Posts Tagged good nursing practice

How Nurses Practice

Working on a PowerPoint presentation, and did up this (yet to be formatted) slide:

Which column do you think represents the current state of nursing practice?


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Dying Alone, Continued

Thanks to commenter Pagan Chaplain (Twitter ~ web) for pointing out the No One Dies Alone program, where volunteers under nursing supervision support patients who would be otherwise alone at the end of life. The program was started by Sandra Clarke at Sacred Heart Medical Center in Eugene, Oregon. She cared for a patient in similar circumstances to what I described in my post and felt the same sort of distress:

One rainy night at Sacred Heart Medical Center, Eugene, Ore., I had a brief encounter with a man whose name I cannot recall, a man I shall never forget. He was one of my seven patients, near death and a DNR. During my initial rounds, he asked, barely audible, “Will you stay with me?” He was so frail, pale, old and tremulous. I said, “Sure as soon as I check my other patients.”
Vital signs, passing meds, chart checks, assessments and bathroom assistance for six other patients took up most of the next hour and a half. When I returned he was dead. I reasoned he was a DNR, no family, very old, end-stage multi-organ disease; now he was gone, and I felt awful. It was okay for him to die, it was his time—but not alone.
I looked around; scores of people were nearby providing state-of-the-art patient care. For this man, state-of-the-art should have been dignity and respect.

The last sentence is particularly striking — and true. It speaks to the core of what ought to be good nursing practice. In critical care areas we are sometimes entirely too focussed on the technical/technological aspects of care, when the reality is often much simpler. In the event, the wonder of it is not that such a program exists, but why it took so long for someone to come up with the idea, so obvious it seems in retrospect.

This is how it works:

A staff nurse generally initiates No One Dies Alone by calling pastoral care or, after 5 p.m., the nursing supervisor. The person who has signed up for that date is called. It is totally a volunteer program, and no minimum or maximum time has been set. The “compassionate companion” is provided with a parking pass and a meal ticket. We have a supply bag with a CD player, various CDs, a journal and a bible. We emphasize that any religious behavior will be initiated by the dying patient and not by the companion. Staff and the “compassionate companion” use an evaluation form in an ongoing effort to improve the program.
[. . .]
The reasons individual employees have volunteered are fascinating and as varied as their departments. Hospital carpenters, administrative heads, maintenance workers, nurses, secretaries, and kitchen workers have come forward. Some who come from large families cannot imagine someone being alone; others are alone themselves. One nurse from the cardiac cath lab has seen many die in spite of the high tech environment and care. He wanted to experience once again “why I became a nurse in the first place—to care for those who can no longer care for themselves.”

Other health care facilities operate similar programs, including a pilot project at the Royal Jubilee Hospital in Victoria. One can only hope the practice becomes universal.

Mary Hynes, of CBC Radio One’s Tapestry, broadcast an episode last year dealing with hope at the end of life, which included an interview with Sandra Clarke. It can be found here.

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