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| The CTICU Bereavement Committee: Improving Care at the End of Life By Majella Venturanza, RN; Lucille Sollazo, RN; Todd Isbell, RN CCRN; David Kampel How will I say Goodbye…? Will I have pain? Who do I want to be with before I close my eyes? Will my family or friends be there? Or should I say… be there so that I can say a proper goodbye… Or the clergy to pray for me and be there to console my family and loved ones… My body feels very tired. I do not want to die; but it seems to be my time… It will be ok…? How can we support patients and families facing end of life decisions? What do we do to acknowledge the loss of life in the Cardiothoracic ICU? These were questions one nurse, Lucille Sollazzo, RN, voiced when technology failed and patients’ families were placed in positions where they had to make urgent decision. The Bereavement Committee of the Cardiothoracic Intensive Care Unit, led by Lucille Sollazo and David Kampel, the CTICU Social Worker, in collaboration with CTICU nurses, Pastoral Care, Doctors, Patient Relations staff, and ethics consultants was formed to address these concerns. Using the PRIDE methodology, we would like to describe how we started this process. There was no organized approach to dealing with bereavement issues or caring for patients/families during the terminal phase of illness. We were unsure of the staff’s needs to humanize the experience of caring for the dying patient. There also was an inadequate utilization of available resources and inconsistent collaboration between the CTICU staff and the ethics committee, social worker, chaplain, surgeons, and intensivists. In the beginning, the staff contributed the cost of cards and postage to mail to bereaved families.. We designed a program to identify patients and families who may benefit from bereavement services. The program consists of family meetings with the healthcare team, chaplain referrals, social work interventions, and ethics consult. During our multidisciplinary rounds that we hold twice per week, we identify the patients and families who are either facing or at risk for facing end of life care decisions and treatments. Members of the CTICU team make an effort to customize the family visitation hours to meet the needs of these patients and their families. If a patient dies, the CTICU staff send a sympathy card to the patient’s family to extend their condolences. The card symbolizes “closure” of the staff-patient/family relationship to the staff that was initiated while the patient was in the CTICU. Another aspect of the bereavement program is the staff support group that is facilitated by David Kampel from social services. This support groups meets regularly and offers the staff a chance to verbalize their feelings and discuss any concerns they may have about end of life care in the CTICU. In the year 2000, the bereavement committee of the CTICU sent 17 sympathy cards that accounted for 32.7% of the families of expired patients. However, in 2001 and 2002, cards were sent to every bereaving family. additionally, every patient and family had the opportunity to participate in a team/family meeting to discuss end of life issues and care. Our bereavement program provides an organized approach now, coordinated by Nurses, Social Workers, and Doctors. Feedback from patients’ families has been positive: “Each of you provided us with the most sophisticated Cardiac Care possible… you also ministered to us…” “We all know you did everything possible to help. Know that you have helped us in profound and meaningful ways.” Team members share experiences during the support group. The staff members were able to identify resources for patients and families that meet their emotional and spiritual needs. The staff feels comforted and supported. |
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