A program that pairs compassionate companions with dying patients communicates a subtle but powerful message: An organization that puts such care into the way people die must also take great care of the patients who will live.
At first parse, a hospital patient's quality of death couldn't have less to do with the organization's marketing department.
Marketing campaigns focus on how healthcare can help patients cure their ailments and get back to a vibrant life; no one likes to think about how hospitals care for the dying.
But there is another, internal audience that cares very much about quality of death: nurses.
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Sandra Clarke |
And now that Medicare is paying for end-of-life discussions with patients and families, the many hospital marketers whose role encompasses internal communications should consider how a health system's culture around death affects employee satisfaction.
No One Dies Alone at Sacred Heart
It was a nurse who sparked the idea of creating the No One Dies Alone program at PeaceHealth Sacred Heart Medical Center in Springfield, OR. In 2001, a dying patient without family asked Sandra Clarke, a critical care nurse, to stay with him, but she had to tend to one of her seven other patients.
By the time she returned, he had died.
"I reasoned he was a DNR, no family, very old, end-stage multi-organ disease; now he was gone, and I felt awful," she wrote in an essay. "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."
Quality of Death Equals Quality of Care
That experience lead to the creation of No One Dies Alone (NODA), a program where volunteers, called "compassionate companions," sit with dying patients who don't have friends or family present.
"Most of the dying are comatose or nearly so. Occasionally patients are awake, but that is the rare instance," says Anne Gordon, NODA's program coordinator. "Having said that, studies have shown that those who appear to be comatose are still aware on many levels. Hearing is often the last sense to go and can be very acute. It is likely that the dying patient is aware of and comforted by a compassionate presence at the bedside."
A Comfort to Nurses
While ensuring a high quality of death is the program's main goal, the peace of mind it gives to nurses is a substantial collateral benefit. PeaceHealth doesn't formally market the program's existence to external audiences, but it does promote it to internal staff.
In the 15 years since its inception, NODA has become a widely used resource. Since nursing staff are often most aware of patients' circumstances, it is usually nurses who request that NODA activate vigils when they have patients who are alone and for whom death is imminent, Gordon says.
"From the standpoint of nursing staff… No One Dies Alone is a cherished service," she says.
"If you read Sandra Clarke's essay describing her initial experience that gave birth to the program, you'll see the effect of having one of their patients die unattended has on a nurse. They are very busy. And while they would love to be able to sit at the bedside of their dying patients, they aren't always able to do that. NODA is there for the patient and for the staff and as such, it is a much-valued program."
An Unintended Halo Effect
The intentions behind the NODA program are purely care-based, but that hasn't stopped the program from sparking a great deal of interest in the U.S. and across the globe.
"No One Dies alone receives frequent and continual exposure in a variety of publications all over the world," Gordon says. "It is a concept that captures the imagination of healthcare workers and volunteers who aspire to become compassionate companions."
Gordon says she fields calls from all over North America and beyond, recently from the UK, Spain, and Brazil. Though she doesn't actively solicit interest in NODA, she regularly hears from hopeful volunteers and other hospital administrators looking to start a similar program.
As a result of the interest, PeaceHealth sells publications, literature, music, and other supplies designed to help facilities create and run their own program and train bedside volunteers.
"No One Dies Alone is an idea that clearly touches and resonates with people and has for many years," Gordon says. "Upon hearing about the program many people have an immediate heartfelt response. I believe that as members of the human family we are hardwired to care for the dying, just as we care for those being born. It is an innate compassionate quality—one of our finest, I believe."
And while Gordon says she doesn't think about how the program affects how the external audiences perceives PeaceHealth on the whole, one can imagine the community understands that an organization that puts such care into the way people die must also take great care of the patients who will live.
Marianne Aiello is a contributing writer at HealthLeaders Media.