Lack of communication causes "sudden death"

A few weeks ago I spoke with a friend whose mother had died “suddenly”.  She said that the death was caused by medications.  She shared her grief at her mom’s death, but she talked of another grief, and described it as a total DISTRESS that the mom’s death was caused by medication and that it could have been prevented.I felt her grief over her mothers death.  I also heard this incredible distress and anger about the death of this dear mother being caused, not by dementia, natural dying process… but rather, the distress that this death was an accident.

Because I am a hospice nurse, I felt a need to understand and better support her.  I asked questions to get clarity.   A few basic questions, including the classic question, “Tell me about your mom… how was she over the past six months, four months, two months, one month, three weeks, two weeks, one week, last days, last day….” I love this question.  I love hearing the family tell me the story of the last months and weeks.  It is often in the tellling of this story that the family comes to “see” in a new way, that which is happening or was happening for their loved one.

She told me about her mom’s decline.  If I am correct in remembering this, a picture developed in my mind of a  a steady decline over the last months, weeks and days of her life.  I saw nurses and a doctor who wanted to help her mom become more comfortable.  I saw a team who worked to provide medicaiton to help settle the restlessness and anxiety that the mom was experiencing.  I also saw a health care team who did not communicate effectively to the daughter, the granddaughters that their mother/ grandmother was dying.  Consequently when death occured it was a “sudden death”.

After pondering this for a few weeks I wrote my friend.  “I am such a hospice nurse.  Everything I see, I see through this lens.”  I went on to explain that what I saw from her story was that her mom was declining, that medications were given for symptom management, but that they did not cause the death.  I explained that the mother had been on the medication for months, that it was very unlikely for her to have a reaction that would have caused a sudden death.  I told her that the sad part of the story for me to hear was that she had not understood that her mom was dying.

I received a letter a few days later. She wrote, “After speaking with you and now reading your thoughts below, I realize tragically that I/family were ill prepared!  As much or as little that the staff knew, no one said anything to me about Mom dying.  We were just beginning to realize  on an intuitive level that she was on her way out when she died.  It felt so sudden.”

One of Davidson’s guidelines suggest that staff “Maintain close contact with family caregivers….”  Close contact, helping families see what we see, helping them prepare for the dying of their loved one,…. will help prevent “SUDDEN” death.

 

2 thoughts on “Lack of communication causes "sudden death"

  1. Sad that they have made care givers/RCA’s/Nursing Assistants, have little or no contact with the families. Caregiver are the ones who spend most of the time with the families and patients, they are the ones who have rapport with families and so communication about a loved one dying is much easier.

    • Christine,
      I think that this is slowly changing. The Health Care Assistants provide over 70% of direct care in the Long Term CAre settings. Current research is linking the Case Assistants with the “nursing family”. Research in the east is looking at “Quality palliative care in long term care” and one of their main areas of focus is on strengthening the care workers. The LPN is replacing the RN in most facilities. The Care Assistants are doing much of the work that was once done by the LPN/RPN… So, perhaps this will shift.
      Warm regards,
      Kath

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