Extraordinary things happen in the CardioCoracic Intensive Care Unit at Ronald Reagan Ucla Medical Center.
Patients are going up with new cores and lungs. The machines valiantly take the faulty kidneys, the heart valves, the bronchial tubes. All patients have serious health problems, and the vast majority have been recovered, or at least on the way of healing.
The unit has 150 nurses, at least two dozen of which are on the ground at any time. They are there for all this: each intubation and needle stick, each reverse, each rebound defying the dimensions. They bind to their patients and recommend hard for their best interest.
“Our company lives, survives and gets everything the patient needs to get there,” said Mojca Nemanic, a nurse authorized in intensive care in the unit.
But sometimes, despite everyone's best efforts, the most common thing in the world is happening here too. The heartbeat slows down and then stop forever. The diaphragms release a final breath and do not contract again. People die.
And when nothing remains to be repaired, the CCRN Lindsay Brant said that honoring him the death of a patient can be affirmed life.
It is philosophy behind the community, an initiative that Brant proposed two years ago to support patients, their families and the staff of the unit during the death process.
1
2
3
1 and 1 Lindsay Brant rings a bell while meeting nursing colleagues before they are patients. 2 Brant caresses a patient's hands. 3 and 3 Brant, on the left and the director of the Katrine Murray unit is preparing candles. (Al seib / for times)
Directed by a nursing committee of 12 members, the initiative gives nurses the tools to take care of a patient until the time of death. The community allows these caregivers to plead as hard for patient preferences at the end of their life as during their treatment and to treat their own sorrow after loss.
“Having someone survive and recovering is such a beautiful story,” said Brant, a 12 -year -old veteran from the unit. “Why should death and transition also be just as important?”
The idea of the community began with Marbel, one of the first Brant patients in its first years in USI.
The nurses of the unit speak of patients in wide contours to preserve their intimacy, but even the bare contours of the history of Marbel are obsessive: a injury so serious that it almost cut its body in two; Exhausting daily treatments that have caused as many sufferings that they have relieved.
Marbel had enough. His surgeons wanted to move forward. Frustration, Brant planted in front of the door of his hospital room, to jump the entrance until the doctors recognize what the patient wanted, who was palliative care and a peaceful death.
Experience triggered an achievement, said Brant: a system installed with the noble objective of saving people could sometimes inadvertently ignore their humanity.
Brant took a course take care of the dying At Upaya Zen Center in Santa Fe, NM, she has become a certified death of death, a person who helps others prepare for the end of life and supports them during the process.
By 2023, she decided to approach her boss, director of unit and CCRN Katrine Murray, with an idea for an initiative called the community.
Molly Mayville, Allison Kirkegaard and Tony Estrada, from left to right, of the Seuil choir are preparing to enter a patient's room to sing at their bedside in the CardioRoracic Usi at Ronald Reagan Ucla Medical Center.
(Juliana Yamada / Los Angeles Times)
Murray was immediately interested. The USI was still in shock from the trauma of the COVVI-19 crisis, in which the staff took care of an apparently endless wave of the most sick patients in the pandemic.
Studies found that nurses in intensive care were at a significant risk of anxiety, depression, post-traumatic stress disorders and professional exhaustion from the pandemic, thanks to the toxic combination of relentless work and the moral distress of the observation of patients suffer and die often, without their loved ones.
“People who die alone – it was one of the things we will never overcome,” said Murray.
Even before nurses in pandemic intensive care reported dissatisfaction and frustration With hospital procedures that have not honored the preferences of patients at the end of their life.
A 2018 study Intensive care nurses have found no physical procedure or patient diagnosis in correlation with the distress of nurses. Attending the death of a patient, said the respondents, was not in itself overwhelming.
Brant, on the left and Murray, on the right, discuss the patients that the threshold choir will visit.
(Juliana Yamada / Los Angeles Times)
But they were three times more likely to report serious emotional distress if they felt that their patient died what they perceived as a “bad” dead: fear, unknown, their wishes and their dignity replaced by those around them.
“The dying process is part of humanity, and therefore the process itself must be respected, just as the patients themselves must be respected,” said Brant.
From June 2023, Brant began to question his colleagues about their comfort and experience with the management of dying patients. She started training in small groups and broadcast “cheating sheets” of advice to support patients and their families.
The community was officially launched in the summer of 2024. It encompassed a band of programs intended to comfort patients and give meaning to death.
In the component of care objectives, nurses speak with patients about their hopes of treatment and comfort with extreme measures, conversations that are documented and used to communicate the wishes of patients to their medical team.
Unit has become a first adopter of the UCLA Health 3 WISHES PROGRAMWho helps caregivers to fill the final requests for patients and their families: a wedding in the hospital room, a plaster mold with the intertwined hands of a patient and their spouse, a last trip outside (no slim, taking into account the armada of medical equipment that must come).
Brant cares about a patient in the unit.
(Al seib / for times)
Brant connected with The threshold choirA national network of volunteers singing alongside patients and dying. The members of the choir chapter visit the unit every Thursday to sing soothing harmonies to patients who need comfort, regardless of their prognosis.
There is the moment of silence, a ritual after the death of a patient in which nurses and doctors join the patient's relatives in the hospital room to honor their death.
And for the staff, there is a presentation and a share, a quarterly session on zoom and in person to debrief on the difficult experiences of the unit. Some people have evacuated. Some people cry. Some participants say nothing, but write in the cat how much it means to hear colleagues expressing a similar emotion.
The hospital had previously put social workers and advisers available to unit nurses, but the adoption of their services was low, said Murray. On the other hand, present and share “work simply, because we do it for each other as opposed to someone else,” she said.
At the end of 2024, CCRN Quentin Wetheholt took care of a patient with a long -term illness when he felt a subtle change in his behavior. He initiated a conversation on the care objectives with the patient, his family and his doctors who examined the possible treatment options, almost all that she had already tried. After hearing her choices, the patient took the floor: she no longer wanted life extension measures.
From that moment, the attitude of the patient “was only joy, ironically. It took me off guard. Normally, when people realize that they are confronted with death, it is a very sad environment to do. But with her, it was released, “said Wetheholt.
“It was a very difficult route on which she was: a lot of pain, a lot of surgery. And so for her to have it just instantly, and she could enjoy her time as she wanted to enjoy it – it brought her her sense of self. ”
“The dying process is part of humanity, and therefore the process itself must be respected, just as the patients themselves must be respected,” said Brant.
(Al seib / for times)
The patient asked relatives to fly from abroad. She asked for a Milk-Shake. She died peacefully about a week later, with a family around her bed.
After the patient's death, the unit held a presentation and sharing session to cry for her and for others who had recently died in the unit.
“Before, it was almost like a point of pride – you know:” Death does not affect me, that's what I do in the life “,” said Wetheholt. “But now it has become such a good thing to live with your colleagues, to be able to have this forum to really heal and not have to bottle it.”
The first data is promising: in a survey of nursing staff five months after the start of silence, 92% felt more connected to their patients and their families, and 80% felt closer to their teammates. Brant asked for a subsidy to share the community program with the other intensive hospital care units.
“We are a family here, and we treat patients as if they were an extension of our family,” said Brant. “Nursing is the best excuse in the world to love foreigners, to treat all of humanity as if it were your friend and your nearest loved one. And it's such a gift to be able to do it. ”
