Mini thread: Death, Nurses and taking Care of Clinicians.

/1 One of the hardest things a healthcare provider can experience is death.
Either your patients pending death or that of a loved one.

/2 Everyone approaches it differently- Whatever you do, however you approach it, you must be honest; you must be compassionate and you must not hurry.

/3 Mortality is something we all face; and one of the worst things is to hear from a stranger that your death is coming. Sometimes it slow- inoperable cancers, neuromuscular conditions, things like that. Those allow time to grieve, and resources should be made available.

/4 Clergy, social workers, support groups- people facing death in weeks, months or years can still have a good life, and we can help them. They must be honestly informed of their condition, allowed to be angry and scared and to ask questions.

/5 Far harder- for me- are the people who are in acute danger of dying. They look into your eyes and ask “Am I going to die?”
It’s a hard question to answer. Sometimes, like when the early covid patients, we knew, and they could see it in our eyes.

/6 I’d usually say ‘Not if I have anything to say about it.’ Or ‘We don’t allow that here.’ To lighten the mood a little and inspire confidence in our treat.

/7 Sometimes, they’d say ‘Be honest with me. Am I going to die?’
Then you have to do one of the hardest things of all: Be honest.
“It’s possible. We’re going to do everything we can, and you’re in for a hell of a fight, but it’s possible.’

/8 Different people respond differently. Some become defiant, and dig their heels in. ‘I WILL survive’. Some pray and resign themselves to fate.
All are scared. No one wants it to end like that.

/9 About the Nurses: The nurses are unsung heroes in this. We (the physicians and nurse practitioners) can give ‘the talk’ and then leave. The nurses stay. They hold hands, cry with them and ease their fears. They deal with the anger and outbursts and through it all, stay kind.

/10 Nurses are truly unique in that regard.
Death is a hard thing to deal with, for everyone. I’ve watched them care for people who are dying; providing comfort and care to the end.

/11 Even after the end, they wash and care for the earthly remains, and make sure their patient; the one they’re charged to protect is audible for their family to see; so that their last memories will be as good as they can.

/12. I will forever stand in awe of the nurses at the bedside during the pandemic. Many tens of thousands of them fell ill- thousands died. The others who didn’t will bear the scars of this in their hearts and souls for the rest of their lives.

/13 They, like their colleagues in medicine, joined to heal and comfort. Losing one patient is a tragedy. Losing several is a bad day/week/year. Watching hundreds die with you seeing your comrades fall ill around you, knowing your turn is coming? That scars the soul.

/14 What do we do, when our nurses burn out, crumbling under the pressure? Rush new nurses through orientation, and put them on the line. But... poorly oriented and prepared increases risk of burnout, and while they burn out patient care mistakes.

/15 So when you run out of them, you start placing new grads... who’ve had altered clinical and classes due to their universities opening and closing; making them even less prepared. To say we’re facing a crisis in professional nursing is an understatement.

/16 But back to death and critical even stress: How do you prepare clinicians for this level of event?
I’m not sure you can. The scale is something you can’t train for. What you CAN do is look out for people.

/16 Research dome by EMS and the military on acute stress shows that even short breaks can recharge your crews and troops. Planned debriefings and an active, engaged leadership focus on preserving mental health of their front line people would

/17 make a big difference. Even as simple as a manager touching base once a week or so- and asking (really asking) how their people are doing makes a difference. Formal stress management programs would be better, of course.

/18 A large pediatric hospital In my city has a debrief after every critical event-the nurse manager, the social worker, Chaplin and involved staff all sit down and run a structured debrief.

/19 Not only good for figuring out root causes (although it ISNT an RCA) it’s also a great way to check on the people involved.

/20 I tried to implement a similar program in my hospital, but couldn’t get but in. Institutional inertia is hard to overcome.

/21 High stress/mass cal events are rare, but we don’t need to let them wipe out our people. With some proper planning, it can be mitigated.
Wether it’s cost effective to do so to hospital administration is another issue.

/23 I’ll have more thoughts on this ( and cite some evidence) soon, but I’ll sign off for now.

/23 Check on the your nurses in your lives, drink water and change your socks.
Out.

/End thread.