Picture this, you arrive to work, receive the assignment and mentally begin to prepare for the task at hand. You create an outline in your mind and on paper of how the next twelve hours will go. You receive the report at the bedside, gather your supplies and prepare for your initial assessment. You're told the family is in the waiting room and they want to see the patient. Your patient is ill but stable, for now. You check the patient, check the ventilator, check your drips and make your way out of the room to the supply closet. 

The time now is 1930. Suddenly, you hear the central monitor alarming loudly with sirens of a fatal occurrence. Naturally, your stomach churns, your heart begins to rapidly beat, and you're hoping it is not your room but deep down you know it may very well be. The charge nurse screams your name and you sprint back to your room to find your neighboring nurse performing compressions on your patient as every available body rushes to your and your patient's rescue. 

This is your first cardiac arrest. 

You lock eyes with the clock in the room and realize life and death rest in the hands of the clock. You haven't felt this before and feel the sweat trickling down your back. As the primary nurse, you are the recorder. 

Arriving late, you begin to jumble times and medications on a paper. Each one of your feet feels like it's buried in quicksand; pulling you deep into the ground as the feeling of paralysis settles in your legs. A momentary brain dump occurs as the whirlwind of events unfold. 

The time now, after multiple rounds of epinephrine, defibrillation and compressions are 1943. The attending physician calls the time of death out loud. The team confirms and it is over. 

5 Ways To Maintain Healthy Emotional Boundaries When Your Patient Dies

This is one of those occurrences that no institution, no book, and no rotation can ever prepare you for. This is a reality that inevitably comes upon us, sometimes forewarned and other times when we least expect it. If you’re like me, you’re a giver. Naturally, you develop love, an affection, a deep concern for those you are responsible for caring for. So, rightfully, it hurts to watch a patient go and to have the knowledge of the inevitable reality that the family has yet to accept or believe. 

However, you also need to intuitively understand the need in professional life for a balance between compassion and healthy emotional boundaries. Because in this line of work, you must continue to love, to give, to heal, and to nurture, despite the unfavorable outcomes and endings. Here are 5 ways I’ve come to accept the process of letting go without experiencing emotional and mental paralysis. 

1. Practice silence. In this situation and many others, you won't have the right words or any words at all. Having stood at this station multiple times over, I want you to know that this is normal and okay. Being present with your patient and their loved ones while accommodating them with anything they need is more than sufficient at this time. In many situations, the best way to intervene is to lend an attentive ear. You will not have all the answers but, you most certainly possess the ability to connect and heal through nonverbal communication. 

As humans, we speak through our eyes, touch with our smiles and heal through our spirits. 

These moments will serve as times of prayer, of silence, of smiles, of tears and of joy; all in one. Practice the art of silence. 

2. Be an advocate for all - the patient and the family. Your care extends beyond the bedside - for the patient and for the family. This is one of those times where your advocacy skills will come into play. Allow adequate time for grieving, extended visitation, chaplaincy/Imam involvement, extra tissue/water, and facilitation of open and sensitive communication between patient, family & the interdisciplinary team. 

Understand that people from all walks of life come to the hospital to seek care. They present to us with their illnesses, but they also bring along their cultural and spiritual practices which to them, are an additional component of their healing and sometimes grieving. Having a comprehensive understanding of the sensitive nature and uniqueness each of your patients present will allow you to provide the necessary support they require.

3. Convey empathy when interacting with the Family - share their feelings of loss, if they are open to it. It is a good idea to spend time with the family of the patient both at the bedside and in private throughout the duration of care rendered. This will help you to better understand the dynamics and communication style of the family. If the family has a designated spokesperson that relays information to the remainder of the family members, use them to effectively communicate with the family. High running emotions can lead to miscommunication and misdirected feelings.

4. Treat your thoughts as guests - mortality is undoubtedly frightening but it reminds us to live a purposeful life. Every day of that which has been granted to us is a gift. A priceless gem. Remain in a state of gratitude. Talk to God. Be open to yourself and your thoughts. 

It is important to accept and address the fact that negative outcomes will happen in your professional life. Know that grieving is natural, even in the context of the nurse-patient relationship. Patient deaths are never easy. 

I want you to know it is okay to grieve and mourn. It is okay to feel for your patient. You may be a health care professional, but you're still a human being capable of feeling pain, sadness, and hurt. It's only natural. 

5. Seek assistance - death changes us. It brings forth unprecedented emotions and psychological consequences that we are never fully prepared for. If you need, use this time to seek out the social services provided by your respective institutions or a third party. The role of these professionals is to facilitate conversations and therapeutic modalities that will help you to address these unprecedented feelings and thoughts. 

There is absolutely no shame in talking with other trained professionals to help you compartmentalize everything you have experienced. The name of the game is consistency and longevity. This may be the first time you've experienced the death of a patient, but it certainly won't be the last. 

Article by: Wali Khan, BSN, RN at Nurse.org