One Nurse's Vision: No One Dies Alone

[Hellllllo Nurse, BSN, RN]

http://www.oregonlive.com/printer/printer.ssf?/base/front_page/1067432492231450.xml

Hospital program means no one dies alone

A nurse, who has earned national attention, calls on 200 volunteers to comfort those at the end of life

10/29/03

INARA VERZEMNIEKS

EUGENE -- And so it has come to this: alone in a hospital bed, no family or friends to hear the last ragged breaths, the sounds of a lifetime ending.

The nurse with the purple highlights running through her hair and a penchant for quoting Mother Teresa -- though she points to the purple as proof she is more Madonna than Teresa -- picks up the phone and punches in numbers.

More than 200 people are on her list: a roster of hospital staff -- housekeepers, engineers, food service workers, administrators -- who have volunteered day and night to come and sit with the dying who have no one else.

It has been nearly two years since Sandra Clarke, a nurse at Sacred Heart Medical Center, launched the program she calls No One Dies Alone, but already her grass-roots effort has earned national attention, and hospitals around the country are asking how they can replicate her idea.

As baby boomers age, as families shrink and settle far apart and as more people choose to live by themselves, the number of those who have no one to be with them at the end of their lives likely will grow.

Even now, Clarke picks up the phone two or three times a month to arrange for a volunteer to sit with someone who might otherwise die alone.

According to the American Geriatrics Society, the size of the older population will double in the next 30 years. By 2030, one in five people will be 65 or older. At the same time, people are living longer and having fewer children, narrowing the circle of family and friends they can depend on as they age.

More people also are living alone. About one in four households consists of a single person, the U.S. Census Bureau says. Among those 65 and older, it's one in three.

"This is only going to get worse," says Dr. Charles Cefalu, chief of geriatric medicine at Louisiana State University medical school in New Orleans. "It's going to become a significant problem."

Answering a call In a hospital, demographic shifts -- the signs of families fragmented and far flung -- play out in the simplest human terms: An elderly man, slipping away, called weakly to the nurse: Please sit with me.

But Clarke was busy, just starting her rounds, with six or seven others who needed her first. It was 1986.

"I'll be right back," she remembers telling him. She'd meant it, too; she hurried to his room as soon as she could. But he already had died.

"That plagued me," says Clarke, 61 and a nursing supervisor.

As she walked the hospital hallways, staff streaming by, she wondered: With all these people working here, wouldn't there be someone who had time to sit with the dying who otherwise would have no one?

For several years, Clarke played with her idea, but it remained just that, an idea -- until one day three years ago, she mentioned it to another nurse. The director of pastoral care overheard Clarke and urged her to write a proposal.

By November 2001, No One Dies Alone was running. And since then, Clarke, an energetic woman who laughs easily and often, the daughter of a professional wrestler turned Hollywood stunt man, has devoted hours to seeing her vision take form.

Today, this is what it looks like: Most of the patients the program serves are elderly. Many have outlived friends and relatives. A few have been abandoned by family. Some have alienated themselves.

Clarke tells the story of one man who died with a hospital engineer at his bedside. When the nursing staff called the family to tell them that they might want to come soon, they said: Good riddance. We hate him.

"Who's to say they weren't right?" Clarke asks. "But I feel at that point, it's not our time to judge."

Others among the dying are far from home -- recent transplants to Eugene, or strangers traveling Interstate 5 when tragedy strikes, and family can't get to the hospital soon enough.

Training with a heart When the nursing staff learns of someone who has less than 72 hours to live, a "do not rescusitate" order and no one else around, they page Clarke, who gets out her list of volunteers and starts to call.

Anyone who volunteers with No One Dies Alone must be employed at the hospital or have at least six months' experience volunteering there. Everyone attends an hourlong orientation, which covers topics such as how to determine whether someone is in pain and how to tell when someone has died. Volunteers get few instructions, though they are told not to talk about religion unless the patient asks.

Clarke urges volunteers to treat the dying person as they would family or friends.

"It has to come from the heart," she says.

For Penny Jones, who works in hospital admitting, that has meant stroking patients' arms, moistening their lips, covering them when they shiver.

For Jim McFerran, a leadership and employee development specialist, it has meant leaning forward and whispering to an elderly woman, as she drew her last breaths, that she was loved, that she would be missed.

For Jim Graham, 67, retired after years of building homes, it has meant playing soft music and offering stories about his own life. " I tell them I wish we could have talked under different circumstances," he says, "but we all come to this place. "

A personal decision Volunteers sign up through a hospital Web page to spend as little or as much time as they like at a patient's side. Some offer to sit until Clarke can summon someone else. Others volunteer to sit all night.

At every orientation, Clarke -- who recently completed a how-to guide for hospitals that want to start their own programs, and has sent 20 copies -- asks each volunteer why they want to do this.

Some say they had a parent or a grandparent or a sibling who died alone and they want, in their small way, to make up for that. Quite a few say they themselves are afraid of dying alone.

"It's not something for everybody, in the sense that being with somebody who is dying causes you to have to think about what that means to you personally," says Barry West, who works in information technology at the hospital and helps Clarke run the program.

"It's the sort of thing that raises unresolved issues, feelings and questions in the person who volunteers."

In many ways, it is as much a program for the living.

Before going to sit with a patient, a volunteer picks up a duffel bag from a battered metal filing cabinet near the hospital's main entrance. Inside is a compact disc player, a few discs, including harp music and Mozart symphonies, a Bible, a journal in which volunteers can write their thoughts, and a stack of notecards.

The notecards were a volunteer's idea -- a way to relay what happens in the person's final hours.

When a patient dies, a card accompanies the body, so that if anyone should claim it, they might take comfort in knowing that someone was there to mark the end.

Inara Verzemnieks: 503-221-8201; [email protected]

Copyright 2003 Oregon Live. All Rights Reserved.

[FutureRNMichael]

That's a cool deal.

[Lecia]

Originally posted by FutureRNMichael

That's a cool deal.

I couldn't agree more.

[jschut, BSN, RN]

What a lovely idea!

[indie]

In Charing Cross Hospital in the early 1970s, my training school, it was part of the general procedure that no one died alone. The head nurse would do whatever it took to free up someone, usually a second or third year student, to stay at the bedside peforming comfort measures until the end.

Even in the years since then, I really don't recall a patient who is known to be dying, dying alone. Somehow wherever I have worked, someone, including myself as I became more senior, has made some sort of comfort person available at the end.

RNs, what's your experience of this?

[nurse2be in ny]

On the student bb recently, someone described a patient dying alone, in restraints, and that image really stayed with me. I'm glad there are caring people out there who are changing that; as I move into clinicals, it's something I'll always be more aware of.

[Dolphin777]

>

Good example of health care workers and uncaring families. When my cat was dying of a stroke, the vet and a nurse were there along with me and my mother (and this animal hospital was very busy, too, but they still made time to comfort a dying cat). Whoever put that patient in restraints deserves to burn in Hell for eternity.

[jnette, ASN, EMT-I]

Was deeply touched reading this. Wonderful. Very much needed.

[TinyNurse, RN]

wow, that is beautiful of the purple hair nurse!!!!! very neat!!

[Dixen81]

Wow...I think every hospital and nursing home should have something like that. What a great idea.

[canoehead, BSN, RN]

I guess I'm in the minority here but I would prefer to die in private. No strangers watching every last gasp and fart- yuck. I agree that having someone die in restaints sounds barbaric. If they were that restless they deserve medication to calm them and make the transition easier.

But no company for me when I croak- shut the door and turn down the lights and I'll be happy.

[SmilingBluEyes]

beautiful...what a beautiful human being and story.