[ad_1]
Something extraordinary happens in the cardiothoracic intensive care unit at Ronald Reagan UCLA Medical Center.
The illness rises from the bed with new hearts and lungs. The machine bravely takes over to spin the kidneys, heart valves and bronchial tubes. All patients enter with significant health concerns, and the majority have been retrieved, or at least on the path to healing.
The unit has 150 nurses and at least 20 are on the floor at any time. They are there for everything: all intubation and needle sticks, all recessions, all odds rebound. They bond with their patients and defend them hard in their best interests.
“Our business survives and survives whatever patients need to get there,” said Mojca Nemanic, the unit’s Critical Care Registered Nurse.
But sometimes, despite everyone’s best efforts, the most common thing in the world happens here too. The heartbeat will stop slowly and forever. The diaphragm releases final breathing and does not contract again. People die.
And when there’s nothing left to fix, CCRN Lindsay Brant said respect for a patient’s death could be life-affirming.
That’s the spirit behind the community, and the initiative Blunt proposed two years ago to support patients, their families and unit staff during the dying process.
1
2
3
1. Lindsay Brandt rings the bell while meeting a fellow nurse before the patient is there. 2. Blunt loves the patient’s hands. 3. Blunt, Left, and unit director Catherine Murray prepares the candles. (Al Cebu/Because of the era)
The initiative, led by a 12-person committee of nurses, gives nurses the tools to care for their patients until and after the death. The community allows these caregivers to work hard to support their patient preferences at the end of their lives, just as they do during treatment, and to process their grief after loss.
“It’s a very beautiful story when someone survives and recovers,” said Brandt, a 12-year veteran of the unit. “Why are death and transitions not that important?”
The community idea began with Marbel, one of the first patients of early Blunt in the ICU.
The unit’s nurses talk about patients in a broad overview to maintain privacy, but even the naked outlines of Marvel’s story are bothered by it. A harsh daily treatment that caused as much suffering as they felt relieved.
Marvel was enough. Her surgeon wanted to push forward. In her frustration, Blunt placed herself in front of the hospital door, leaving her admission until she recognized what the patient wanted: palliative care and peaceful death.
This experience sparked recognition, Brandt said:
Blunt died at the Upayazen Center in Santa Fe, New Mexico, and she became a certified death doula.
By 2023, she decided to approach her boss, unit director, CCRN Katrine Murray, with the idea of an initiative called Community.
Molly Mayville, Allison Kierkegaard and Tony Estrada prepare to enter the patient’s room to sing at the bedside of the chest ICU on the premises from the left.
(Juliana Yamada/Los Angeles Times)
Murray was immediately interested. The ICU was still shaking from the trauma of the Covid-19 crisis, when staff were caring for the seemingly endless wave of the pandemic’s most sick patients.
Research has found that critical care nurses are at risk of anxiety, depression, post-traumatic stress disorder and burnout since the pandemic thanks to the toxic combination of merciless work and the moral distress of patients suffering and often dying without a loved one.
“People die alone – that was one thing we never get through,” Murray said.
Even before the pandemic, intensive care nurses reported complaints and frustration with hospital procedures that failed to respect patient preferences during the terminal stages.
A 2018 study of intensive care nurses found no physical procedures or patient diagnosis correlated with nurse distress. Respondents said witnessing the patient’s death was not perturbed in itself.
Brandt on the left and Murray on the right discuss which patients will be visited by the threshold choir.
(Juliana Yamada/Los Angeles Times)
However, if a patient felt that he was dead that he was perceived as a “bad” death, they were three times more likely to report severe emotional distress.
“Because dying processes are part of humanity, we need to respect the process itself, just as patients themselves need to be respected,” Brandt said.
Starting in June 2023, Blunt began researching colleagues about the comfort and experience of caring for dying patients. She began training small groups and distributed “cheat sheets” advice to support patients and their families.
The community officially launched in the summer of 2024. It covers a band of programs aimed at comforting patients and making meaning out of death.
In the goal of the care component, nurses talk to patients about the extreme measures that are documented and used to communicate their wishes to the health care team, and about the comfort and comfort of extreme measures.
The unit has become an early adopter of UCLA Health’s 3 Wishes program. This helps caregivers to carry out the final requests of patients and their families. There is no hospital room wedding, plaster molds of the intertwined hands of the patient and their spouse, and there is no last trip outdoors.
Blunt cares for the patients in the unit.
(Al Cebu/Because of the era)
Blunt sang at the bedside of illness and connected with the Threshold Choir, a national network of dying volunteers. Members of the choir’s Westside branch visit the unit every Thursday to sing harmonies that will soothe patients who need comfort regardless of their prognosis.
There is a moment of silence. It is a post-death ritual for a patient, in which nurses and doctors join the patient’s loved one in the hospital room along with the patient’s loved ones to honor their death.
Staff also show up and share quarterly sessions on Zoom to report on their challenging experiences with the unit. Some people are evacuated. Some people cry. Some participants may not say anything, but write in the chat how meaningful it is to hear your colleagues voice similar emotions.
The hospital previously made social workers and counselors available to nurses in the unit, but their intakes for services were low, Murray said. In contrast, “We’re doing it to each other, in contrast to someone else, so it’s just working,” she said.
In late 2024, CCRN Quentin Wetherholt was caring for a patient with long-term illness when she felt a subtle change in her attitude. He began a goal of care conversations with patients, her family and doctors who reviewed possible treatment options. After hearing her choice, the patient spoke: she no longer wanted any means to extend her life.
From that point on, the patient’s attitude was “ironically, nothing more than joy. I was caught off guard. Usually, when people realize they are facing death, it’s a very sad environment.
“It was a very difficult road that she was there. Lots of pain, lots of surgeries. And she left it instantly and was able to enjoy her time in the way she wanted to enjoy it.
“Because dying processes are part of humanity, we need to respect the process itself, just as patients themselves need to be respected,” Brandt said.
(Al Cebu/Because of the era)
The patient asked his relative to fly from abroad. She asked for a milkshake. She passed away peacefully about a week later, with her family around her bed.
After the patient’s death, the unit raised and shared a session to grieve for her and others who recently passed the unit.
“Previously, it was like a point of pride. “Death doesn’t affect me. This is what I do for a living,” Wetherholt said. “But now it’s great to be able to do it with my colleagues and really heal this forum and not have to bottle it.”
The initial data is promising. A survey of nursing staff five months after the moment of silence began showed that 92% felt connected to patients and their families, while 80% felt closer to their teammates. Brant applied for a grant to share the community program with six other intensive care units at the hospital.
“We are a family here and treat patients as if they were an extension of their family,” Brandt said. “Nursing is the best excuse in the world to love strangers and treat all humanity as if they were your close friends and loved ones. And what you can do is such a gift.”
[ad_2]Source link
