A lonely patient’s seemingly simple request to his nurse spurred the
creation, more than a decade later, of a unique program that makes volunteers
available to comfort dying patients during their final moments.
Sandra Clarke, CCRN, created the No One Dies Alone program at Sacred Heart
Medical Center in Eugene, Oregon. Hospital employees from every department
volunteer to sit with "elderly orphans" and other dying patients who are on
In 1986, Clarke was working the night shift on the Med-Surg floor, with a
"six- or seven-patient load," she said. As the shift change approached, she
checked all her patients, including an "elderly gentleman who was ‘do not
resuscitate’ and very frail," she said.
He asked her to sit with him and she replied she had to check on her other
patients first—the correct thing for a nurse to do, she noted. When she returned
to him an hour or so later, he had died.
"It was very upsetting," Clarke said. "I felt frustrated. I felt guilty."
Her greatest regret stemmed from the fact that modern hospitals can do so
much for a patient.
"Yet when the medicine bag is empty, probably the greatest thing that a
patient needs is comfort and dignity," Clarke said. "Those two simple things I
couldn’t give to this man."
While that experience left a mark on her, it was years before the program
actually took shape a few years ago when a colleague urged her to write a
proposal for her idea to match hospital staff with dying patients. The program
has been in place for two years.
Clarke described most of those served by the program as "elder orphans" who
have outlived their family and friends. Others may be out-of-town accident
victims traveling on I-5 whose relatives live elsewhere. Still others have been
disowned by family, but the program’s participants make no judgments about why
they may not have family on hand, Clarke said.
The volunteers come from all areas of the hospital, with kitchen workers,
hospital engineers, housekeepers, administrators, nurses, respiratory
therapists, secretaries and medical transcriptionists represented. A therapy dog
soon will go through orientation to participate with its owner.
The volunteers benefit from the program, too.
"It’s enhanced their jobs," Clarke said. "Now they feel a part of what
patient care is about."
She cited a medical transcriptionist who had worked for the hospital for 20
years, yet never had a connection to the hospital’s mission.
Volunteers use the hospital’s internal Web site to enter times they are
available—often before or after their regular shift, or on a day off. They are
called as needed, with the program activated about two to four times a month.
Volunteers have access to a duffel bag with a CD player and calming music, a
journal for the volunteer to record thoughts, a sweater, parking pass, a $2 meal
voucher and a list of important phone numbers.
Volunteers retain their individual styles, with little training on how they
should behave. Indeed, the orientation "is not complicated," Clarke said,
consisting mostly of "the nuts and bolts of how you get into a hospital after
Volunteers do "whatever comes naturally to them," chatting with the patient,
holding their hand or just sitting quietly, she said.
"Some people sing—they wouldn’t want me doing that," Clarke quipped.
Volunteers are moved by the experience, Clarke said, and "realize that this
is a spiritual journey."
"A lot of our volunteers volunteer because they’re alone here and they think
of themselves," Clarke said. "Others have huge families, and they say they can’t
imagine there not being a crowd of people."
Clarke has also produced a manual so that other hospitals can replicate her
program. She describes the evolution simply.
"I grew up as a staff nurse in ICU, and I had a simple idea," Clarke said.
"And it’s grown into this."
Clarke shared her philosophy on death.
"Dying is a natural process," she said. "It’s the natural end to life. It
should be celebrated in some way, and you can’t do that alone."
When Clarke sits with dying patients—some are comatose—she said she thinks
about the person’s experiences, where they have been and what stories they have
"We ignore death in the United States," she said. "It’s not a good thing."
The program is all the more necessary because families "are very scattered"
these days, she said.
With recent attention stemming from a local newspaper article, Clarke said
the volunteer job is more daunting than normal now, with more phone calls coming
in and manuals to be sent out.
She related that her husband, while "very cooperative" about the time she
spends working on the program, has quipped: "You know who’s going to die alone?
I’m going to die alone because you’re going to be at some meeting."
© 2003. AMN Healthcare, Inc. All Rights Reserved.