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CentraState nurses offer caring hearts at end of life

Monday May 5, 2014
Nurse Jacqueline Coughlin, RN, places a lavender-colored butterfly — a symbol of the program — outside of a room for a patient at the end of life.
Nurse Jacqueline Coughlin, RN, places a lavender-colored butterfly — a symbol of the program — outside of a room for a patient at the end of life.
(Photos courtesy of CentraState Medical Center)
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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.

RNs Terri McNamara (from left), Jacqueline Coughlin and Michele Archer are part of CentraState Medical Center’s nurse-led comfort care program.
At the same time, CentraState’s 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 CentraState’s 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.

Rosanne Wike, RN-BC
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 for that, 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 is a freelance writer.

To comment, email editorNJ@nurse.com.
Keys to starting a comfort care program

Nurses should encourage families of patients at the end of life to bring personal effects, such as music or photographs, to the hospital to comfort their loved ones.

One family brought in Frank Sinatra music because the patient loved his music and singing, said Terri McNamara, RN-BC, staff nurse at CentraState Medical Center, Freehold, N.J. McNamara even heard the whole family singing one of Sinatra’s songs to the patient.

“It helped them because it made them feel connected to the patient,” she said.

Here are four more ways to increase the success of a comfort care program, according to McNamara:

Have nursing staff on board with the program, including nurses working weekends, holidays and all shifts.

Develop a standard order set so patients can receive appropriate care quickly.

Focus on the individuality of the patient and family to meet their needs.

Create kits with appropriate items, such as lotion and a journal, in advance.

Source: Nurse interviews