Safety Culture & Virtue 2: End of Life Care

Some of my fondest memories from being a nurse were the times that I end of life care. It is a critical moment for the patient, but it’s also a critical moment for us. Whether we treat the dying with dignity and without rush is an excellent test for virtue and safety culture.

Why is efficiency the enemy here? Why is rushing a problem? Rushing someone who is dying robs them of the spiritual and relational care that is critical to their developmental stage. Eric Ericson’s eighth stage of development is a bridge between regret and satisfaction with the life you’ve lived, and if we rush the end-of-life process we may impede their preparation. And it’s not like there is a checklist for dying. It’s something that no one is experienced at doing and each experience is highly unique to the individual. 

Despite this, I have seen hospital staff push the process because beds were needed, or because it was “taking too long.” It’s a big job to manage the patient, the family, and the legal paperwork, and sometimes professionals get caught up in wanting to sign off on their papers and move on. I know because I have felt that way, but I also felt convicted that I needed to pause and address those feelings.

How can I tell if end of life care is rushed in my organization? The hospital chaplains can give you a good clue. If staff are taking time to offer chaplain services to dying patients, then they are not rushing the process. They are delivering personalized, tailored end of life care that meets the patient’s specific requests and personal needs. You may even want to get a routine report from the chaplaincy department asking how many requests they receive and of what type. Here’s the catch: If your chaplaincy staff are rounding based on an electronic assessment alone because no one actually calls them, then there is a problem and it’s a clear sign of a rushed dying process. In that environment, throughput of expired bodies takes a higher priority than the intrinsic value of human beings.

But if your staff call the chaplains in the middle of the night to request communion for last rites, then you have an engaged staff that does not rush end of life and treats patients like they are valuable human beings, even though they can’t always speak for themselves. Give yourself a point for excellent end of life care and let the House Supervisor know that you appreciate their bed management skills that allow the dying to have time and space to end well.