Feature articles by:Erik K. Fromme; Amy E. Guthrie; Cynthia Grueber; William Brinson Weeks, FACHE and William A. Nelson
My dog sitter, a 19-year-old nursing student and nurse’s aide, stopped by recently to be paid for recent care of my dogs. Our conversation turned to her career and healthcare.
She talked about her job in the local nursing facility, amazing me with her youthful wisdom. She relayed what she’d said to one of her nursing home coworkers about their work at the nursing facility. She had realized that her patients are people who’d had long lives enriched by meaningful relationships, fun pastimes, careers, families, vacations, and social events—all the things that make life special and full of memories. Now, in the role of nursing facility patient (for many, dying patient), each is the same person he or she was before admission to the facility. The only difference is that now many of them are near the end of their lives, and my young friend is the one caring for them. For some patients, this nursing student and her coworkers are their sole human contact—the person who sees them through their last weeks or months and is there at the moment of their death. My friend spoke with heart of wanting that time to be worthy of their lives and their humanity. At 19, she has already seen 42 people “transition” (in the words of feature authors Erik Fromme and colleagues). Knowing this young lady, I know that she takes the extra moment, offers the smile, says the extra word, and is present and available to each of her charges. She helps the person feel alive.
Facing the end of life with our patients is arduous. Our training and organizations center on recapturing health even in the face of the most devastating illnesses and injuries, no matter the patient’s age. The American College of Healthcare Executives offers guidance to its affiliates about their role in end-of-life decision making through the policy statement “Decisions Near the End of Life” (reprinted at the end of this issue). At the heart of the policy statement is the recognition that the patient is the real decision maker, and we in the care environment have the sacred responsibility to honor that patient’s autonomy and wishes. Medical technology has reshaped the circumstances of death, giving us options that may affect when, where, and how we die. Our technology can now sustain bodies even when there is no hope for recovery. Finding the balance between the patient's wishes and medical capability is our dilemma; honoring their wishes is our mandate.