Sourcebook : 6.0 Relationships, Spirituality, and Bereavement : 6.0.1 Case Study - Fairview Health Systems

Many Breakthrough Series participants made changes to address patients' emotional and spiritual needs while providing medical care. Among the successes achieved were those by Fairview Health Systems, a Minneapolis-based system of hospitals, nursing homes, and home health and hospice care. The Fairview team included hospice, geriatrics, and home health care program staff.

The team tried many changes, often working to blend traditional medical care with alternative healing methods. For instance, an ICU nurse who was also a Hebrew cantor sang to a frail elderly patient who was in isolation and on a ventilator. The patient's high anxiety often triggered alarms. However, as the cantor/nurse intoned psalms, his breathing rate quieted, his anxiety level went down, and he slept peacefully.

Other seriously ill and dying patients at Fairview have been comforted by a harpist trained in performing for - and working with - very sick patients. As the harpist plays, patient pulses, breathing, and anxiety improve. The harpist has played for families keeping vigil for loved ones in the ICU.

The Fairview team's Plan-Do-Study-Act cycle aimed to increase patient comfort by reducing pain, dyspnea, anxiety, and depression by half. Changes tested included guided imagery exercises and meditation as an adjuvant to pain treatment; imagery and therapeutic massage to reduce anxiety among families in the pediatric ICU; and harp music for pain and anxiety among pediatric patients and their families. Grant money enabled the team to provide music and massage therapy in its nursing homes and hospice.

To measure the effect of changes, the group asked nurses, chaplains, and social workers to carry out a test on one or two patients and report the results to the end-of-life study team. The team worked with other health care providers to use therapies that they might not have tried previously.

In many situations, patient symptoms improved. As a result, the end-of-life team offered a two-day conference at which 70 participants learned more about using complementary therapies at the end of life. Orders to initiate complementary therapies were added to the standard palliative care plan, which is now available in four of Fairview's hospitals. In addition, the group has assembled 13 palliative care kits that are available on several nursing units. The group wrote a booklet titled "Journey through the Dying Process," which Fairview printed and is distributing systemwide.

Palliative Care Kit Contents - Fairview Health Systems
This kit will be used for many patients. Some of the items will be given to the patient or family; other items should remain in the kit to be reused.
Prayer book: to meet a variety of spiritual needs The book includes a variety of poems, prayers, and scripture Refer to the table of contents and ask the patient and family if they have any requests or topics listed that would be helpful to them. These can be read silently by the patient; or aloud by the patient, family, or caregiver The book should remain in the kit
Anointing oil: to be used for blessings and other rituals There is an instruction sheet that accompanies each vial of oil that will assist you in how to use it Any remaining oil in the vial should be given to the family
CD player/tape player and CDs/tapes: to provide music therapy Music therapy can ease stress and help relieve pain. Play the tapes, or ask the family to bring in some music the patient enjoys All tapes and CDs should remain in the kit (Only a few kits have a CD or tape player included; it will be clearly marked if it is supposed to have a player included)
Potpourri/sachet: to provide aromatherapy Aromatherapy is intended to relieve pain and alleviate tension Put some potpourri/sachet in the small blue dish to add a soothing fragrance to the room. Only a small amount is needed Close the bag and save the fragrance for future use
Lotions: to provide massage therapy Massage therapy can help both muscle pain and stress-related conditions. Use the lotions to have the family provide a simple massage to the patient’s hands For massage, apply lotion, then simply gently rub the back of the patient’s hand, working lotion into the thumb and fingers. Then turn the hand over and massage the palm, extending the massage to the fingers. This routine allows the family to hold the patient’s hand while taking part in the patient’s care The patient and family can keep lotion, if they choose

With foundation money, the Fairview team continues work begun during the Breakthrough Series. Staff plan to:

Hold seven community meetings to enhance awareness of end-of-life issues and to discuss ways to develop community-wide strategies to improve end-of-life care
Provide comprehensive training to physicians and other health care practitioners about end-of-life care
Expand bereavement support groups beyond the current programs
Offer additional support groups for grieving children

Through this process, the Fairview team learned that patients and families want to try complementary therapies - but found that professionals had to volunteer their services. The team developed a list of providers within the Fairview system who can provide complementary therapies. The team plans to develop ways to improve access to complementary therapies, pay for these services, and centralize requests.

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Keywords: music thanatology

This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].