When Cindy Mueller, RN, MN, MAHCM (Master of Arts in Healthcare Mission), picked up a brochure at another hospital about its No One Dies Alone program, she was astounded. The brochure described how the program provided compassionate companions for patients in their final hours of life.
I thought to myself, ‘I can’t believe I’ve been a nurse 35 years and I’ve never thought of this before. What a travesty to allow someone to journey into everlasting life alone,’ recalls Mueller, the vice president for mission integration at Mission Hospital in Mission Viejo, Calif. It was like somebody throwing water in my face.
She was able to quickly transform that revelation, which occurred in December 2006, into Mission’s own No One Dies Alone program by February 2007. I found [the program] fairly easy to put into place, she says. Probably the most challenging [part] is finding a volunteer coordinator.
The ProcessCindy Mueller, RN
Usually the bedside nurse or charge nurse activates the No One Dies Alone process by calling that volunteer coordinator when patients either have no family or friends to be with them in their final stage of life, or their family and friends are exhausted and need a respite. The coordinator schedules the continuous stream of compassionate companions who sit with the dying patient, providing a gentle presence, a warm hand to hold, peaceful music on a CD, or an attentive ear.
Mission’s No One Dies Alone Program has about 55 volunteers, who include nurses, chaplains, other staff members, and spiritual care volunteers who have been with the hospital for at least six months. Since the program’s inception, 131 compassionate companions have sat vigil with 20 patients for a total of 370 hours.
All volunteers go through an orientation program to discuss the stages, signs, and symptoms of dying, as well as explore how to be a compassionate presence. Participants receive a backpack with peaceful music CDs to play and books to read if the patient wishes.
Mueller patterned Mission’s program after the one Sandra Clarke, RN, started in 2001 at Sacred Heart Medical Center in Eugene, Ore. Clarke, too, had a revelation about the need for end-of-life companionship. But hers came in 1986.
At the time, Clarke, who is now an administrative supervisor for nursing clinical support at Sacred Heart Medical Center, was just starting her night shift on the facility’s med/surg unit. A terminally ill elderly gentleman beseeched her to stay with him. She promised to return after checking on her other patients. But by the time she made it back to his bedside, he had died. I just felt awful, she says. You’re left with such a sense of guilt and frustration.
That experience troubled her for years, even as she transferred to the ICU, where, she says, no one dies alone. But a conversation with Sacred Heart’s director of spiritual care about 15 years after the incident prompted her to assuage her regret by founding the No One Dies Alone program, inspired by Mother Teresa’s belief that everyone should die in view of a loving face.
Clarke has compiled a guidebook to help others who would like to establish programs. It is available at www.peacehealth.org/Oregon/NoOneDiesAlone.htm.
An Honor and a Privilege
Although No One Dies Alone is a volunteer program, not a nursing program, nurses value the service for their patients. I think the nurses feel relieved there is someone there, Mueller says. I think it’s a struggle for nurses when they realize somebody is at the end of life, if they don’t have someone to sit with them.
Nurses have been enthusiastic volunteers in both Sacred Heart’s and Mission’s No One Dies Alone programs. When you speak to them [nurses] about a program such as this, they want to sign up, Mueller says. I think it really speaks to why a nurse goes into nursing — to heal the sick and honor the dignity of the person.
But as volunteer companions, nurses play a different role than they do while on duty, Mueller stresses. When she sits vigil with a patient, even though I’m a nurse, I don’t know the diagnosis, why that person was dying, how old he was — any of those things that typically a nurse would know, she says. There are no nursing functions you get involved in. To be quite honest, once you realize you are there to be a compassionate presence, your focus goes from nursing interventions to something deeper, something about the meaning of life.
As she has sat vigil herself, Mueller remembers wondering about who the person was in the prime of his life. You are contributing to a way that honors the dignity of this person who’s lying in the bed, she says. It’s just a very profound and meaningful experience.