Some of the things you have to do as a nurse, especially if you are in charge, are uncomfortable, weird.
So someone dies. Family is in the room with their loved one sitting at the bedside. Looking bewildered. Another family member comes. Three hours later family is still sitting there. Patient's nurse gently hints at leaving. Family still sits at bedside.
Finally, I go in. I point blank ask them: How much longer do you think you will be, are their more relatives coming, anything I can do for you? They tell me about a half hour more.
I feel like a jerk. Who am I to suggest that they need to have a time limit? But I have to. Its the reality of the ER. Sometimes it seems like people need a push to leave. Sometimes it feels like they don't know what to do.
In the ER, people come in who are dying because something catastrophic has happened and we can't bring them back or they don't want to be brought back. Then after they die, we have to deal with the family of this person we never knew, who are shocked and grieving. We have to help them through the initial loss, even if the ER is bursting at the seams.
10 comments:
Isn't that something the Chaplin can do, or can the family move to another location in the hospital to grieve?
One of the hardest things I ever had to do was pry the body of a child out of his mother's hands to place it in the coroner's van. It was the third 4 year-old child she had lost to sudden death (some weird congenital heart thing?). This was after she had spent several hours grieving in the ER. A nightmare for all involved.
Our facility has a policy:
30 minutes to get the body to the morgue
Never happens.
Sometimes rules are made to be broken.
That has to be one of the hardest things you have to do. Ugh. I would hate it!
I agree with your first commentor, call the chaplain... or a social worker who is people-friendly. Someone who can lead the family/friends to a more-private space to grieve.
Classof65
You guys are assuming that a chaplain or a social worker is available to the ER after hours...
Actually I think your approach with this family is actually the best way of doing it.(Probably because it's the same tack I use.) Direct is best, and I think families actually appreciate the frankness --- but I also tell them there are absolutely no time limits.
The hard cases are the ones where there's a family member they can't contact or who is several hours away. I try then to find a underused room --- even if it's the eye room --- to move the body to, which in the end is better for everyone. Gives the family some much needed privacy and frees up the bed (and our time.)
chaplains and social workers are only available from 9-5. We have another 18 hrs to cover and it usually doesn't happen in the daytime.
I've had to do this a number of times in the ICU, and of course it has to happen in the ER. But, while we are doing it mostly because of space needs, some families need someone to direct them, to keep them going....no one knows what they're supposed to do when a loved one dies. I've met quite a few families who want to spend the appropriate amount of time with their dead loved one, but don't know what that amount of time is and actually ask how long they should stay, when they should leave, etc. Being compassionate guide to families is what we get to do sometimes.
I remember one especially disturbing time from my days in the surgical ICU- we had a patient on and off for about 7 months (3 failed transplants, septic etc)- and the day he died, I was his nurse. Charge comes in and tells me his family has 'about 5 minutes' at the bedside because we need the bed for another patient. Are you for real?! We can't even give them the respect of a half an hour with him? We knew these people intimately after all this time- and now I have to shag them out because some doc in the OR has a bug in his rump about his patient sitting in PACU for a little while? (She was a stable AAA repair).
Suffice to say, I advocated for the family- and we moved him into an empty (unused) area of the ICU so his family could take the time they needed to say goodbye. I realize you have a different situation in the ER- but sometimes the family needs that time to come to grips with what's happened.
I also agree that the direct approach is best, though. I told the family that we needed to get another critical patient up to ICU, and that moving him would allow them to say their good bye without being rushed. They were grateful for the honesty. Just discovered your blog- love it! Keep up the great writing!
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