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    'Will you stay with me?': The No One Dies Alone program

    Program helps to ensure patients have a caring companion in their final hours.


    ANYONE WHO'S BEEN A NURSE for any length of time has known the feeling of being left with an an unpleasant, lingering memory from a patient case. It may be an error made, an innocent oversight, a decision that reflects lack of judgment, or something said—or even not said—by a patient. Whatever the circumstance, few nurses are ever granted the privilege of transforming this event into a vision that will blossom into one of the most extraordinary and rewarding experiences of a lifetime.

    SACRED HEART MEDICAL CENTER, 1986 It was a rainy night in Eugene, OR, in 1986. Sandra Clarke, RN, was working as a staff nurse at Sacred Heart Medical Center. While making rounds at the beginning of her shift, she entered the room of a frail, elderly man with a DNR order on his chart. In a barely audible voice, he pleaded, "Will you stay with me?" Sandra promised him she would return as soon as she checked on her other six patients. After taking longer than she had anticipated, she returned to his room, ready to apologize for the delay. As she approached his bedside, she saw his pale, outstretched hand. He had died alone.

    Sandra tried to rationalize the event. Her patient was elderly, had multisystem failure, and was going to die anyway. But his final moments were not supposed to be this way. It is unlikely that any human being would ever choose to die alone. Sometimes, however, circumstances are such that a person has no family or close friends, as was the case with this gentleman. Other times, someone may not have those who care living in close proximity to the healthcare facility. We live in a mobile society, and it could happen to anyone.

    A PROGRAM IS BORN Sandra decided she would transfer to the intensive care unit, an environment in which patients are surrounded by personnel and technology. However, troubled by her broken promise, she was determined to find a way in which other patients at her hospital would never have to die alone. She envisioned a volunteer companion program. When she questioned other employees about being willing to sit with a stranger who was dying, she received mixed responses.

    Fourteen years later, while working in ICU, Sandra still was harboring thoughts from the 1986 incident. She had volunteered to participate in a new pilot program at her hospital to develop an ethics resource team for staff members. During the training period, the Director of Pastoral Care, Bob Scheri, overheard Sandra discussing her concept. At his request, she outlined a proposal. PeaceHealth, the corporate organization of Sacred Heart Medical Center, endorsed her innovative idea. No One Dies Alone (NODA) became a reality in 2001, and the rest is a heartwarming history.

    HOW IT WORKS No One Dies Alone is a simple and economical plan. It is basically a voluntary, unpaid phone-tree program in which volunteers sign up on an Internet site for a week, during which time they pledge to be available to stay with a dying patient. At PeaceHealth, a two-hour minimum bedside vigil assignment is preferred. The volunteers are comprised of hospital employees as well as existing unpaid volunteer staff. There is one part-time paid position of program coordinator, who oversees all functions of NODA and administers the program's advisory committee.

    According to specific criteria on each nursing unit, either the chaplain or the nursing supervisor is notified when a patient is expected to die within 48 to 72 hours and there are no friends or family available to stay with them. The chaplain or supervisor reviews the request and contacts the phone coordinator, who then schedules coverage. The volunteers, who are called "Compassionate Companions," wear a special badge with an attached ribbon that identifies them. Upon arrival to the unit, they introduce themselves to the nursing staff, which supervises and assists them.