Facing the inevitable

The death of a client can hit you like a ton of bricks – unless you are prepared, says Ishbel Straker.

2017 brought me many surprises; some have been amazing, some a whirlwind of negativity, but all have been an opportunity to reflect and learn. My biggest revelation was death – not the fact that people die, but our differing experiences of it as nurses within the addiction field.

Throughout our nursing training we make the assumption that we will experience death – some being more traumatic than others, some needing hands-on experience and others that we see from a distance. We may then go on to believe that working in the field of addiction – where clients place themselves at risk daily and allow physical deterioration – our mental preparation for the experience of death will improve.

Making these assumptions is dangerous and will leave you unprepared for the reality. Shock and grief are odd things and as nurses we are not immune to them. Our clients are different – yes, they are risky and yes, death at times seems like an inevitability – but our role as nurses is to prevent this, so when it happens there can be a lot of blame attached.

We become close to our clients – boundaried, but emotionally invested in them. We want them to succeed and we believe that they will. If we did not have this belief system we would not be doing the job we do, but it leaves us vulnerable to the emotions that come with their death. All of this is made far more stressful by the inevitable, and of course necessary, root cause analysis (RCA), unearthing fears of possible Nursing and Midwifery Council (NMC) involvement even when there is no cause for concern. We are trained to think, ‘what could I have done differently?’ and these thoughts can be incredibly negative if left to fester.

So how do we safeguard our ability to cope with death? I believe the first step is to have a robust system to manage this after the event – supervision, reflection, and perhaps a group debrief to ensure the focus remains on the client and their family members, to maintain some perspective. It’s also to ensure any RCA systems and investigations do not have a punitive feel but are supportive, and most importantly it is to admit that we are not immune to grief, shock and fear when a client dies and understand that all the preparation in the world will not prevent it hitting you like a ton of bricks.

Our reactions are not just about the death of this client, but about the deaths that have gone before – in both our professional and personal lives. Our reactions can also be about where we are emotionally at that time. Of course, as nurses we are all 100 per cent professional all of the time – but it’s good to remember that we are still only human.

Ishbel Straker is a clinical director, registered mental health nurse, independent nurse prescriber and board member of IntANSA

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