Sandra Clarke, CCRN, initiated what is now available in several hospitals in the USA: a voluntary programme to ensure that nobody is alone in their last days and hours.
The inspiration was one patient, for whom she was responsible, at Sacred Heart Medical Center, Eugene, Oregon. “During my initial rounds” she recalls, “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 [someone not wishing to be resuscitated], 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.
“Since that night I have on occasion mentioned to peers and administrators my idea for putting together a group of volunteers made up of hospital employees who would be willing to sit with the alone and dying. Usually this is met with “Good idea,” and sometimes, “I already give this place enough of my time!” For 16 years my vision quest remained only conversation.
“The past 14 years I have worked where No One Dies Alone—the ICU. Speaking with nurses from other ICUs, there seems to be an unwritten universal protocol for the patient who is dying without the presence of friends or family. One’s other patients’ care will be taken over by nearby nurses. Rituals of passing are acted out: I’ve seen nurses quietly singing, holding the hand of the dying, and, in other manners of behavior, showing care and respect while an individual passes on to death. Nurses know the awe of being present at the birth or the death of another human. I believe awe and privilege is an innate human response at these times—the very essence of humanity….
“’No One Dies Alone’ has been up and running since November 2001. It is still a work in progress with a few things that need to be tweaked, but overall it fills the void for which it was intended…. I am not an especially pious person. I do have a strong belief in human rights, particularly when a person is most vulnerable. No One Dies Alone has been a profound professional and spiritual experience. It gives both job satisfaction and a raison d’etre. It is a plan which could be readily implemented in any hospital. In time, it may be true that No One Dies Alone.
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