Handling Death and Dying

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Outline

Overview

Dealing with death and dying is something every nurse does differently. We do not share the same beliefs and grieving process. In nursing, handling death and dying can be an emotional roller coaster if you work in an acute care setting.

Nursing Points

General

  1. Death and Dying
    1. Death is inevitable
    2. Textbooks don’t prepare you
    3. Everyone deals with death differently
      1. Different beliefs and grieving process
    4. Emotional rollercoaster in an acute care setting
  2. Handling Death and Dying
    1. Advice from a nurse
      1. Unless you work in hospice
        1. Dealing with death sucks
      2. Take a moment for yourself
      3. Talk to chaplain or coworkers
      4. Keep your emotions controlled
      5. You may have other patients that need to see a happy nurse
      6. Show respect for the death
      7. Comforting family may be challenging for some
      8. Figure out what works for you to cope with death

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Transcript

Hey guys. So in this short lesson, we’re going to talk about handling death and dying. So just a little disclaimer. This is not my favorite subject. I don’t like it. I don’t like dealing with it. Basically nursing schools give you all the proper information about it. I’m going to give you a nurse’s perspective about it because it sucks. So with that being said, let’s talk about it. So like you have learned in nursing school, death and dying is inevitable. It’s going to happen. There’s nothing we can do about it, everybody dies. I don’t think you’ve ever met anybody that’s been alive for an indefinite amount of time, we will all dye, it’s going to happen. And because we work in healthcare, because we take care for people that are sick, death happens. Textbooks don’t prepare you on how to handle it. We all grieve differently, we all have different beliefs and we all have a different grieving process.

So however you grieve, whatever your beliefs are, they are different from mine. So that can affect us on how we handle death and dying. This one, I do agree with the textbooks. If you know your own personal beliefs on death and dying, then it kind of helps you deal with it a little easier. However, unfortunately, it can be an emotional roller coaster to deal with death and dying. Especially if you don’t work in that type of environment like a hospice facility. If you don’t work with that every single day and you have to face death, then it can be a little bit overwhelming. So let’s go a little further into this. So here are a nurse’s perspective or nurse’s advice, on how to handle death and dying. Number one, yes, it’s sucks when our patients die. And this affects nurses more that are not in hospice.

Okay. So if you are in an acute care facility, if you are in an ICU, if you are in a med surge floor, or a telemetry floor, wherever you are, it sucks. Sometimes when they pass they may be a DNR and they pass peacefully and you give them some morphine and they go. But usually, it doesn’t happen that way the majority of the time. Especially when you have somebody who’s just going bad, they code and then they die. So it sucks. But my advice, take a moment for yourself after the death of a patient. Again, most of the time when it’s a code and they die, take a minute. This is why I say it can be an emotional roller.

You usually may have about three to four other patients and then you have one that just codes and dies. Guess what? These three to four other patients don’t know anything about it. You can’t tell them cause you can’t violate HIPAA. When you go in the room, they have to see a happy nurse. They don’t want to see a nurse that is crying because they just lost a patient. They don’t want to hear that. This is why as nurses, you’ve got to learn to keep your emotions under control because of other patients that you may have. This is what makes it so hard. This is why sometimes it seems like we can become a little cold or insensitive to death because we have to learn how to keep our emotions under control. Now, some of y’all may disagree with me and that is okay but this is why chaplain is available for us.

Talk to other coworkers, talk about it so that you are able to express your feelings but from my experience, if I have a nurse who was patient just coded and she has three to four other patients, you cannot walk in that other room crying because your one patient just coded. You can’t. You can’t do that. You’ve got to learn how to keep yourself together when you take care of the rest of your patients. Quick story, I had a patient code one night. The body was still in the room. They had not come to pick them up and the ER was trying to send me another patient and I had to stop because it was so overwhelming. I had to just tell the ER, I, I need a minute and you are going to have to wait for me.

You’ve got to stand up for yourself. And if you need to take a minute, take a moment, It is okay. So a little bit more advice. Show respect for the death. I know that sometimes we can get overwhelmed and sometimes you’ll be in a code and some people are laughing and cutting up. Well, you know what? You gotta be respectful especially to the family. And again, this is usually in a code situation or even if it’s not a code situation, be respectful to the patient. It’s their last moments of life. Be respectful if you have to, provide some type of comfort to the family. Go ahead and do that. This is personally one of the hardest things for me to do because when I see a mother, there are no words to express the sorrow of a mother that just lost her child. Or a daughter who is losing their mom or brother or sister or husband who just lost their wife of 20 something years. How do you make them, okay, what do you say? What words do you say? All I can tell you is if they need you to pray with them at that moment, pray with them. If they need you to hold a hand, hold a hand. It’s hard. And the good thing about some hospitals is if they have a chaplain available, call chaplain, get them involved to come consult with family. Because for me personally, it’s hard when I have patient’s families crying, I’m not a consoling person and you know, it just makes it a little difficult, especially when they’re going through the death themselves for their family member. And my last bit of advice is to figure out what works for you to cope with the death.

If you just had a patient in that coded and you need a minute, take a moment. If you’ve got to go in the bathroom and lock the door and cry for just a couple of minutes, do that. If you got to go meditate if you have to go run around if you’ve got to go talk to somebody else, if you, when you leave work, if you need a drink, fine, but when you leave work! find what works for you. Because if you don’t, if you hold all that in, it’s not going to make you a productive nurse. If you’re going to carry it with you, you’re going to carry it with you through your next patient that codes or through your next patient that has passed. Make sure that you figure out what works for you and how to cope with the death. Talk to other people. You’re not the only nurse that’s gone through this. Talk to other nurses or chaplain. Again, whatever it is you got to do, pray, whatever. Because unfortunately this happens often and you have got to learn what works for you to be able to cope with a death of a patient.

So just to recap on the short little lesson, death and dying is inevitable, having a patient that dies is going to happen. Unless it’s a DNR and a peaceful death, you know, for the most part it’s not fun having to deal with it. And as nurses, you have to find out what works for you on how to cope with the patient that’s died and with the family. That is my best piece of advice to y’all is find coping mechanisms. Again, I’m going to recap really quickly. If you got to pray and you got to just meditate. If you got to go work out, if you have to just talk to somebody or if you just need a moment, whatever it is that you have to do, do that for yourself before you move on to provide care for somebody else.

So I hope this little lesson has helped y’all just a little bit with some little tips on handling death and dying. You know, it’ll happen. You guys will get there. Your first patient will die. And I’ve been a nurse for 15 years, and there isn’t a time that a patient doesn’t die, that it still doesn’t affect me. I’m human and it does affect me sometimes. But you gotta figure out how to cope with it so that you can move on. So I hope that again, this has helped you guys and make sure that you guys go out and be your best selves today And anytime that you are faced with any type of adversity or a difficult situation in your nursing careers, and as always, happy nursing, you guys.

 

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Mental Health Prep

Concepts Covered:

  • Studying
  • Substance Abuse Disorders
  • Anxiety Disorders
  • Central Nervous System Disorders – Brain
  • Cognitive Disorders
  • Eating Disorders
  • Medication Administration
  • Depressive Disorders
  • Personality Disorders
  • Psychotic Disorders
  • Trauma-Stress Disorders
  • Bipolar Disorders
  • Developmental Considerations
  • Concepts of Mental Health
  • Health & Stress
  • Psychological Emergencies
  • Somatoform Disorders
  • Communication

Study Plan Lessons

08.01 Psychological Review for CCRN Review
Addiction – Behavioral Problems Nursing Mnemonic (The 5 D’s)
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alcohol Withdrawal Case Study (45 min)
Alcoholism – Outcomes Nursing Mnemonic (BAD)
Alprazolam (Xanax) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alzheimer – Diagnosis Nursing Mnemonic (The 5 A’s)
Ammonia (NH3) Lab Values
Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
Antianxiety Meds
Antianxiety Meds
Antidepressants
Antidepressants
Antipsychotics
Antipsychotics
Anxiety
Anxiety Disorders (PTSD, Anxiety, Panic Attack) for Certified Emergency Nursing (CEN)
Atypical Antipsychotics
Benzodiazepines
Benzodiazepines Nursing Mnemonic (Donuts and TLC)
Blood Urea Nitrogen (BUN) Lab Values
Bulimia – Signs and Symptoms 1 Nursing Mnemonic (BULIMIA)
Bulimia – Signs and Symptoms 2 Nursing Mnemonic (WASHED)
Buspirone (Buspar) Nursing Considerations
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Carbamazepine (Tegretol) Nursing Considerations
Chloride-Cl (Hyperchloremia, Hypochloremia)
Chlorpromazine (Thorazine) Nursing Considerations
Cholesterol (Chol) Lab Values
Cognitive Impairment Disorders
Creatinine (Cr) Lab Values
Day in the Life of a Hospice, Palliative Care Nurse
Day in the Life of a Mental Health Nurse
Defense Mechanisms
Defense Mechanisms
Dementia Nursing Mnemonic (DEMENTIA)
Depression
Depression Assessment Nursing Mnemonic (SIGNS)
Depression Concept Map
Diazepam (Valium) Nursing Considerations
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Dissociative Disorders
Divalproex (Depakote) Nursing Considerations
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Encephalopathy Case Study (45 min)
End of Life for Progressive Care Certified Nurse (PCCN)
End-of-Life and Palliative Care (Organ and Tissue Donation, Advance Directives, Care Withholding, Family Presence) for Certified Emergency Nursing (CEN)
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Generalized Anxiety Disorder
Glomerular Filtration Rate (GFR)
Grief and Loss
Grief and Loss
Haloperidol (Haldol) Nursing Considerations
Handling Death and Dying
Head to Toe Nursing Assessment (Physical Exam)
Homicidal and Suicidal Ideation for Certified Emergency Nursing (CEN)
Hypochondriasis (Hypochondriac)
Lamotrigine (Lamictal) Nursing Considerations
Lithium (Lithonate) Nursing Considerations
Lithium Lab Values
Liver Function Tests
Lorazepam (Ativan) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
MAOIs
Meds for Alzheimers
Mental Health Course Introduction
Metabolic Alkalosis
Methadone (Methadose) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Mood Disorders (Bipolar)
Mood Stabilizers
Mood Stabilizers
Nurse-Patient Relationship
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Depression
Nursing Care Plan (NCP) for Dissociative Disorders
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Bipolar Disorder
Nursing Case Study for Mania (Manic Syndrome)
Olanzapine (Zyprexa) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Palliative Care for Progressive Care Certified Nurse (PCCN)
Paranoid Disorders
Paroxetine (Paxil) Nursing Considerations
Personality Disorders
Phases of Nurse-Client Relationship
Phosphorus-Phos
Post-Traumatic Stress Disorder (PTSD)
Postmortem Care
Potassium-K (Hyperkalemia, Hypokalemia)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Quetiapine (Seroquel) Nursing Considerations
Schizophrenia
Schizophrenia Case Study (45 min)
Self Concept
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Sertraline (Zoloft) Nursing Considerations
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Somatoform Disorder Case Study (30 min)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
SSRIs
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Suicidal Behavior
TCAs
Therapeutic Communication
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Total Bilirubin (T. Billi) Lab Values
Types of Schizophrenia
Urinalysis (UA)
Vitamin B12 Lab Values