Dear Barbara, Do you have any thoughts or guidance in a situation where you would be the nurse on call going to a death visit for a patient and family you’ve never met? How have you approached that in the past or would approach it now? How would you connect with them and have meaningful interaction when you have not developed rapport with them before?

A great question: First, I introduce myself and shake hands. I know that sounds strange but it gives physical contact and slows things down. I actually place my other hand on top of the joined hands. Physical contact helps bonding. Also be sure to wear your name tag. Then proceed as you would on any first visit.

We do this all the time. We enter tense situations where people are frightened and unsure, with people who have never seen us before. This is what we do: We create a bond of trust with strangers at a first visit. Being on call to a death visit is no different.

Get information from the family or caregiver in a calm manner, “Tell me what is happening.” Then, assess what you have been told and proceed. Be gentle, calm and efficient, and explain yourself as you proceed with your assessment.

After determining death I talk with the family. I tell them that I am going to tidy the room (If a bath is necessary to clean the body, I give the family the opportunity to help me if they would like. No is okay, too.). I straighten the bed, position the body naturally, dim the lights and suggest each person go in alone and say goodbye. If someone is afraid, I offer to go in with them and then am as invisible as possible while offering strength and guidance.

When that is finished, but before I notify the funeral home, I always check to see if there are other people who would like to be there that need to be called. We can wait for them to arrive before the funeral home is called. Once the funeral home is called they will want to take the body ---but they don’t have to be notified until everyone has said goodbye.

This home time with the body is special time. This will be the last opportunity to say goodbye in a natural setting. While waiting for the funeral home to arrive I explain to the family what is going to happen. I suggest the family wait in another room and I will go into the room with the funeral home people while they lift the body from the bed to a gurney. I explain that the body will then be covered and wheeled out to the car.

While the body is being put on the gurney I make the bed with clean sheets and pillowcases {even if it is a hospital bed) and put a memento on the pillow. This can be a flower, picture, stuffed animal, rosary, prayer book, something that I find in the room that is personal. Some hospices have a special memento just for this purpose.

Leave a small light on. There is nothing worse than returning to the room a loved one died in and finding a messy, empty bed in the dark as your first memory after they are gone.

Before I leave I sit with the family and talk. I’ll ask them to tell me about their loved one who just died and if there are other people who need to be notified. Finally, I’ll say to them, “Are there any questions that you want to ask before I leave? Is there anything you want to say?” You want to make sure everyone understands what has happened and what is to follow.

By doing the above you have created a special room and memory. You have helped build a sacred memory from what could have been a lasting nightmare.

Something More about...

My book, The Final Act of Living: Reflections of a Long Time Hospice Nurse, is full of stories about my experiences as a hospice nurse. It offers knowledge and clarity to ease the fear and misinformation about dying and death. It explores the topics of living with a life threatening illness, fear of death, understanding the signs of approaching death from disease, the dying process, stages of death, the normal grieving process, living wills and other end of life issues.