How do nurses cope with death? By talking with one another. This strategy presents itself repeatedly in the literature, blogs and nurse forums. Regardless of the source, one thing is very clear, nurses know the benefit of talking about patient deaths with one another for comfort, debriefing, support and the ability to continue caring for other patients.

Adaptive Coping

Nursing Today urges nurses to practice adaptive coping to deal with patient deaths instead of avoidance and emotional distance. Adaptive coping strategies help to reduce stress, rather than adding to it. For example; when faced with noisy, hungry children and pressure to make dinner after a long day at work, adaptive coping skills would lead the person to leave the room for 15 minutes to refocus. Screaming at the children to quiet down is an example of a maladaptive coping strategy.

The Problem with Avoidance

Avoidance and emotional distance can exacerbate stress. Even when the situation makes withholding one’s emotions appropriate, doing so will take its toll on the nurse. It can compound the sense of loss. Robert S. McKelvey, MD, a professor of psychiatry at Oregon Health and Science University, Portland, and author of the book, “When a Child Dies: How Pediatric Physicians and Nurses Cope” says that nurses who don’t allow themselves to process grief, “…may feel reluctant to get close to other patients, have difficulty with personal relationships or have trouble sleeping or eating properly.”

Examples of Adaptive Coping Strategies

Many nurses say they practice adaptive coping strategies to deal with the death of patients. One of the most powerful examples was posted on the Nursing Today blog:

Rowena Orosco, RN, BSN, was a nurse at the Johns Hopkins Bayview Burn Center in Baltimore. A family with seven children was brought to the hospital after a fire destroyed their home. The one survivor, a 7-year-old girl, was transferred to the burn center with burns over 70% of her body. As the medical team worked desperately to save the girl, Orosco sat with her, crying and holding her hand as she died. This moment still haunts her 15 years later.“I  got through that day, but after that I thought about quitting,” Orosco said. Instead, she attended a debriefing, leaned on colleagues, talked with one her co-workers frequently, and stayed on the job. “You kind of put your emotions aside because there are other patients waiting for you,” she said.

“You kind of put your emotions aside because there are other patients waiting for you,” Rowena Orosco, RN, BSN said.

Nurses on the allnurses.com blog shared their adaptive coping strategies:

“I find peace in praying for the patient, family, my coworkers, and myself. I hold on to my faith that there is something greater after this life.”

Michelle, RN, CPN. Perianesthesia, hematology/oncology, Driscoll Children’s Hospital

“You have to learn to take time, even if it’s 30 minutes for lunch or five minutes to take a breather during those heavy days. Find an outlet; gym time, walking, talking to fellow nurses who understand what you’re going through, or family, friends who you can just vent to. You’ve got to have some ME time with interruptions. I have a lot of faith in God. Especially on those emotionally trying days.”

Jenny Martinez, RN. Med-Surg, Driscoll Children’s Hospital

“You remember the difference you have made in every patient’s life. Even if the outcome wasn’t what you had hoped and prayed for, know that you had a positive impact on that patient and their family through your care and compassion. Let that give you peace for today and encouragement to wake up and do it all over again tomorrow.”

Candace Mayle, DNP, APRN, CPNP-AC. University of Arkansas for Medical Sciences in the Department of Pediatrics.

“It may sound insensitive but as an ER nurse, I learned how to be stiff in dealing with patient deaths. We can have up to five patient deaths per shift. Over time, I learned to practice empathic caring rather than sympathetic caring. I would give compassionate nursing care for my patients but not to the point that I would break down as their health deteriorates.”

T. McAdam, RN, California

“I’m an oncology nurse and you would think that by now I’m used to patient deaths. But there were times that patients will get close to my heart and their deaths will leave me too exhausted to work. During these times, I will do yoga and meditate along with it. I also believe that after all the sufferings they experienced with their illnesses through their death they are now in a better place. A place where there is no more pain and misery.”

H. Scott, RN, Ohio

Developing a Comfort Level with Death and Dying

A study in the Open Journal of Nursing suggests that a nurse’s comfort level with death and dying depends largely on their personal beliefs on the subject. “Nurses who had a more positive attitude towards death were more likely to have a positive attitude towards providing end of life care for patients.” It also found that age and experience level directly impacted a nurse’s ability to cope with death. “Younger nurses (under the age of 30) consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care.”

In general, there are ten strategies that nurses follow to cope with patient deaths.

1. Recognize death is inevitable
2. Give yourself time to grieve
3. Communicate with family members
4. Talk with your colleagues
5. Pray or meditate
6. Give yourself a break
7. Engage in a relaxing trip to reflect
8. Be outdoors
9. Never look for a reason
10. Do not dwell in grief

Nurses are on the front lines of patient care and frequently become close with patients and their families. They hold the patient’s hand during illness and suffering; many are committed to not allowing their patients to die alone. Death becomes up-front and personal, part of a nurse’s daily work. Coping strategies are essential so that they can continue to do their important work caring for patients with empathy and skill.