News :How Nurses Cope with Patient Mortality

Posted on Wednesday, March 25, 2009

“It has changed my view of life,” nurse Beth Josolowitz told Mark Somerson of the Columbus Dispatch in a January 11, 2009 article, talking about death. A hospice nurse at Nationwide Children’s Hospital in Columbus, Ohio, Josolowitz provides care and comfort to children who will never realize their dreams and parents struggling with the realization that they will outlive their child.

“There are no words to describe what it’s like to be with a family at this time,” said Josolowitz in reference to professionals who confront death every day and how they cope with the constant emotional drain of their work. It’s an issue that hospice nurses like Josolowitz and her nursing colleagues working in critical care units and long-term care facilities across the country grapple with every day.

While children’s hospice may seem the most daunting because young patients have had so little time to experience life, nurses in many settings live with the daily struggles of patients who are facing their final days. They bear witness to the intimate struggle against the gradual, but inexorable, loss of abilities as the body and mind deteriorate and patients grieve for their own mortality. As death nears, the care and comfort of the patient’s spirit becomes as important as caring for his physical needs. “With hospice, it’s no longer curative care,” explained Josolowitz, “it’s comfort care. It’s support; it’s helping people live out their wishes for their final months, weeks and days.”

It’s a myth that nurses focus solely on the clinical details of care to distance themselves from the pain and suffering of their patients. There is no “off switch” for compassion. More often than not, nurses connect with their patients on an emotional level to provide quality care. In doing so, they can’t help but be moved by their patients’ daily struggles. Josolowitz said that she takes time to cry. In front of the families for whom she has become an anchor she may only shed a trickle of tears; but in private, often on the car ride home after an exhausting day, she breaks down and sobs. She has come to understand the importance of grieving as a way of recognizing loss and reaffirming the preciousness of life.

It is this acceptance of mortality that allows nurses to maintain their equilibrium when confronted with death and dying. This acceptance enables nurses to refocus their thinking when providing end-of-life care. As patients enter the final phase of life, care focus shifts from cure to comfort. Nurses can derive joy and satisfaction from making the final days of a dying patient’s life comfortable. Quality nursing care at the end of life goes beyond making a patient pain free. It involves providing a ready ear and a comforting word.

“In the journey toward death, patients need to relieve their anger; they need to talk about their fear of dying, their unfinished relationships, and their family’s future without them,” said Rochester General Hospital clinical nurse Zara Brenner, an assistant professor at State University of New York-Brockport, in a 2002 guest editorial posted on Critical Care Nurse online. “Nurses must give patients opportunity and active encouragement to talk these things out.”

There is, consequently, a risk of becoming overly involved in the lives of patients and their families. Life must have balance. Nurses who work in highly-charged emotional settings need to take special care of their own needs – eat well, exercise, sleep, take time for themselves – in order to provide quality care for their patients and avoid professional burn out. Nurses that work every day with patients in critical care, long-term care or hospice situations also emphasize the value of communal support. Sharing experiences, frustrations and emotions with co-workers provides crucial support that helps nurses cope with their own emotions and the sometimes volatile emotions of patients and their families.

While it is important to be compassionate, nurses do need to create some separation between their professional and personal lives. Building a support system with colleagues at work allows nurses to more easily shift focus to personal and family life when the work day ends. Nurses that provide care in patients’ homes can find support through online nurse forums, emails with colleagues, or by occasionally meeting for an early breakfast and a chat before they go on duty.

Many nurses who work with dying patients find solace and comfort in prayer. “I pray to the universe to make this a meaningful time, a pain-free time for the child,” Josolowitz said. “I send prayers that I will be of assistance, that I can make the child comfortable.”

“In order to care for people, you have to experience the loss yourself, create and maintain your own balance, find meaning and purpose in all experiences, even loss,” said Kathy Egan, a certified hospice and palliative nurse, in a June 18, 2001 article by Jose Alaniz posted on NurseWeek online. Egan co-drafted the bereavement module for the ground-breaking three-year End-of-Life Nursing Education Consortium project (initiated by the American Association of Colleges of Nursing in 2000) at City of Hope National Medical Center in Los Angeles.

“It’s a matter of recognizing loss, acknowledging loss, reconstructing those relationships, working in a supportive team environment,” Eagan told Alaniz. “The staff here talks about the people who died; we process the grief. We ask how the family’s doing, even long after the death. We ask the question: What did this experience do for me? What lessons did the dying person give back to us, what can we use to better care for the next patient? That’s how you invest the experience – with meaning and purpose – so you end up with gain, not just loss.”
Sources:
Mortality. It’s part of the job by Mark Somerson, Columbus Dispatch, Columbus, OH, 1/11/09.
Personal experience with hospice nurses, chaplain and caregivers while nursing father through six months of home hospice before his death.
http://allnurses.com/nursing-issues-patient/coping-death-dying-7192.html
http://ccn.aacnjournals.org/cgi/content/full/22/1/11
http://www.nurseweek.com/news/features/00-10/end-life.asp
http://www.nursetogether.com/tabid/100/itemid/13/Dealing-With-Dying-Loved-Ones.aspx
http://findarticles.com/p/articles/mi_m0FSS/is_4_15/ai_n17214423
http://www.nurseweek.com/news/features/01-06/lessons.html

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.