Critical Care: The Sorrowful Side of Nursing

Most men and women go into the nursing field because they have a desire to help others. Nowhere is that aid more indispensable than in a critical care environment. This is where a trained nurse must rise to the occasion to handle not just the physical needs of a patient in critical condition, but his or her emotional needs and those of the immediate family.

Nursing in a critical care unit can present some of the most challenging and unthinkable scenarios, but if you can stomach the sorrow and stress, then you are sure to experience the incomparable rewards that come from this valuable profession.

Critical care nursing involves an array of qualities and medical skills that can help provide for a patient’s care and recovery. When tending to terminal individuals, an emotional attachment, whether great or small, can leave the caregiver with feelings that he or she may have not been prepared to manage. Death due to old age can be difficult, but easier to accept that a sudden and premature death of a young person. Often, even with the best training, caring for someone with an incurable illness can be expressively taxing on a nurse. When grief strikes a caregiver, it can be complicated.

Statistically, accidents, injuries and catastrophic illnesses are the most common cause of death for young people from infants to age 24. A young child that loses a life due to an accident is a tearing experience that is difficult on the family as well as the nursing staff. Everyone is thrown into a crisis situation without warning. Rita James, a critical care nurse, describes how the shock can be impactful: “The family dynamics are so hard at that time, everyone is in need of a lot of support, and accordingly, a nurse must put her own things aside and help the family cope.”

As a nurse who sees patients dying often, James had to learn early that death, like life, is a process. “People in general are afraid of death,” she said. “So once someone is nearing the end, a nurse is really treating the family as well as the patient.”

Grief and mourning are natural reactions to death, and a nurse must be proficient at helping families cope, as well as dealing with the immediate sorrow on a personal basis. The characteristic feelings initially experienced by the survivors are numbness and shock, followed by tears and emotional release. The process, though heartbreaking to watch, must be regarded as a natural reaction to a natural event.

James claims that dealing with death on an ongoing basis affects to the extreme. And she learned early in her career that she had to leave her feelings at the hospital. “For a nurse who cannot detach after she leaves, the experience can be extremely emotionally draining, and repeated anguish can be psychologically unhealthy,” she explained. “I usually require about a minute when I get home to pull myself together and disengage from the tragedy of the day.”

When she turns off the monitors the minute the death occurs, it’s because the beep is so loud it can be daunting. “When I tell the family that it’s over, the loved one is no longer struggling, there is a strong, undeniable sense of peace,” she explained. In dealing with the family of a terminal patient, James maintains that a capable nurse must adapt to different cultures and different styles of grief. “Some people cry out, others throw themselves on top of the body,” she described. “I close the door and let them do what they have to do for hours if needed.”

Critical care nurses as a whole pull together whenever there is a critical event in the unit: “If we notice that a nurse is struggling or overwhelmed at losing a patient, we will quietly come alongside and help her fulfill her medical responsibilities,” she said. “Death can be difficult on everyone, including the nurse.”

Terri Carr, an oncology nurse in New York, learned that in her line of work an emotional attachment to a patient has its pros and cons. “I became really close to a terminal patient and her family,” she said. “We were all on a first name basis, and after months of caring for Natalie, I grew really close to her, her kids and her grandkids.”

The patient’s numerous visits to the hospital offered many opportunities for Carr and Natalie to talk about life experiences, and they shared a great deal about each other during the course of a normal day of care. This natural friendship was important to the patient, because her illness was so severe, and she needed the emotional support of a knowledgeable caregiver. The family began to trust Carr as well, and relied on her for frequent updates, requests and answers to questions about life and death and its process.

“By the time Natalie died, I felt so connected to she and her family that I experienced grief right along with them,” she said. “I thought that as a nurse I could keep my professional hat on and rise above my feelings, but it was an uncontrollable reaction that I couldn’t ignore.”

Death is challenging no matter the department, as Vicki Ransenberg, who works in labor has learned. “Helping to deliver a stillborn is a tremendously upsetting event,” she explained. “Once we announce to the patient that she will be birthing a nonviable fetus, we quickly make arrangements to move her to a different unit so she doesn’t have to endure the agony of hearing other women enjoy their healthy babies.”

Ransenberg understands that sometimes people bring their emotional problems to the hospital along with their physical ailments. Patients can have a tendency, while they lay there feeling lousy, to think about everything that is going wrong in their lives. “I began to realize that I must be a good listener, let them vent their feelings and not give advice,” she explained. “A nurse simply can’t be judgmental, but should offer encouragement whenever possible.”
All of this care, emotional support and medical attention are no small accomplishments. There is a shortage of critical care nurses, who must be RNs, that it is determined to become worse as the baby boomers continue to age. According to a 2000 Department of Health and Human Services study, nurses who provide this type of care, whether in intensive care, cardiac care, emergency rooms and/or postoperative recovery units, account for more than 400,000 of the 1.3 million nurses employed. Critical care nurses are also necessary for home healthcare and other types of clinics and patient care.

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