Posted 11 June 2021 - 16:26
Posted 11 June 2021 - 16:26
Clinical placements
Your first patient death: how to cope and what it teaches you about end of life care
A second-year student explains what she learned from the death of a patient during a placement
A second-year student explains what she learned from the death of a patient during a clinical placement
In the first year of my adult nursing degree, my first clinical placement was on a female respiratory ward, where I helped to care for a patient who was nearing the end of her life.
The patient, who I will call Grace, had been admitted to hospital following breathlessness and pain caused by advanced stage lung cancer. She had chosen to withdraw from active treatment and was following a palliative care plan.
Implementing a do not attempt cardiopulmonary resuscitation notice
Grace had a partner who visited her in hospital every day. The rest of her family lived quite far away, so she didn’t get to see them often.
She had accepted that she was dying and, after discussing it with her partner and the medical and nursing teams, it was decided that a do not attempt cardiopulmonary resuscitation (DNACPR) notice should be put in place.
Although Grace’s partner accepted her decision to withdraw from treatment, it went against the wishes of her wider family, who felt that continuing treatment would extend her life.
But Grace had made it clear that she did not wish to be resuscitated in the event of a cardiac arrest.
The value of advanced planning and good communication in end of life care
In May, the Resuscitation Council UK (RCUK) published its latest guidelines, with a new section on ethical practice. This focuses on advance care planning to promote shared decision-making and using evidence-based communication to improve discussions around end of life care.
Advance care planning and effective communication are essential in delivering good end of life care.
Had discussions not taken place with Grace and her partner before her health deteriorated, her preferences would not have been known and she may not have been able to die with dignity as she wanted.
Grace’s family arrived on the ward just a few hours before she died. They, along with me and her partner, were by her bedside as she died.
The emotional impact when a patient dies
Staff on the ward had cared for Grace on numerous occasions over the previous two years and her death was sad for the whole team.
I had looked after Grace on more than one admission over my 12-week placement and had developed a therapeutic relationship with her. This was the first time I had witnessed the death of a patient and I underestimated the impact it would have on me emotionally.
I felt helpless that neither I, nor the nurses I was working with, could prevent Grace’s death. But by being present at the end of her life, I learned a lot about how to manage my emotions and how to handle the situation professionally and sensitively.
Advice on coping with the death of a patient
- It is okay to show emotion We are all human, and it is natural to be upset when a patient you have been caring for dies. But it is important to remain professional so you can support the patient’s relatives. If you need to, take a moment away from the immediate area so you can collect your thoughts
- Communicate with compassion Effective communication is paramount when caring for a dying patient, as well as after their death. If you feel out of your depth speaking to relatives, get support from another member of the nursing team
- Take part in performing last offices This is the last thing you will be able to do for your patient. Although it can be an emotional experience, it will help you come to terms with the patient’s death and ensure you are treating them with the dignity and respect they deserve
- Reflect on the experience Coping with the death of a patient can be hard, particularly if it is the first time. Writing a reflective account can help you process the experience, understand what you have learned and how you could improve your practice next time
- Get support if you need to Looking after your own emotional well-being is paramount following the death of a patient. Ask for a debrief to help you come to terms with what has happened or talk your peers, colleagues, family or friends. If you feel you are struggling to cope, talk to your practice supervisors or university lecturers so you can get support
- Shadow specialist nurses Most NHS trusts will have nurses who specialise in end of life and bereavement care. Ask if you can spend the day with them while on placement to get a better understanding of their roles and improve your knowledge and skills in this area. It is also a good idea to familiarise yourself with local policies and procedures, as well as national guidance, on delivering end of life care
Supporting the deceased patient’s family
The nurse in charge of Grace’s care had a heavy patient caseload and was called away to see another patient shortly after Grace died. This meant that she was unable to spend any time with Grace’s family after her death.
As I was inexperienced and had only just met Grace’s family, I wasn’t unsure of the best way to support them. They were upset and angry and left the ward quickly after her death.
On reflection, the situation could have been improved by taking them to the relative’s room so they could start to process Grace’s death and ask questions.
Caring for the patient after death
After caring for Grace and witnessing her death, I asked my supervisor if I could help perform last offices, both to show respect and to learn from the experience.
Grace was Catholic and frequently visited the chaplain for prayer during her admission. We respected her faith and her wishes by placing a bible and cross by her bedside on a cotton cloth.
Preparing Grace for the mortuary was an upsetting experience that will stay with me throughout my life. But rather than feeling as though we had failed Grace, I felt content that we had helped her die as comfortably as possible, respecting her wishes and delivering person-centred, dignified care at the end of life and in death.
‘As a student, caring for a dying patient is invaluable for personal and professional development and it is important not to shy away from death’
Later that day, all the ward staff came together to share our feelings and talk about the effect Grace had on the whole ward. My mentor, who knew this was the first patient death I had experienced, explained the importance of a debrief after someone dies and gave me time away from the ward to collect my thoughts. This helped clear my mind so I could continue with the rest of my shift.
Reflecting on experiencing the death of a patient
Caring for Grace helped me to understand how respecting a patient’s wishes, values and cultural beliefs, before and after death, are paramount to providing quality nursing care.
It also helped develop my confidence in discussions about end of life care, highlighted the importance of communicating effectively with family members, and made me more emotionally resilient.
As a student, caring for a dying patient is invaluable for personal and professional development and it is important not to shy away from death. The care you give to a patient at the end of life is just as important as care delivered at any other time, for the patient and their loved ones.
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