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    This has become a major fear and worry for me recently, and im wondering how doctors cope with this- as ive exhausted all the nurses, and still havn't had an 'ah ha, thats what im meant to do' moment

    Ive not been round some dying or even a dead person yet, im worried how i'd react, im also worried about communication skills, that i wont say enough, or say the wrong thing and i want to make their last hours as comfortable as possible and not ruin it.

    any tips, experiences or just gentle words of comfort..i know im going to see at least one person die on my clinical placement, the ward sister told me on an average shift atleast one person has a cardiac arrest.
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    Can't say from a nurse point of view but I have done a short placement on a cancer ward and have seen and worked on a fair few dead people.
    I'd say that yes it is difficult but just try and be there for them and their family when they are dying. Some may want to sit and talk, most will likely have accepted their death and in many cases will welcome it. I expect that if it is likely they will die that day they will have family with them and they may prefer to spend their last few hours / minutes alone with family. Its basically just a case of accepting what they want.
    When people die you just have to remember its a natural part of life and that somewhere at the same moment a baby is being brought into the world just about to start their life.
    With communication I'd just say maybe try and observe other nurses just after a patient has died. You'll soon pick up what to do and say.
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    (Original post by anna_spanner89)
    the ward sister told me on an average shift atleast one person has a cardiac arrest.
    :s eh really? I've only seen one person die, ever and it was an AAA...
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    What would happen to them if they weren't there? Its better that you tried to help and save their lives instead of them getting no treatment at all...

    in your profession, you'll simply have to build up experience in terms of communication with that dying person. you can hardly say something wrong because you're already aware that you shouldn't say the wrong things, if that makes sense... but don't treat them as someone close to you? maybe that would bring about deeper emotion and maybe you'll need to steer clear of that?
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    (Original post by carrotboy)
    What would happen to them if they weren't there? Its better that you tried to help and save their lives instead of them getting no treatment at all...

    in your profession, you'll simply have to build up experience in terms of communication with that dying person. you can hardly say something wrong because you're already aware that you shouldn't say the wrong things, if that makes sense... but don't treat them as someone close to you? maybe that would bring about deeper emotion and maybe you'll need to steer clear of that?

    i disagree, sometimes you just can't give any treatment and just need to give pain relief. i'd much rather make a patient whos in their last days comfortable than try and keep them alive a few extra hours longer
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    (Original post by carrotboy)
    What would happen to them if they weren't there? Its better that you tried to help and save their lives instead of them getting no treatment at all...

    in your profession, you'll simply have to build up experience in terms of communication with that dying person. you can hardly say something wrong because you're already aware that you shouldn't say the wrong things, if that makes sense... but don't treat them as someone close to you? maybe that would bring about deeper emotion and maybe you'll need to steer clear of that?
    Quite often patients will have Do Not Resusitate orders on them and so as Anna said your job is just to make sure their comfortable.
    Its when you get into the pre-hospital environment that things tend to become more complicated.
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    (Original post by anna_spanner89)
    i disagree, sometimes you just can't give any treatment and just need to give pain relief. i'd much rather make a patient whos in their last days comfortable than try and keep them alive a few extra hours longer
    sorry in my post i meant 'what would happen if YOU weren't there' by the way.
    Yeah point taken, but you can keep them alive for longer and make their lives a bit more comfortable at the same time can you not?
    You'll be fine i'm sure
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    (Original post by Happy_Holidays)
    Quite often patients will have Do Not Resusitate orders on them and so as Anna said your job is just to make sure their comfortable.
    Its when you get into the pre-hospital environment that things tend to become more complicated.
    Oh sorry i have quite a restricted view on nurses and doctors i forgot about the pre-hospital aspect of it.

    I would have thought that finding the right words to say and the right actions to make would come from experience...i wouldn't know but if i were a nurse/doctor i would hope that my experience along the years allows me to deal with those situations appropriately, maybe i'm wrong
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    I don't know if this will help, but my flatmate is currently on a mental health nursing placement in the psychiatric ward. On her second day, her and another student went into a patient's room to find that she had tried to hang herself with the cord from her jogging bottoms. She was taken to hospital and they got her breathing and everything again and she was taken back the next day.
    I asked my flatmate if this deterred her from mental health nursing, and her answer was:
    "No, because without me, that woman would probably be dead, and her two children would be left without a mother."

    So you could take some solace in the fact that your care is significantly improving the quality of life of these patients for what little time they have left. The best thing you can do is to listen, and to comfort - you don't even need to say anything, sometimes all people need is someone next to them.
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    No matter how much death is a part of life, when it's a 40 year old bloke and his wife and 3 young children are in the waiting area, or an 11 year old child dies, or an 92 year old game bird who has already told you she's had a great innings and isn't scared of death for that matter, it's still a privledged (but often devistating) position to be in witnessing something as private and personal as death.

    Realise you're only human and it's OK to get upset.

    "Debrief" with colleagues after and talk about how you're feeling - don't try to bottle it up.

    Recently, one of my friends got really, really upset in a breast clinic once, having seen the 5th woman that morning get the crushing news of a breast cancer diagnosis. Her consultant at the time has a reputation for being a little inpersonal with staff and does come across as quite stand off ish and 'untouchable'. However, the consultant was amazing with my friend and shared some of her stories of coping with working alongside death and cancer, and they really bonded over the experience.
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    (Original post by Happy_Holidays)
    Quite often patients will have Do Not Resusitate orders on them and so as Anna said your job is just to make sure their comfortable.
    That's the LPC/terminal pathway. DNARs are just that - do not attempt resuscitation (as in active BLS/ILS/ALS resus - not fluid resus etc) - they are not make confortable and let die orders. You still manage their conditions medically, and many people with DNARs signed are sucessfully treated (or at least the life threatening exacerbation of what ever condition they have is) and leave hospital!
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    (Original post by anna_spanner89)
    and still havn't had an 'ah ha, thats what im meant to do' moment
    That's probably because there's no such thing.

    There's no one 'trick' to understanding and coping with dead and dying punters. It's just something insidious that you develop over time.
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    And just why was this topic, in here, of any interest to a civil engineer?
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    (Original post by Renal)
    And just why was this topic, in here, of any interest to a civil engineer?
    Cause that seems to be the done thing in the Medicine forum these days, GD is quiet so lets go advise on things we know **** all about :rolleyes:

    Edit: Moved
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    I was a medic in the armed forces before commissioning. There was one soldier who died on the treatment table right beneath my hands. Im not authorised to declare death so standard protocols were carried out CPR, intubation and defib even though i knew he was gone. At first you have hope but it hits you hard when the eyes roll back and pallor sets in. And when the sputum starts ejecting you know its done. You just need to follow the resus protocols and procedures and know that you tried your best to save life. Sometimes its beyond you and you lose but theres really nothing you could have done.
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    This has been moved to the current medical students forum in the hope that Anna can get some more informed responses from them.
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    Thanks for moving this, i won't get a warning will I though?

    Just a thought, how about coping with the families? I had to call a woman up in australia as she was a mans next of kin, and he had died 3 hours before starting my shift and although i'd never seen him they said it would be 'developing' for me to do it. he was 56yrs old, and she was his daughter, turns out he'd never told her about his bowel cancer- and i had her crying hysterically on the phone for around 10minutes, then i started crying a bit...as, i really felt for this woman, it was so hard

    and lo and behold my ***** of a sister told me that it was 'unprofessional' for me to have started crying, i can see why- as i need to have a professional stance with these issues, but i feel very..scared about being in this situation again
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    (Original post by hotshot)
    I was a medic in the armed forces before commissioning. There was one soldier who died on the treatment table right beneath my hands. Im not authorised to declare death so standard protocols were carried out CPR, intubation and defib even though i knew he was gone. At first you have hope but it hits you hard when the eyes roll back and pallor sets in. And when the sputum starts ejecting you know its done. You just need to follow the resus protocols and procedures and know that you tried your best to save life. Sometimes its beyond you and you lose but theres really nothing you could have done.

    i could never have done that....doing those things to a dead man...when knowing its no point

    what sort of characteristics do dead people/dying people have? I've know about rigor mortis, the 'dying rattle', change of colour etc, but sputum?!
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    (Original post by anna_spanner89)
    This has become a major fear and worry for me recently, and im wondering how doctors cope with this- as ive exhausted all the nurses, and still havn't had an 'ah ha, thats what im meant to do' moment
    There is no ready recipe for what you need to do as everyone is different. Some people get more upset then others. You will find your own ways of coping with those things as you gain more experience. Personaly I do not normally get upset by expected deaths. I have sat with quite a few patients on Liverpool care pathways as they did pass on. It can be very satisfying when you are there with a dieing person keeping them comfortable and making sure they are not alone. What makes me angry and very frustrated is when you are unable to provide those patients with optimal care and they struggle with pain and other symptoms, often alone and forgotten in a side room.

    There have been a few deaths that made me upset. Either becouse I have get to know the patient over prolonged period of time or becouse of the unexpected and often quite dramatic circumstances surrounding it. I was quite lucky in fact that people I worked with on occassions were very supportive. It seems to get easier over time but there always seem to be times when you are cought off guard and it realy gets to you. Normaly when it happens I have a good cry when I get home.

    the ward sister told me on an average shift atleast one person has a cardiac arrest
    That sounds like a lot. What kind of ward is it? We have a few wards where somones dies pretty much every day but majority of those patients are NFR and on Liverpool pathways.

    i could never have done that....doing those things to a dead man...when knowing its no point what sort of characteristics do dead people/dying people have? I've know about rigor mortis, the 'dying rattle', change of colour etc, but sputum?!
    You will do it at some point. There will be planty of patients that suffer a cardiac arrest before a DNR is put in place. You will have no choice but to initiate resuscitation.

    Your death rattle is all the secretions that are pooling in their chest. If you start chest compressions all this sputum is likely to come up-not a pretty sight but quite a natural thing to happen if you think about it.
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    (Original post by anna_spanner89)
    Thanks for moving this, i won't get a warning will I though?

    Just a thought, how about coping with the families? I had to call a woman up in australia as she was a mans next of kin, and he had died 3 hours before starting my shift and although i'd never seen him they said it would be 'developing' for me to do it. he was 56yrs old, and she was his daughter, turns out he'd never told her about his bowel cancer- and i had her crying hysterically on the phone for around 10minutes, then i started crying a bit...as, i really felt for this woman, it was so hard

    and lo and behold my ***** of a sister told me that it was 'unprofessional' for me to have started crying, i can see why- as i need to have a professional stance with these issues, but i feel very..scared about being in this situation again
    Anna, don't beat yourself up about this. It was a completely inappropriate situation to have put you in, either as an HCA or as a student nurse - not sure which role you were in, as you haven't the experience to deal with such a difficult task. The fact it was breaking bad news over the phone makes it even worse than doing it face to face, especially when the NOK is so far away and unaware of her father's illness. Totally inappropriate and your reaction was a perfectly normal one to such a situation.

    As for dealing with death. I still find it very hard and get sad about it but that is okay. It is what makes us human. With time, you do learn to deal with it more easily although it isn't always easy. Talking to other staff can help. Importantly, let yourself develop these skills with time and experience and don't look for a magic solution to dealing with death as there isn't one.
 
 
 
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