by Exceptional things happen in the cardiothoracic intensive care unit of the Ronald Reagan Ucla Medical Center.
The sick climb from the bed with new hearts and lungs. Machines take over bravely for stalling kidneys, heart valves, bronchial pipes. All patients occur with serious health concerns, and the vast majority recovers or at least on the way to healing.
The unit has 150 nurses, of whom are at least two dozen on the ground at all times. You are there for all of this: every intubation and every needle stick, every setback, every typing back rash. They combine with their patients and support their best interests.
“Our business lives, survives and gets what the patient needs to get there,” said Mojca Nemanic, a nurse in unity.
But sometimes here, despite all efforts of all efforts in the world. Heart strikes slowly and then stop forever. Dwarf fur release a last breath and do not sit down again. People die.
And if there is nothing left to repair, CCRN Lindsay Brant said that the death of a patient can be life -affirming.
This is the ethos behind the community, an initiative that Brant proposed two years ago to support patients, families and employees during the dying process.
The initiative, led by a 12-member nurse committee, offers nurses the instruments to look after a patient until and even after the moment of death. The community enables these supervisors to work hard for the patient’s preferences at the end of life, how they do during their treatment and process their own grief after a loss.
“Survival and relax someone is such a beautiful story,” said Brant, a 12-year-old veteran of the unit. “Why shouldn’t death and the transition be just as important?”
The idea for the community began with Marbel, one of Brant’s first patients in their early years in the intensive care unit.
The nurses in the unity speak of patients in widths to preserve their privacy, but even pursue the mere contours of Marbel’s story: a wound that is so difficult that it has almost separated her body in two parts; Daily treatments that caused as much suffering as they made it easier.
Marbel had had enough. Their surgeons wanted to. In the frustration, Brant planted herself in front of the door to her hospital room, apart from admission until the doctors recognized what the patient wanted, which was palliative care and peaceful death.
Experience triggers knowledge, said Brant: A system with the noble goal of saving people could sometimes accidentally overlook their humanity.
Brant started a course Care for the dying In the Upaya Zen Center in Santa Fe, she became a certified Death Doula, a person who helps others prepare for the end of life and to support them during the process.
By 2023, she decided to contact her boss, her unit director and CCRN Katrine Murray, with an idea for an initiative, which is referred to as a community.
Murray was immediately interested. The intensive care unit was still from the trauma of the Covid 19 crisis, in which the employees took care of an apparently endless wave of the sick most patients in pandemic.
Studies have found that the nurses in the intensive care unit since the pandemic have a considerable risk of fear, depression, post -traumatic stress disorder and burnout, thanks to the toxic combination of relentless work and the moral stress on the observations of patients suffer and often die without their relatives.
“People who die alone – that was one of the things we will never overcome,” said Murray.
Even before pandemic, intensive care sisters reported dissatisfaction and frustration With hospital proceedings that could not honor the patients’ preferences at the end of life.
A 2018 study From the intensive care unit, nurses found no physical procedures or patient diagnosis that correlated with the combatal control. The death of a patient, said the respondents, are not annoying in themselves.
But they were three times so likely that they reported serious emotional stress when they thought they died that their patient died what they saw as a “bad” death: fear, unheard of their wishes and their dignity, which was overridden by their fellow human beings.
“The dying process is part of humanity, and therefore the process itself must be respected, just how the patients themselves have to be respected,” said Brant.
From June 2023, Brant began to monitor colleagues about their comfort and experience with the care of dying patients. She started small group training and circulated “cheat sheets” of advice for the support of patients and their families.
The community was officially introduced in the summer of 2024. It includes a number of programs that consolate patients and influence death.
In the goals of the nursing component, nurses talk to patients about their hopes of treatment and comfort with extreme measures, conversations that are documented and used to convey the wishes of the patients to their medical team.
The unit became an early user of the UCLA Health’s 3 wishes programWhat helps nurses to carry out the final inquiries for patients and their families: a wedding in the hospital room, a plaster form of the hands of a patient and his spouse, a last trip outdoors (no small performance if you have the armada of medical equipment that has to come).
Brant connected to The threshold choirA national network of volunteers who sing on the beds of the disease and die. Members of the choir’s Westside chapter visit the unit every Thursday to sing patients who need comfort, regardless of their forecast, soothing harmonies.
There is the moment of silence, a ritual after the death of a patient in which nurses and doctors join the patient’s members of the hospital room to honor their death.
And for the staff there is an appearance and share, a quarterly meeting on zoom and personally, to record the challenge of challenging experience with unity. Breathed some people. Some people cry. Some participants say nothing, but write in the chat how much it means to hear colleagues a similar emotion.
The hospital previously made social workers and consultants available to the department’s nurses, but the assumption for their services was low, said Murray. In contrast, they appear and share “just works, because we do it for each other in contrast to someone else,” she said.
At the end of 2024, CCRN Quentin Wetherholt took care of a patient with a long -term illness when he felt a subtle change in her occurrence. He initiated a conversation with the patient, her family and her doctors who checked possible treatment options, almost everyone who had already tried them. After hearing her decisions, the patient said: she no longer wanted life measures.
From this point on, the patient’s attitude was “nothing but joy. It surprised me. Usually when people realize that they are confronted with death, it is a very sad environment. But it was free,” said Wetherholt.
“It was a very difficult street on which she was: a lot of pain, a lot of surgery. And so that she had disappeared so immediately, and she could enjoy her time as she wanted to enjoy – she brought her back to her self -confidence.”
The patient asked the relatives to fly from overseas. She asked for a milkshake. About a week later she died peacefully with the family around her bed.
After the patient’s death, the unit held a show and Share meeting to mourn it and others that had recently passed in unity.
“Before that, it was almost like a proud point – you know that death doesn’t affect me, that’s what I do professionally,” said Wetherolt. “But now it has become such a nice thing to go through with their employees, to have this forum to really heal and not to bring it to bottles.”
Early data is promising: In a survey by the nursing staff five months after the beginning of silence, 92% more felt connected to their patients and families, and 80% felt closer to their teammates. Brant has applied for a scholarship to share the community program with the six other intensive care units of the hospital.
“We are a family here and treat patients as an expansion of our family,” said Brant. “Nursing is the best excuse in the world to love strangers, to treat all of humanity as if it were her closest friend and beloved person. And it is a gift to do this.”
This story originally appeared in the Los Angeles Times.
