By “Why are you still holding her hand?” one of my co-workers asked well after the time of death had been called. As I looked down and saw my hand still firmly grasping the frail, lifeless hand of my patient, I really had no answer. Maybe I wanted to make sure she made that journey and that someone, anyone, was holding her hand since no family was there to do it. Maybe since I couldn’t make use of my medically trained knowledge to save her from dying, I felt that this comfort was the only thing I could do for her.
After spending most of my years as a post-surgical nurse, I really had no experience with death. The only thing I knew how to do well, was transfer my patient to the hospice unit so those nurses could expertly help patients and their families make the transition. But, nursing doesn’t serve us or our patients well unless we get out of comfort zones and learn. After a transfer to the stroke unit in my hospital, I certainly added a lot of knowledge under my nursing belt and that included how to deal with death. Here are my best tips:
1. It’s not your fault. It’s instinct for nurses to run scenarios over and over in their heads and try to think what they could have done differently for a better outcome. But despite our best efforts, sometimes the patient is just ready to die.
2. Keep them comfortable. At first, I was unsure how to administer “End of Life” PRN medications. I felt like I was giving TOO much medication. But a Hospice nurse once asked me, “Does the patient look comfortable?” My answer was an immediate NO as I watched my patient struggle to breathe and lay restless. Asking that simple question definitely helps guide your care.
3. Talk to the patient. Even though they may be unresponsive, I talk to my patients just like I would anyone else. I tell them what I’m doing and talk about the weather and what’s going on in the news. I try and continuously comfort and reassure them that everything is OK.
4. Encourage family to talk their loved one and comfort them. I always tell the family to hold their loved ones hands and talk to them about their favorite memories. If anything, it seems to comfort the family as they are often scared to even touch their loved one.
5. Create a calm environment. I try and foster a calm and quiet environment for everyone involved by turning on soft music and offering a cart with snacks. I encourage questions and try to prompt the family with the next steps so that the process is as smooth as possible.
These tips are simple, but they help me care for my patients and families more effectively. It might sound funny, but it takes practice caring for a dying patient. I remember being nervous and finding it difficult changing my mindset from healing my patient back to health to helping them through the journey toward death.
After feeling more comfortable with death, I started to learn what a true honor it is to guide patients and their families during some of the most intimate moments of their lives. It’s up to you, as the bedside nurse, to foster a safe environment during these most troubling times. Now I know that holding my patient’s hand that day was truly a beautiful gift for both her and I, and I am forever grateful that my profession has allowed me to be a part of these moments.
Amanda Lynn Walk, RN
Charge Nurse on the Stroke Unit at St. Clair Hospital
