Sunday, January 16, 2005

Pronouncing Death

In most hospitals, an MD must pronounce death. However, with palliative care patients, as the nurse is the one who is watching and caring for the patients continuously, the nurse always makes his/her own pronouncement before asking the doctor to come and officially pronounce. Usually the nurse pronounces her/his own patients' death. Lately, however, I have been pronouncing other nurses' patient's deaths. Either I have been asked by fellow nurses to verify that their patients are in fact dead, because they are not yet confident in making that assessment on their own or, as in the last shift I worked, it was a chaplain who was present at the patient's death who then came searching for the patient's nurse to pronounce. In that case, that patient's nurse couldn't be located immediately, so I went to assess the patient. In that case, immediately after pronouncing the patient's death, I also prepared the patient's body for visitors.

At first, these seemed like isolated events - pronouncing the death of patients I'd had no contact with prior. However, as this has become an ongoing experience for one reason or another, I think I need to give my behavior more thought.

When I am pronouncing my own patient's death, I carry with me a very deliberate peaceful energy as I approach the patient's bed, whether or not there is any family present. But I've noticed, when a co-worker asks me to simply confirm her own assessment, I waltz swiftly into the room, place my stethoscope on the patient's chest, feel for breath sounds, and nod my head affirmatively to the nurse and then swiftly exit in my haste to get back to my own patients. And my behavior is no different whether or not there is family present at the bedside.

I'd noticed this difference awhile ago. And admittedly, the last time it happened, I did slow myself down enough to offer my condolances to the family. I think part of the awkwardness comes from not wanting to interfere with the rapport already established between that patient's family and their nurse. This role, as it is infrequent, is also not clearly defined.

I still don't have an answer - what exactly would be most appropriate. But I do know that minimally I need to slow down. Maybe putting this is writing will help sink it in better.

I hope so.

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