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Elicit and attend to the needs of the dying person and his/her family:
- Attending
MD and other clinicians continue to meet with the family of a dying
patient as appropriate to emphasize comfort care and to convey non-abandonment.
Distribute written material (booklet) for families that includes:
orientation to the ICU environment and open visitation guidelines; logistical
information
(nearby hotels, banks, restaurants, directions, etc.); listings of financial
consultation services; and bereavement programs and resources:
- Develop
written materials described above.
- Ensure consistency in the distribution of
these written materials.
- Develop guidelines for children and pet visitation.
Facilitate strengthening of patient-family relationships and communication:
- Support
open visitation to accommodate patient and family needs.
- Talk to patient and/or
family about young children’s and grandchildren’s
needs and provide appropriate supportive referrals.
- Encourage family and loved
ones to talk to the patient regardless of
the patient’s
level of consciousness.
- Clarify family’s desired level of involvement
in patient’s
physical care and involve as appropriate.
- Reduce unnecessary patient sedation,
while ensuring adequate treatment of pain and anxiety.
- Use consistent scoring
system for assessing and titrating sedation.
- Provide access to telephones
for patient and family.
- Consider making pager or beeper system available to
family members so they may leave the ICU more comfortably knowing that
they can be reached
quickly, or document family cell phone and pagers in the medical record for easy access.
- Consider offering a toll free number to patients and families to facilitate long distance calls.
Maximize privacy for the patient and family:
- Move the patient
to the most private area of the ICU.
- Consider transfer of the patient from
the ICU for more privacy, if feasible and desired by the patient and family.
- Provide
comfortable chairs for family members in the patient’s
room.
- Provide a private room with toilet articles near the ICU for family
to place
their belongings, wait and rest.
Value and support the patient’s and family’s cultural
traditions:
- Provide staff with an overview of various cultures’ significant
rituals around death and dying.
- Allow for cultural differences in dying
rituals and body care after death whenever possible.
- Arrange culture mediators
and/or consultants where appropriate.
Arrange for social support for dying patients without family or
friends:
- If patient wishes and is conscious, request appropriate pastoral
care
representative
or trained volunteer to visit.
Distribute written material (booklet) to families containing listings
of bereavement support programs/resources:
- Ensure consistency in
distribution of these materials.
Support the family through the patient’s death and their bereavement:
- Clinicians
lend their physical presence and support to the dying patient and family,
whenever requested.
- Explore the family’s wishes about being at the bedside
if life-support is withdrawn and/or during the dying process.
- Discuss issues
of funeral arrangements, release of the patient’s
body, etc.
(if possible and appropriate) prior to death so that during the dying process
and immediately after, the family does not need to make these decisions and
may have a quiet time.
- Provide a private room for the family after the patient’s
death.
- Give family the opportunity to meet with the health care team after
the patient dies.
- Send a preprinted card of condolence signed by the health
care team to the family after the patient dies.
- Consider making phone contact
with the family one month after the patient’s
death, if circumstances permit.
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Promoting Excellence in End-of-Life Care is a national program of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit PromotingExcellence.org for more resources.
