No One Dies Alone: A Guide for Creating & maintaining a Volunteer Companion Program for Dying Hospital Patients

by

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Eugene, OR: Sacred Heart Medical Center, 1255 Hilyard Street, Eugene, OR 97401 www.peacehealth.org $20

This manual presents an extraordinary, innovative hospital care program for volunteers who sit with dying patients who are alone - because their relatives could not come to the hospital in time or because they have no available relatives. It offers comprehensive suggestions for developing, introducing, coordinating and supervising the program. It serves people who have no surviving family, no family living nearby when they are hospitalized in terminal condition, or are hospitalized when passing through the city where the hospital is located.

Volunteers are drawn from employees at all levels within and outside the hospital. The program is non-sectarian, seeking solely to provide a human presence for people who are dying without anyone else available.

The program is usually activated by a staff member who calls pastoral care (or, after the normal working day, the nursing supervisor). The volunteer on the roster for that date is phoned. The program is completely voluntary, with no rules or expectations for how long or short a time the volunteer will be present at any deathing. The "compassionate companion' receives a meal ticket and parking pass, and has access to a supply bag containing a CD player with several CDs, a journal to record whatever feels appropriate and a bible. Any reference to religion must not be initiated by the "compassionate companion' but rather by the dying patient. Both the "companion' and the staff use an evaluation form intended to improve the program.

Employees have volunteered from all levels of hospital services and maintenance, including carpenters, kitchen workers, secretaries, nurses and administrative heads. A common reason to volunteer might be a person with a large family of origin who cannot imagine someone being alone at the time of death; other volunteers come forward because they are themselves alone. A nurse from the cardiac cath lab saw many people die despite the high tech care. He wished once again to experience "why I became a nurse in the first placeÑto care for those who can no longer care for themselves."

Sandra M Clarke, CCRN, founder of this program, relates that she worked for fourteen years on the ICU, where no one dies alone. Speaking with nurses from various ICUs, she found what seemed to be an unwritten, universally accepted protocol for attending patients who are dying with no friends or family present. The nurses' other patients' care is covered by other nurses. Rituals of passing are enacted: they may quietly sing, hold the hand of the dying, and in other ways show care and respect while a person passes through the portals of death. Nurses acknowledge their awe at being present for the birth or death of another person. Clarke believes these are innate human responses, "the very essence of humanity."

Clarke states, "I am not an especially pious person. I do have a strong belief in human rights, particularly when a person is most vulnerable. No One Dies Alone has been a profound professional and spiritual experience. It gives both job satisfaction and a raison d'etre. It is a plan which could be readily implemented in any hospital. In time, it may be true that No One Dies Alone."  

(Quotes from article originally published in Supportive Voice, Vol. 8, No. 3, Summer 2002.)

The volunteers often report they feel incredibly enriched by the experiences of sitting with the dying. Here is a report from this manual.

Reflections from Staff

A few weeks ago I had the opportunity to sit with an elderly man in the last hours of his life, through the No One Dies Alone program. When I first got there things were starting to settle down on the unit and it seemed to be fairly quiet and serene. The room was dimly lit, and the patient appeared to be comatose, though his breathing was ragged and uneven. He sometimes gasped and would stop breathing for a second or two at a time. At first I was uncomfortable and I asked the nurse if there was something I could do for him. I hadn't been through the program's orientation yet and didn't know what was expected of me, though the staff members were very nice and kept coming in to see if I needed anything.

I brought a book with me and began reading to the man, whom I'll call Mr. Smith, and I noticed after awhile that his breathing became more even and deep and he seemed to be resting better. By about 11 p.m. the night shift was coming on and the evening shift was leaving. The unit seemed pretty well under control. I was tired of reading, and Mr. Smith continued to rest comfortably. I began to feel like it was sort of a waste of my time to be there. I was really tired since I had gotten up at 4:30 that morning and I needed to be at work the next day. I began to feel a little sorry I'd volunteered for this duty.

Then a young CNA walked into the room. She said she was leaving the area but wanted to tell me how much it meant to Mrs. Smith that someone was going to be with her husband that night. She told me that Mr. and Mrs. Smith had been married more than 60 years and she had felt really bad that she couldn't be with him 24/7. When the nurses had offered the NODA program, Mrs. Smith was amazed and couldn't believe Sacred Heart had a program like that. The CNA told me a little more about Mr. Smith and the difficult time the family was having dealing with his impending passing. It was so obvious how much this young woman cared about her patients. I told her how much I appreciated her going out of her way to stop by and let me know about those things. She told me about how she was working full-time as a CNA and went to school part-time in the hopes of getting into the nursing program at Lane Community College. She said it had been her lifelong dream to work at Sacred Hart as a nurse, and she was so excited to be realizing that dream; she just couldn't believe it.

Even in the dim light I could see the light in her eyes, and her wake of energy and enthusiasm stayed with me through the wee hours of the morning. That night, she helped me to remember that everything we do can just be a job or it can be a calling... it can be something we do or something we are. I could either be sitting all night with an old man in a coma, or I could be providing comfort to a grieving wife and to a man who was transitioning from his time here on earth.

I was with Mr. Smith until 4 the next morning, when the next volunteer came in to sit with him. I got a couple of hours sleep, showered and came into the office. Later I went back up to the unit to see how Mr. Smith was doing. I learned he had passed away at 8 that morning, just before Mrs. Smith got there. The other volunteer had been with him, though, and the nurse said Mrs. Smith was just so grateful he hadn't been alone.

In the past few weeks I've thought about that night and the example that CNA has been to me. I've often been proud to say I work at Sacred Heart, but since that night I've also been proud to work with the people here and to be a part of the way lives are touched and changed by the care we all provide. I'm sure that little gal doesn't know about the legacy she passed on, but I hope I can pass it on to someone else here, and they'll pass it on, and they'll pass it on, and on and on.

--Jan Steigleder, Medical Staff Services.

See more reports from volunteers in this program as shared in the article of Cindy Clair in this issue of IJHC.

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