End-of-Life Care Specialists Get Creative During COVID-19

Nov. 1, 2021 — In pre-pandemic occasions, end-of-life care professionals tried to ensure family members had been on the bedside when a affected person had solely hours or days to stay. Like many features of drugs, COVID-19 upended that ritual, leaving many individuals to die alone in isolation, restricted to at least one customer for an hour or two or to say goodbye by means of video conferencing.

Determined to not let these be the one decisions, docs and workers on the David Geffen School of Medicine at UCLA tailored their “3 Wishes” end-of-life recognition program, began in 2017, to fulfill the challenges of COVID-19.

The program enlists docs, nurses, and different hospital personnel to create art work, small mementos, and different customized reminders for grieving members of the family and family members. And a brand new research measured its success.

“The incapacity to say goodbye on the bedside brought about misery for a lot of members of the family,” mentioned research creator Thanh Neville, MD.

The initiative engaged sufferers. Participation jumped from a median of 18 sufferers per thirty days within the yr earlier than COVID-19 emerged to 25 sufferers in the course of the pandemic, the research discovered.

At the identical time, the variety of needs accomplished in the course of the pandemic jumped to 969, in comparison with 736 within the yr earlier than COVID-19. People with COVID-19 accounted for about one-third of the 969 needs.

Positive Feedback From Providers

Nurses and different well being care professionals in any other case overwhelmed with care of COVID-19 sufferers welcomed the chance to do one thing optimistic for households, the research, revealed Oct. 8 in Critical Care Explorations, additionally reveals.

“During these tragic months, a number of nurses instructed me how grateful they had been to have a program already in place the place they will provide sufferers and households acts of kindness,” mentioned Neville, medical director of the three Wishes Program and a pulmonologist within the UCLA Division of Pulmonary and Critical Care.

“Caring for sufferers on the finish of life could be emotionally taxing for any well being care employee, particularly these working within the ICU in the course of the COVID pandemic,” mentioned Nathan Goldstein, MD, president of the American Academy of Hospice and Palliative Medicine.

Although the researchers didn’t acquire knowledge on supplier satisfaction particularly, “one might think about that fulfilling the needs of dying sufferers and their households might definitely relieve among the emotional pressure and burden of the well being care employees concerned,” mentioned Goldstein, who was not affiliated with the research.

The Wedding Will Go On

Keepsakes had been the commonest request amongst sufferers. Fingerprint key chains and locks of hair had been among the keepsakes shared with members of the family and family members after dying of the affected person. Three volunteer artists additionally created customized work that integrated affected person fingerprints.

The 3 Wishes staff tailored an infection management measures as properly. To make sure the fingerprint keepsakes of people that died from COVID-19 had been infection-free, for instance, they handled them with ultraviolet irradiation sometimes used for N95 masks.

Not each want concerned a memento. In one occasion, the staff introduced a Mariachi band to the hospital. Another request, relating to a marriage, stood out particularly to Neville.

“I took care of a affected person who was sadly on the finish of her life. Her household instructed me that her son just lately received engaged and it will imply lots of the household if she could be a part of the marriage,” Neville says.

Because the affected person was too sick for discharge, they moved the marriage to the hospital. “Given visitation restrictions, we needed to host the marriage open air and in addition ask for particular permission to have a pair extra guests,” she mentioned. “We reserved the terrace exterior the ICU for the socially distanced occasion.”

The nuptials featured flowers, cake, and the bride and groom dressed for the event. Nurses additionally made a marriage arch utilizing IV poles and bedsheets. “The 3 Wishes staff offered the affected person with a pleasant blanket and pushed her mattress exterior. The affected person smiled in her hospital mattress along with her nurse at her facet,” Neville says.

“It was wedding ceremony to be remembered,” she says. “Seeing the groom, her son, cry tears of pleasure and disappointment made me understand the way it was such a privilege to have the ability to present such patient- and family-centered care.”

Patients and households turn into eligible for the three Wishes Program when the treating staff determines that the likelihood of dying is bigger than 95%. They may take part if a choice is made to withdraw or withhold superior life assist.

During the 25-month research, 523 sufferers and households took half in this system as a part of their end-of-life care. The research included contributors from six grownup ICUs at two hospitals within the UCLA system.

Frontline Workers Essential to Success

Unlike pre-pandemic occasions, when such care was typically delivered by specialists, COVID-19 transitioned end-of-life care to frontline well being care employees on the bedside. Nurses who need to ship compassionate end-of-life care “are unequivocally chargeable for the success of the three Wishes Program,” Neville says.

“These nurses typically stepped up above their name of obligation to offer greater than medical care for his or her sufferers,” she says.

Neville additionally credit assist from UCLA. “I’m grateful that I work at an establishment that believes within the mission of offering compassionate end-of-life care.”

Goldstein describes the UCLA program as “laudable and essential. While the UCLA 3 Wishes program is essential in that it will probably assist present some closure to the affected person and household, which definitely would have advantages to bereaved members of the family, I’d argue that this isn’t a palliative care initiative per se however as an alternative a approach to consolation the households of dying sufferers.”

A Model Initiative for Others

Neville and staff plan to proceed the three Wishes Program, pandemic or no pandemic. They plan to proceed with a number of elements of this system added in the course of the COVID-19 period as properly.

Implementing the three Wishes Program primarily takes initiative, compassion, and willpower, Neville says. “It could be difficult to start out, however it is extremely doable and my staff at UCLA are additionally very happy to assist with suggestions and steerage.”

For extra perspective on adapting end-of-life care in the course of the COVID-19, watch this 4-minute video the place bioethicist Arthur L. Caplan, PhD, shares his ideas.