Nurse Launches Program to Ensure No Patient Dies Alone

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By Debra Wood, RN, contributor

Ideally, people will pass from life to death surrounded by loved ones or a nurse but, often times, patients lack friends and family willing or able to stay with them. And nurses are often too busy these days to sit with a terminally ill patient. In an effort to ensure that patients make the journey in the presence of a caring person, a number of hospitals around the country have launched No One Dies Alone or compassionate companion programs.

“It’s extremely important to patients,” said Lori Caldwell, RN, BSN, an occupational health nurse and a No One Dies Alone volunteer at Mission Hospital in Mission Viejo, California. “A lot of us involved in the program sense this as a moment in a person’s existence that is best to be with someone, even if it’s a stranger. It’s someone who cares. Nursing staff would love to be at the bedside continuously during the dying experience but, time wise, often can’t. We are volunteers who step into that role.”

Mission began its program in 2007. The volunteers, many from the hospital’s spiritual care service but also from other departments, stay three or four hours with the dying person and may play soft music or hold the patient’s hand.

“It’s a very unique experience for everyone,” said Caldwell, describing it as moving for the volunteer. “Those of us who volunteer have a sense we can assist people and be there during those moments.”

Sandra Clarke, CCRN, a nurse at Sacred Heart Medical Center in Eugene, Oregon, is credited with having initiated the concept of a No One Dies Alone program, about caring for a patient who was near death who had asked her to please stay with him. She answered, “Sure, as soon as I check my other patients.” But by the time she rounded on her other patients and returned, the man had died, and she felt terrible.

That prompted Clarke to establish No One Dies Alone at her facility. It took her some time to convince people of the need and the benefits, and the program launched in November 2001. She has also developed a guide and materials other hospitals can use to begin similar programs and has sent information to more than 900 hospitals. 

“This is a win-win,” said Clarke, explaining that staff nurses no long feel guilty about not being able to stay with a dying patient. Volunteers find the experience changes them and prepares them about what to expect with death.

The volunteers make sure the patient is warm, comfortable and clean.

“Those last hours are not undignified and they are not abandoned,” Clarke said. “The idea is not to abandon them on their last journey.”

Providence Alaska Medical Center designed its program with Clarke’s help in 2006. About 52 volunteers, including 16 hospital employees, agree to take call four times per month and sit with patients for two- to four-hour shifts. The volunteers provide comfort-care measures to imminently dying patients at the hospital or its affiliated nursing home and assisted living facility. The volunteers receive four hours of training.

“Nurses love our program,” says Kathy Archey, program coordinator in palliative care at Providence Alaska. “The volunteers are seen as advocates and can tell the nurse if the patient is in pain or having congestion.”

Archey said the volunteers find it fulfilling, receiving immediate feedback that they are making a difference in someone’s life by providing companionship at the end of life.

“It’s not a difficult program to put into place, but medical centers have to have the commitment to want to do something like this,” said Archey, indicating that many of the hospital’s patients live in remote rural areas surrounding Anchorage, so Providence may have had a greater need than other facilities for such a program.

The Palliative Care Service at Montefiore Medical Center in New York took a different approach to supporting patients with limited family and friend support. It established, in collaboration with the Jewish Board of Family and Children’s Services, an end-of-life doula program in 2007, paring a patient at end of life with a volunteer willing to establish a one-on-one relationship over time with the ill, socially isolated individual.

Ronit Fallek, the manager of Montefiore’s supportive and complementary care programs, said patients report feeing less depressed and anxious when they have someone at their side.

“It’s heartwarming,” Fallek said. “And the providers are happy to have something else to offer people.”

The volunteers provide emotional, spiritual and social support in whatever care setting the patient resides—in the hospital, nursing home, home or hospice. Nurses and other clinicians may refer patients to the program.

The volunteers receive eight weeks of training about the need for self-awareness when working with dying individuals and families, the impact of cultural factors, individual needs as death approaches, spiritual issues and advanced directives. They commit to meet with the patient at least weekly through the course of the person’s illness or until family members arrive. The hospital offers the volunteers ongoing support and meets with them on a regular basis.

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