After every patient I have lost, there's always that feeling of "Damn! What could I have done differently?" But usually, I can't process a full answer in my mind because I need to clear that room to receive a new patient.
How well do we cope after losing a patient? We usually don't, we are not allowed time to cope. A few weeks ago I witnessed a couple situations that left me pensive with the way death and dying are handled in our current systems.
Healthcare professionals can be exceptional at providing empathetic quality care, however, we're also humans, we grieve, mourn, hurt and feel very deeply, especially during the many challenging situations often faced when caring for complex patients and families.
A rapid was called as one of our patients became unresponsive after pulling a sheath post angioplasty, he then became apneic and bradycardic for a few seconds, before the atropine kicked in. The nursing supervisor responded to the call, as usual, stood by the door, witnessed the charge nurse holding pressure at the groin site and other nurses pulling the crash cart and dealing with the situation, the supervisor simply yelled into the room to the charge nurse telling her "don't forget to assign those two patients" and walked away. An emergency situation going on and her main concern at that specific time was to clear her bed board.
We were able to stabilize the patient, but the whole situation with the supervisor irritated me, (My charge nurse kept her cool better than I would have). The system aloud no time to deal with a emergency situation before having to move on to the next patient, like nothing happened.
Another situation that struck a nerve was witnessing a nurse lose her patient and while getting ready to "bag and tag" she had 2 patients being picked up for discharge and getting calls for a report on an oncoming transfer. She was given no time to process the death of her patient.
I'm not trying to go all soft on the topic, I understand we need to rise up and move on to the next, but we aren't machines, yet we have become desensitized to it given the nature of our work. But death, either expected or not, shakes up anyone's psyche. It is human to feel grief after witnessing death, especially if you were in charge of that person's life during their last minutes. Psychotherapy and mental health services should be offered for hospital employees at anytime it is needed. It is unnatural to completely forget a patient's death and simply move on to the next like nothing has happened.
Care givers should be allowed time to debrief after a loss and mental health services should be offered. It is one way of humanizing healthcare.
We, however, do not pay much attention to the mental health and psychological wellbeing of nurses and other healthcare professionals after exposure to situations such as the death of a patient we are caring for. We are not provided with, or at the least, offered the option of taking a step back to regroup, to gather our emotional stability, after losing a patient; instead, we are pressured into clearing the bed to receive the next patient.
I fully understand the limitations and ratio of beds to patients needing care, but how can I and my team provide the same quality of care, to this new individual coming into a room where a life was just lost? How can I overcome the fact that I have not quite figured out if I missed something that might've saved the last life before admitting this new one onto my care?
I knew quite well what I was signing up to, and feel I am emotionally strong to deal with death and dying, but we all cope differently. I have witnessed some not take it so well, especially unexpected deaths and code situations, others suppress their emotions and become compassion fatigued, while others take on the whole weight of blame for a death, and still, no counseling is offered. It should be the norm in healthcare facilities to have mental health counseling available for all employees, not only those providing direct patient care; I have also seen housekeepers breakdown after learning of a patient's death because they grew quite fond of the person while cleaning their rooms daily.
We work in a highly emotional demanding field, and I believe more should be sought out to ensure we remain mentally stable and emotionally capable of providing care to our patients. Healthcare professionals should be encouraged to seek counseling after a complex patient case, trauma, a death, or anytime they feel their psychological wellbeing is compromised.
The Dude Nurse
Klaus Campos, BSN-RN