Supporting Nurses When a Patient Dies.

Abstract

Background: When a patient dies, nurses are often quickly assigned a new patient, leading to frustration due to the lack of time to complete postmortem care, care for the deceased patient's family members, or even take a short break. The trauma that nurses experience when a patient dies is underrecognized and contributes to moral distress, burnout, and thoughts of leaving the profession. To address this problem, we developed and implemented a Post-Death Care Team Protocol as a systematic approach to support nurses in the wake of a patient's death and to better support nurses' emotional well-being.

Purpose: The aim of this program evaluation is to report early focus group and first-year survey data on the impact of the Post-Death Care Team Protocol. Creating and implementing systematic processes that support clinicians' well-being is a complex and iterative process, and this report highlights strategies for success.

Methods: The development and evaluation of the protocol was conducted at a medium-sized hospital in the mid-Atlantic region of the United States. The hospital's staff resilience coordinator developed and implemented the protocol using input from nursing leadership and the hospital administration beginning in March 2022, after a patient's death. The protocol was specifically designed to support the nurse who was assigned to the deceased patient, including protection from immediate additions to the nurse's work assignment, time for one additional short break, and continuing workload protections for the remainder of the shift. The protocol was evaluated using an institutional review board-approved mixed-methods approach (qualitative focus group study and descriptive survey study). Two small focus groups were conducted to learn more about nurses' experiences after a patient's death and about their experiences with the protocol. Descriptive surveys were emailed to RNs who had been assigned to deceased patients at the time of their death; the nurses were asked to complete the survey within about a week after the death. Survey responses from 69 nurses who were associated with 148 patient deaths (a 46.6% response rate) were collected in the first year of protocol implementation and were used to evaluate protocol use, perceived helpfulness, and impact.

Results: Focus group data analysis showed that nurses desire meaningful support after a patient's death, including sufficient time to complete postmortem care and process the event, a supervisor's presence to manage assignment changes, protection from the work overload associated with rapidly arriving admissions, and a reduction in uncompassionate comments from colleagues regarding these desires. Survey results showed that the Post-Death Care Team Protocol was used in 42% of patient deaths in the first year, with rich anecdotal comments highlighting both the positive benefits of using the protocol as well as negative experiences when the protocol wasn't used.

Conclusions: Both focus group and survey findings pointed to process changes that can improve workflow following a patient's death. They also highlighted an ongoing need for culture change regarding the ways in which colleagues can improve support of one another after a patient's death. The protocol addresses system improvements designed to provide meaningful support to nurses and foster institutional culture change concerning nurse well-being in one of the most heart-wrenching aspects of clinical care delivery.