to save the patient, Gerow says. Many ICU and ED nurses become angry and upset after seeing very sick or elderly patients die in pain after extreme and futile treatments to prolong their lives, says Catherine Miller, RN, MSN, CCRN, clinical education program manager for the ICU and special care units at Howard County General Hospital in Columbia, Md. They might feel they didn’t advocate enough for the patient to experience a “good death,” she says.

Self Care

Some coping strategies, developed over time, nurses say, include: rituals to help the patient and family feel better, such as bringing the family food; attending funerals or posting obituaries; and praying or drawing strength from spiritual beliefs. Some nurses use exercise and relaxation therapies, such as a hot bath, to help ease stress caused by patient death. “The nurses that care for themselves will grieve better,” Miller says, especially if they recognize their…….[read the rest of the article here]

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2 Comments »

  1. Good Grief Nurses Cope With Patient Deaths…

    […]Nursing students might learn how to help family members grieve, but seldom learn how to deal with their own[…]…

    Trackback by Pro Blogger News — March 1, 2011 @ 10:18 am | Reply

  2. Ourselves, our body, our health….. enhancing self usage towards prevention of illnesses & promoting well-being.
    that what Nurses do 🙂

    Comment by lifenurses — February 3, 2012 @ 7:26 pm | Reply


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