Rubian, Roeylene Joyce G.

BSN 3- B

The Tough Stuff: How to Deal With the Death of a Patient

Hospice nurse, Camille Adair, RN, shares her strategies for honouring the life and death of a patient – and
nurses’ own suffering.

Facing issues related to death and dying is a natural part of nursing – but that doesn’t mean it’s easy. For
some nurses, the death of a patient can be one of the most difficult moments of their career. Nurses deal
with death on a daily basis, so you would think nursing curriculums would cover strategies for coping with
death and dying. Unfortunately, many nursing programs focus only on ensuring students pass the NCLEX.

“I think that we’re ready for a new model that includes nurses learning to care for themselves – and that
means learning to deal with losing a patient,” says Camille Adair, RN. Adair was a hospice nurse for more
than 10 years and created the documentary SOLACE: Wisdom of the Dying. She also developed The Solace
Teachings, an 11-part documentary-based teaching program on death and dying created specifically for
physicians and nurses. Adair shared some strategies that nurses can use to cope.

Practice self-care - Since grief affects the body physically, it’s important to care for yourself in that way.
Make sure you’re getting adequate sleep, squeeze in regular exercise, and eat healthy. “If we don't do our
own inner work and stay connected to our own quality of life, then we can either over identify with the
dying and become lost in that experience or we develop armour for protection.”

Own your story - Often nurses hear so many people’s stories that they lose sight of their own lives and the
lives of their patients, explains Adair. She used to encourage the nurses at the hospice she managed to put
a small keepsake or stone to represent their own lives in their pocket. When the nurse entered the room,
she would place the keepsake at the door. Then the nurse would be fully present for the patient (and try
not to think about his/her own issues outside of the hospital). Then, when it was time to leave the room
the nurse would pick up the object and put it back in her pocket. This practice can help nurses be present
for their patients, but it also reminds them that they are not the patient.

Talk to a grief counselor or your supervisor - In addition to caring for yourself physically, during times of
stress, it’s crucial to care for yourself emotionally. Although hospitals often have grief counselors or spiritual
care, it’s usually only available for the patients’ families, not the staff. “When nurses ask their supervisors
if grief counseling is available, it helps spread awareness about the need for grief services,” says Adair.
She also suggests reaching out to your state nurses association to ask about available resources.

Acknowledge each death - Death may be easier for hospice nurses to process, because they witness death
frequently and help patients and their families go through the natural end-of-life process . “We get to see
patients experience transformative, even healing moments within themselves and with their families. We
saw how they died and are often able to go to the funeral. We process death as a natural, normal part of
life,” says Adair.

However, other nurses may have seen the patients as they suffered through trauma, were in a lot of pain,
or fighting for their lives. Adair created a bridge program at her organization, in which hospice nurses would
share stories about the end of a patient’s life (with permission) to their former oncology nurses. “There was
a continuity of information with the oncology nurses who'd been really involved and had strong attachments.
The patients also wanted them to continue to be aware of their status. That was really powerful,” says
Adair.

Know it’s OK to experience joy - It’s important to give ourselves permission to experience humour and joy
in the face of the dying process. “Any hospice nurse will tell you there’s often an amazing amount of
gratitude and inspiration at the end of a patient’s life,” says Adair. Humour also helps to relieve stress in
unique ways. Death is part of the human experience. It can be very hard, but there’s beauty in it, too.

Heal however you can - Because every nurse and situation is unique, there’s no one-size-fits-all approach
to dealing with death. Each of us has to take time to reflect and process the experience in our own way.
Certain situations can be even more difficult or can cause more pain for a nurse, such as the death of a
child, a sudden death, or a suicide.
As hard as it may be to cope with death, research shows that health care workers who care for dying patients
find meaning and satisfaction in their work.Sharing stories and feelings with trusted colleagues or friends
can help with the grief process.

Sources:
> McGrath, P., & Kearsley, J. (2011, February 08). Caring for dying patients can be a satisfying
experience. Retrieved September 11, 2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033918/
> The solace documentary - Camille Adair, RN -. (n.d.). Retrieved September 11, 2017, from
http://camilleadair.com/solace-wisdom-dying-movie/watch-the-solace-documentary
> https://engage.healthynursehealthynation.org/blogs/8/684

Always be prepared: Coping with death and dying in the ICU

Section Editor(s): Brandolini, Jenna Marie BSN, RN, CCRN
Nursing made Incredibly Easy: September/October 2012 - Volume 10 - Issue 5 - p 4–5
doi: 10.1097/01.NME.0000418038.14878.c2
Department: Editorial

Being a nurse in the pediatric ICU (PICU) isn't all that different from the boy scouts. We both follow the
same motto: “Always be prepared.” In the PICU, we have a plan for everything. Trauma on the way? Sick
admission? Line placement? We have a plan for that. Somewhere in the back of my mind, I have an acronym
or checklist from which to draw. I can tell you what supplies I need, what medications are warranted, and
how to set up the room. Although these checklists aren't fool proof, they're similar to the mise en place in
the culinary world. The more things I have in place, the more prepared I can be for whatever might happen.

We even have a checklist for death. I've helped families make handprints with their dying child. I've cut
locks of hair, played favorite songs, and taken photographs of families on their last days. We've done baths,
performed last rites, faced beds toward Mecca, and consulted with Gift of Life. I've participated in meetings
between families and the medical team—the type of meetings during which we know we have to look parents
in the eye and tell them their child isn't going to grow up. I've been to patients' funerals, hugged families,
and said goodbye with a sense of closure.
After a while, you learn what to say. You tell a family who's withdrawing care that they're doing the right
thing. You tell a father whose praying for a miracle what one ICU mom told me at her son's funeral: “We
don't always get to choose our miracles and maybe it was a miracle that we had him for as long as we did.”
You tell a mother who's about to help her child exit the world that we should all be so lucky to die in the
arms of our mothers. And when you leave your shift that day sad and heavy-hearted, you also leave with a
greater sense of self. Some days at work I don't get to help children live, but I do get to help them die.

In the worst situations, when there's no time for meetings and death is sudden, there's still a sense of closure
in resuscitation. As medical professionals, we're counting every round of epinephrine and each minute of
compressions, until we're convinced that it isn't working, until we're certain that the end result would leave
a family with a child who's nothing like the one they used to know. There's a moment when you see a look
cross everyone's face and you know what you're doing isn't going to work. And then we still go for one more
round so we can take comfort in telling the family that we did everything we could do. As nurses and as
human beings, we all try to do the best we can. But this job is full of unexpected twists and turns and
sometimes no matter how many checklists and plans we have in place, just when you feel like you know the
lay of the land, something comes along that knocks you off your feet. What can you do when you aren't
prepared for your patient to die? More often than not, when situations arise for which we aren't prepared,
as nurses, we simply push on. We fill assignments quickly, turn rooms over, and go about the shift. We aren't
always encouraged to talk about death and dying, especially in situations that don't necessarily go as
planned. Stifling emotions has long been associated with professionalism of medical staff. When a patient
dies, should we act as if death is simply a part of our job? Or is there another way to cope?

Communicating with patients and their families is an integral part of the process of coping with death and
dying. Talk to your coworkers. Work with your medical team to initiate debriefings on particularly difficult
or traumatic cases. You may want to talk to your friends and family, but remember that outside parties
often find it difficult to relate to these intense situations. Many hospitals offer private and confidential
mental health professionals and grief counselors to nurses and staff. Find out if your hospital has a program
and spread the word to your coworkers. Hospitals and supervisors can offer support with the simple
acknowledgment of a patient death. Giving nurses time to talk and grieve together, and admit that death
can affect us, can be extremely helpful.
The truth is, no matter how many lists we have in place, we can't always be prepared. I encourage you to
share your stories. Not only can we learn from them as nurses, but we can also help each other cope as
human beings.

>
https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2012/09000/Always_be_prepared__Coping
_with_death_and_dying_in.2.aspx

Interdisciplinary collaboration, patient education

The importance of interdisciplinary involvement by the total health care team is central to effective patient
care and is an area of JCAHO focus. Although some agencies have achieve excellent interdisciplinary
collaboration, lack of communication among disciplines often creates barriers. Inadequate communication
can lead to disagreements over „turf“ and an inability to collaborate, both between individuals and in team
conferences. Patients are often baffled by various team members who repeat instructions already taught
by someone else. The need to move patients through the health care system in an effective and cost-
effective way means that nurses and other health care professionals must learn ways of providing patient
teaching collaboratively.
Because of nursing’s continuous and visible presence at the patient’s side, nurses are in the unique position
to provide leadership for patient education and to capitalize on the strengths of each discipline for the
patient’s ultimate benefit. Understanding the significant contributions that other health care professionals
can make to patient teaching is an important part of the nurse’s knowledge base. To do this, the nurse
needs an accurate understanding of the expertise of each member of the team.
Physicians help patients understand the health care problem and the treatment plan. Physicians report that
they depend on nurses to help reinforce the teaching they do. Nurses are often asked follow up questions
by patients and families, especially when physician explanations are not in terms the patient understands
or when patients and families have additional questions. Collaboration with physicians increases with good
communication and effective documentation. Physical therapists teach patients and families about mobility
and how to perform functional activities safely. Occupational therapy teaching focuses on how to make
adaptations that enable patients to be as independent as possible in activities of daily living. Physical and
occupational therapists depend on nurses to educate patients about their disease condition and to reinforce
instructions they give, particularly regarding carrying through with positioning, transfers, and the use of
adaptive devices. Nurses‘ active participation in formal team meetings and informal meetings on patient
units or by telephone maximizes the contributions of both disciplines. Dietitians teach patients and families
about therapeutic diets. They assess the patient’s usual dietary patterns and plan with the patient and
family how the customary diet can be modified to achieve health management goals. Dieticians depend on
nurses to reinforce the importance of following the dietary plan and providing feedback about patient
participation. Pharmacists teach patients how drugs work in their bodies, what the medications are for, why
it’s important to take them, how to store them, and how to avoid drug interactions with other medications
and food. Pharmacists often depend on nurses to reinforce information they have given patients. Social
workers serve as an important liaison between the hospital staff and the community. Social workers
coordinate referrals to many different agencies and resources, and provide emotional support to patients
and families. The efforts of social workers are maximized when nurses are able to provide specific
information about the patient’s home situation.

In well-functioning interdisciplinary teams, team members view nurses as their „eyes and ears“- to provide
feedback about patient participation, to share information that may help team members plan and adjust
goals, and to reinforce and follow through with teaching they have provided. In turn, nurse members of top
performing teams communicate superbly, both orally and in writing. They keep communication channels
open, are active participants in team conferences, and provide excellent and current progress notes about
patient teaching results so that other team members are kept continuously informed. Effective teams often
cite specific characteristics that allow them to work well together. Some of the characteristics of effective
interdisciplinary teams include:
• Good communication, both verbal and written, facilitated by planning meetings, patient care conferences,
telephone consultation, good documentation, and the willingness to go „out of the way“ to make sure
communication takes place
• Mutual respect among disciplines, recognizing respective areas of expertise, knowing one’s limits, and
teaching each other
• A desire to work as a team and recognition of a common goal

https://www.euromedinfo.eu/interdisciplinary-collaboration-patient-education.html/