One of Rosanne Wike’s patients loved the snow. He had worked outside in it throughout his life and liked to look out at it.
Snow covered the ground when the patient’s health took a turn for the worse. Wike, RN-BC, BSN, remembered her conversation with the patient and took action.
”We moved his bed over toward the window and turned it so he could be looking right out the window,” said Wike, assistant nurse manager at CentraState Medical Center in Freehold, N.J. ”When the family came in, they were so happy about that.”
Those accommodations that focus on treating patients as individuals with dignity at the end of their lives are core elements of CentraState’s comfort care program, which nurses started about three years ago as part of a Transforming Care at the Bedside project. Though the program doesn’t have a formal name, its nurses use butterflies and a lavender theme to soothe patients and their loved ones when the patients are at the end of life.
How it started
End-of-life care had been near and dear to Terri McNamara’s heart after the experience of her aunt’s death. McNamara, RN-BC, a CentraState staff nurse, saw how difficult it was for families and wanted instead for them to have a peaceful, beautiful memory of their loved one’s final days.
At the same time, CentraStates med/surg unit was seeing more end-of-life patients with one to two weeks to live who were being treated as typical hospital patients — not with the special accommodations needed to comfort them and their families.
”We needed to do something better for those families,” McNamara said.
The comfort care program was born out of the nurses’ brainstorming for the TCAB project, Wike said.
Butterflies in the hospital
The first priority was to tell hospital staff the patient was at the end of life. McNamara had seen a butterfly in her aunt’s room at another hospital and liked the symbolism of a butterfly transforming into a new phase of life when the patient dies.
So CentraStates staff found lavender butterfly symbols from a floral website, glued magnets on the back and attached them to the patients’ doors. Vice President of Patient Services Linda Geisler, RN, NEA-BC, FACHE, explained to all hospital staff that if they saw a butterfly next to the room number on a door, the patient was at the end of life and should be treated accordingly.
“For example, housekeeping staff knew to ask whether it was OK to enter the room to clean it,” McNamara said. The families are very grateful that they see everyone is being respectful and mindful of what’s going on in their lives, she said.
The nurses continued with the lavender theme because of the scent’s soothing effects, Wike said. They bought lavender soap and lotion to put them in lavender-colored bottles. They bought lamps with purple shades for softer lighting and purchased lavender glass candle holders with flameless candles for each room.
Along with the butterfly, patients receive a satchel with the soap and lotion, along with a journal and pen. At the start of the program, nurses put the packs together themselves. “Now that the program is hospitalwide, they’re kept in a warehouse so any nurse on any floor can call and ask for a hospice pack,” Wike said.
Importance of standing orders
The hardest part of the program, according to McNamara, was to research and create a set of end-of-life standing orders, which took more than six months.
“Before implementing the standing orders, families would choose hospice and have to wait for the physician-ordered evaluation by a hospice nurse,” Wike said.
The nurses could not start comfort measures, such as pain management or anti-anxiety medications, until the evaluation was complete and the hospice nurse made recommendations to the doctor.
“Now, with the standing orders, the hospital nurses can take steps right away to comfort the patient, such as starting a morphine drip and stopping blood draws,” Wike said.
Nurses feel rewarded
CentraState’s nurses feel honored to care for end-of-life patients and their families and to allow them to spend time together.
“The family is going to remember those moments for the rest of their life,” Wike said.
“It’s a special time as a nurse to deal not only with the physical aspects of what’s happening with the patient, but to hold the family members’ hands and let them tell stories about their loved one,” McNamara said.
Families are appreciative of the nurses’ efforts. ”I had one family member say as hard as it was, it made a very sad situation feel very peaceful,” McNamara said. ”That’s all they want is for their loved one to be at peace and not suffer.”
Many write letters after patients die. Wike recalls a letter from one woman who had lost her mother. The woman thanked the nurses for their superb care, noting in a letter to them that “you allowed her the dignity and peace we all desire and deserve.”
Karen Long contributed to the research and writing of this article.
To comment, email [email protected]