13. Dealing with death and trauma
Inner North Central London Branch
(MFD) That this meeting of RCN Congress discusses the personal and emotional toll on nurses of dealing with trauma, death and dying
Debate report
Dominic Walsh, from the Inner North Central London Branch, asked Congress delegates to discuss the personal and emotional toll on nurses of dealing with trauma, death and dying.
The death of a colleague, who committed suicide, changed Dominic’s approach to the issue. Up until then, he accepted dealing with trauma and death as part of his job. Now his work as a palliative nurse in the community has led to him getting to know his patients more, and he asked: “How do we, as a nursing family, deal with it?”
Members spoke about the privilege of spending the last hours with a patient, but while acknowledging the importance of their role in supporting the family of patients, they stressed the need for support and access to appropriate counselling for staff. “If this doesn’t have an effect on you, perhaps nursing isn’t for you,” said David Jones.
“Nothing can prepare you for your first death,” said Jessica Curtis. The training is helpful but the reality was very different, she said, as she described how the death of a seven week old baby had made a “massive impact” on her career. Spending hours with the baby’s family, doing her last offices and taking her patient to the mortuary was a privilege, she said, and this had a direct impact on her decision to write her dissertation on sudden infant death. Neil Thompson also talked about the first time he faced the death of a patient as a nursing student and he praised the compassion shown by a colleague whose work influenced the rest of Neil’s career.
Margaret McCambridge recounted her experiences of nursing in Northern Ireland during the Troubles. The support of her friends and the informal counselling she received in the nursing home was essential, she said.
David Baker gave delegates a different view, stressing the pressure on staff. When facing the death of a patient he said another consideration sometimes enters his mind. “Shamefully, the first thought is I hope I’ve documented everything. I hope that’s just me, but I fear it’s not,” he said.
Background
When a patient dies, the experience can be very difficult and traumatic for those close to them. This is often described as one of the most profound experiences in life.
What many people often overlook is that the experience can be difficult for the nursing staff involved with the patient’s care. This is particularly true for nurses who care for patients over a significant period of time. In these situations, the nursing staff involved often get to know the patients well and when the patient dies, it can be an emotional time. What impact does this have on the nurse professionally? Is it something that is to be expected, or should something be done to prepare people working in health care for the experience? Is it part and parcel of working in health care? For most people death is something they experience only a few times in life, but for those working in nursing it is much more frequent.
There is little formal research into the issue in the UK, but there has been significant anecdotal evidence of ‘burnout’, stress related sickness and emotional distress.
What we do know is that nurses rarely have the space and time to reflect on issues that they find challenging. Does working in nursing automatically build your emotional resilience, or do we need to pay explicit attention to this aspect of our work?
Some nurses in non-specialist settings believe they do not always have the skills to initiate difficult conversations with people at the end of their lives. As a result, communication issues can arise that result in a poor experience for the patient and their families, and can lead to a higher emotional toll for the staff involved.
Research has been undertaken beyond the UK, most notably in Canada. There, a research-based documentary asked the question: What is the experience of grieving, for obstetric and neonatal nurses caring for families who experience perinatal death? Nurses describe the professional and personal impact of grieving. What helps them, and how the experience has changed them, helping them to grow. One nurse notes that, following the death of an unborn baby, “...no one checks up on you, no one realises the effects it has on you, nothing. It’s just part of nursing.”
The National End of Life Program has resources that nurses can access to help improve their understanding of palliative care issues.
References and further reading
Jonas-Simpson C (Producer) (2010) Nurses grieve too: insights into experiences with perinatal loss, Toronto, Canada: Faculty of Health School of Nursing, York University. Available from: http://patientcommando.com/stories/nurses-grieve-too-insights-into-experiences-with-perinatal-loss/(accessed 14/03/13) (Web).
NHS National End of Life Care Programme (no date) Support & advice [online]. Available at: www.endoflifecare.nhs.uk/support-advice (accessed 14/03/13) (Web).
Royal College of Nursing (no date) Spirituality in nursing care: online resource introduction, London: RCN. Available at: www.rcn.org.uk/development/practice/spirituality/about_spirituality_in_nursing_care (accessed 14/03/13) (Web).
