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January 2012, Volume 42 Number 1 , p 62 - 63


  • Miriam Ramos-Martinez MSN, RN, CMSRN


WORKING IN a Magnet(R) organization that's a teaching facility with 988 beds and three campuses can be challenging. Patient care units specialize in everything from trauma to hospice. My unit, a medical-surgical unit, receives mostly low-risk patients with chest pain who are usually discharged home the next day, but some of our patients require longer stays and some need end-of-life care.One day, while taking care of my assigned patients, a technical partner (which is what we call our unlicensed assistive personnel) asked me, "Why are you going into that room so often? Everyone else avoids going in."The patient in that room needed end-of-life care and the family frequently requested attention from the nursing staff. My colleague's comment made me realize that we as a unit were uncomfortable providing care for dying patients and their families.This article describes how we implemented a white rose program to address these patients' needs. Based on similar programs at other hospitals, this program gets its name from a white rose magnet placed on the patient's doorframe to alert staff of the patient's prognosis and the need to keep their voices low. We started by researching the literature and assessing staff attitudes toward end-of-life care.We conducted a review of the literature and found that patients at the end of life and their families want to know what's going on and with whom they can speak about the patient's condition. Explicit communication had proven to be comforting and helpful; this means the healthcare team was available, listened, explained what was happening, and expressed concern and sensitivity.1 In addition, the literature showed that healthcare teams have identified poor communication as one of the biggest barriers during end-of-life care.2Next, I informally surveyed the staff about end-of-life care. For example, I asked, "Why do you avoid going into a dying patient's room?"Usually I heard, "The room is full of family, and I don't know what to say

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