Family Support - Guidance for Bedside Staff

Due to the novel coronavirus pandemic, many of our patient and family care practices have changed. One of the toughest challenges we face is the need to restrict visitors for COVID-19 patients. This can be especially hard when the patient is dying. Visitor restrictions protect the larger community, yet also cause increased grief and anguish for families and care team members.

We encourage you to reach out to your Social Work and Spiritual Care colleagues for support. Maine Medical Center has formed a new Family Support Team, along with Palliative Care and Ethics, to help with coordinating family communication. Our team can help assess needs and provide consistent, empathetic family communication as well as emotional support for staff. Look for our care team messages in EPIC Sticky Notes and Secure Chat.

Hospital Chaplains

  • Can help with lending an ear to concerns about family members, making medical decisions, offering prayer or simply providing comfort with a non-anxious presence
  • Confidential, trustworthy and dedicated to helping people find hope, healing and wholeness
  • Available 24/7 at 741-1964
  • Page the on-call chaplain, who can contact the patient and/or family by phone. Chaplains are also available on site for staff support.

Social Workers

  • Can help maintain communication between the family and the medical team, connect families with community resources, and provide support and connect with other health providers as needed
  • Available 7:30 a.m. to 4 p.m., seven days a week at 662-1736

Spiritual Support Guide for Dying Patients and their Care Team

During the COVID-19 pandemic, upholding the inherent worth and dignity of patients is more important than ever. For this reason, our Spiritual Care Department has created this guide to help you support the spiritual needs of patients who are dying. What follows are some words to help you care for others, and yourself. While we may not be at the bedside with you, a Chaplain can assist you. Page us at 741-1964.

Ways You Can Offer Spiritual Support to a Dying Patient

SILENCE
“The Pause” is a tradition of asking for and holding a moment of silence when a patient is unable to be resuscitated from a cardiac arrest. It can be used by the care team any time a patient dies, as a
group or one on one. Holding a moment of silence for 30-90 seconds is a ritual that evokes reverence for the person who has died and their loved ones. It also allows care providers the opportunity to take a moment to process their own emotions, before jumping into a debriefing or the next task.

During the moment of silence, notice how you feel physically and emotionally. Notice your breath, the pace of your heartbeat, and if there is anywhere in your body where you feel pain or discomfort.
Notice if any words come to mind that you would like to share with the patient, the patient’s family, or your coworkers. Use the silence to acknowledge that there has been a death—and with every death there is profound loss and change.

WORDS OF COMPASSION
If a patient is dying and you do not know their religious and spiritual beliefs, you can offer them general words of compassion, such as:

  • “I am with you. I am going to stay with you.”
  • “I am going to do everything I can to keep you comfortable.”
  • “I am grateful to be here with you now.”

If you have had the opportunity to speak with the patient’s family, you may also be able to convey a message, for example:

  • “I spoke with your family. They love you so much.”
  • “I spoke with your family. They are all okay right now. They love you.”

If the patient’s family or loved ones cannot be located, you can offer support from the team:

  • “You are not alone. You matter to us. We are here for you.”

GENERAL PRAYER
If the patient, family, or Chaplain indicated to you that the patient would like a prayer, you may offer one. Prayers are acts of love and come in many forms. While some traditions like Catholicism and
Judaism have established prayers, most traditions also welcome spontaneous prayer. If you would like to offer a prayer and you feel more comfortable praying spontaneously, here are examples of what you may want to include for a patient that is dying:

  • Gratitude for the patient: “Thank you, God for ____”
  • A request for the patient to be comfortable: “May X be free from pain and fear”
  • Gratitude for the patient’s family and a request for them to be comforted: “Thank you for X’s loving family. May they know how deeply X loves them and may they be comforted at this time.”
  • A request for forgiveness and reconciliation: “May forgiveness be found wherever forgiveness is needed.”
  • Raise up the prayers that the patient is unable to speak: “God, may you hear all of the prayers that are on X’s heart at this time, that he/she is unable to speak aloud.”

SPECIFIC PRAYER
If you know the patient’s religious affiliation, you may want to offer a prayer that is specific to their tradition. Here are some of the most common prayers for:

  • CATHOLICISM
    • The Lord’s Prayer: “Our Father, Who art in heaven, hallowed be thy name. Thy kingdom come, Thy will be done, on Earth as it is in heaven. Give us this day our daily bread, and forgive us our trespasses, as we forgive those who trespass against us, and lead us not into temptation, but deliver us from evil. Amen.”
    • The Hail Mary: “Hail Mary, full of grace, the Lord is with you. Blessed are thou among women and blessed is the fruit of your womb, Jesus. Holy Mary, Mother of God, pray for us sinners now and at the hour of our death. Amen.”
  • PROTESTANT CHRISTIANITY
    •  The Lord’s Prayer: [as above, with an additional sentence] “…deliver us from evil, for Thine is the Kingdom, and the Power, and the Glory forever. Amen.”
    • Psalm 23: “The Lord is my shepherd; I shall not want. He makes me lie down in green pastures. He leads me beside still waters. He restores my soul. He leads me in the paths of righteousness for His name's sake. Yea, though I walk through the valley of the shadow of death, I will fear no evil; for You are with me; Your rod and Your staff, they comfort me. You prepare a table before me in the presence of my enemies; You anoint my head with oil; My cup overflows. Surely goodness and mercy shall follow me all the days of my life; and I will dwell in the house of the Lord forever.”
  • JUDAISM
    •  Sh’ma in Hebrew: Sh’ma Yisra'eil Adonai Eloheinu Adonai echad.
    • Sh’ma in English: Hear, O Israel, the Lord is our God, the Lord is One.
    • Psalm 121: I turn my eyes to the mountains; from where will my help come? My help comes from the LORD, maker of heaven and hearth. He will not let your foot give way; your guardian will not slumber; See, the guardian of Israel neither slumbers nor sleeps! The LORD is your guardian, the LORD is your protection at your right hand. By day the sun will not strike you, nor the moon by night. The LORD will guard your going and coming now and forever.

    ISLAM

    • Shahada in Arabic: La ilaha illa Allah Muhammed asul Allah
    • Shahada in English: There is no God but Allah, and Muhammad is his messenger. 

Sample Goodbye Script: Supporting Family Members Who Are Unable to Be Present in Person

 

Clinician Family
I’m one of the doctors/nurses on the team. I’m here to walk you through this. Wow. I have no idea what to do or what to say.
We have the opportunity to make this time special. Do you want to think for a minute? My mind is blank, honestly.

Here are 5 things you might want to say. Just pick the ones that ring true for you:

  • Please forgive me.
  • I forgive you.
  • Thank you.
  • I love you.
  • Goodbye.

Do any of those sound right for you at this time?

 
Maybe I’ll just start with Thank you. Is that ok?
I think Thank you is a beautiful thing to say. He can probably hear you even if he can’t answer. He’ll recognize your voice.  Ok. I’ll do Thank you, and see where it goes from there. 
If my daughter/son were saying that to me, I would feel so valued and so touched.  (Pause,while device is brought close to the patient) 
You can start whenever you’re ready. I have the phone/tablet right next to his ear. Hey Dad, it’s me. 
(Family speaks their words of farewell. Encourage everyone to have a chance to speak if there are others present on the call.)  I think I’ve said everything 
That was such a loving moment. I felt privileged to be part of it.  Oh, thank you. 
(Expect emotion and allow time and space for it. A moment of silence is fine.)   
I can see that he meant so much to you.  He was an amazing man. I am going to miss him. 
Can you stay on the line for a minute? I just want to check on how you are doing.   

Adapted from VitalTalk. For more scripts visit: https://www.vitaltalk.org/guides/covid-19-communication-skills/
For more about “Five Things”: Ira Byock, MD visit: https://irabyock.org/books/the-four-things-that-matter-most/

Supporting Yourself: Some Caring Words for Challenging Times

Sometimes the hardest person to care for is yourself. Many of us are facing multiple and unexpected layers of stress at this time. The way in which we talk to ourselves can make things easier, and it can also make things harder. Here are some practical strategies for self-talk in the moment, followed by some time-honored practices that can help you after feelings subside.

Anticipating

  What You Fear What You Can Do
When you’re worrying about what might happen.
That patient’s son is going to be very angry. Before you go in the room, take a moment for one deep breath. What’s the anger about? Love, responsibility, fear?
When you’re worrying about what might happen. I don’t know how to tell this adorable grandmother that I can’t put her in the ICU and that she is going to die.

Remember what you can do: you can hear what she’s concerned about, you can explain what’s happening, you can help  her prepare, you can be present. These are gifts.

When you’re worrying about what might happen.
I have been working all day with infected people and I am worried I could be
passing this on to the people who matter most.
Talk to them about what you are worried about. You can decide together about what is best. There are no simple answers.
But worries are easier to bear when you share them.
When you’re worrying about what might happen.  I am afraid of burnout, and of losing my heart. Can you look for moments every day where you connect with someone, share something, enjoy something? It is possible to find little pockets of peace - even in the middle of a storm. 
When you’re worrying about what might happen.  I’m worried that I will be overwhelmed and that I won’t be able to do what is really the best for my patients. Check your own state of being, even if you only have a moment. If one extreme is wiped out, and the other is feeling strong, where am I now? Remember that whatever your own state, that these feelings are inextricable to our human condition. Can you accept them, not try to push them away, and then decide what you need? 

 

Grieving

  What You Are Thinking  What You Can Do
 When you’ve lost someone.
I should have been able to save that person. Notice: Am I talking to myself the way I would talk to a good friend? Could I step back and just feel? Maybe it’s sadness, or frustration, or just fatigue. Those feelings are normal. And these times are distinctly abnormal.
 When you’ve lost someone. I cannot believe we don’t have the right equipment (or how mean that person was to me or how everything I do seems like it’s blowing up).

Notice: Am I letting everything get to me? Is all this analyzing really about something else? Like how sad this is, how powerless I feel, how puny our efforts look?

Under these conditions, such thoughts are to be expected. But we don’t have to let them suck us under. Can we notice them, and feel them, maybe share them? And then ask ourselves: Can I step into a less reactive, more balanced place even as I move into the next thing?

 Adapted from VitalTalk

Selected Spiritual Practices

The Spiritual Practice of Hand Washing

As you wash your hands, make a commitment to say a prayer, sing or chant a sacred tune in your mind. You may choose to engage your own religious tradition or you may find your own words.
Here are some suggestions:

Judaism
Baruch Atah Adonai Eloheinu Melech Ha’Olam Asher Kidshanu
B’mitzvotav Vitzivanu al Netilat Yadayim

Blessed are You, Adonai our God, Sovereign of the Universe, Who has sanctified us with mitzvot, and commanded us concerning the washing of our hands.

Islam
Truly, God loves those who turn unto Him in repentance and loves those who purify themselves. (Qur’an 2:222)
O ye who believe! When ye rise up for prayer, wash your face, and your hands up to the elbows. (Qur’an 17:9)

Christianity
The Lord’s Prayer: Our Father, who art in heaven, Hallowed be thy Name. Thy Kingdom come. Thy will be done on earth as it is in heaven. Give us this day our daily bread and forgive us our trespasses., as we forgive those who trespass against us. Lead us not into temptation but deliver us from evil. For thine is the kingdom and the power and the glory, forever and ever. Amen.

Buddhism
Hand washing – just like meditation – is not about you. It is an opportunity to cultivate and strengthen our mindfulness and loving-kindness practice. As you approach the sink, you can place your hands on the sink and just feel your feet on the floor. Grounding yourself in the present moment right here, right now, you would be so mindful of how you turn on the faucet, how you get the temperature of the water, how you put the soap on your hands and suds them, turning off the water while you rub in between the fingers, around the fingernails not forgetting your thumbs. As you’re doing this, you realize that when you’re so very present and attentive, this is mindfulness. This is washing your hands mindfully.

The Spiritual Practice of Being in Nature

Make a commitment to spend time in nature every day. For example, go for a morning walk or walk your neighborhood in the evening or walk the MMC campus during a break. Notice your feet
touching the ground. Notice the air and the changing weather. Notice what is around you and notice the sky. Breathe deeply and reach out and up. You are a part of it all and nature takes you in and
holds you each time.

The Spiritual Practice of Silence

Once or twice a day sit in silence for 5 or 10 minutes. Find a spot that allows you to ground yourself. Settle down and focus on your breath. No need to force it or change your breathing. Just observe.
Focus on a word sacred to you while you exhale. Whenever your mind wanders – as all of our minds do – simply return to your sacred word. During the rest of your day, whenever you get overwhelmed or stressed, remember the silence you can always return to.

The Spiritual Practice of Being in the Present Moment

“Goals and contingencies exist in the future and the past.
The path of mastery exists only in the present.
You can see it, hear it, smell it, feel it.
To love the present is to love the eternal now…
To love the present is to love what is most essential and enduring in your life.”
(George Leonard from ‘Mastery’)

Explore the present moment.
Just this. Just now.
This moment only is enough.

The Spiritual Practice of Self-Compassion

Connect with your spiritual self. Be still and know that you are more than this current crisis or fear or unsettled-ness. Your spirit is eternal in this moment. Having connected to your spiritual self,
practice self-compassion. Say to yourself:

I am suffering right now; all human beings suffer and deserve kindness; may I be kind to myself.

Combining these words with placing your hand on your heart can spur the sense that you are connected with self and others. This practice may help to switch from fight-or-flight into relax-and-respond.

From this more centered place, ask yourself: What gesture of kindness can I do now for those who are in need?
See what comes to you.

We have no idea the far-reaching impact of our large or small gestures, even the simple act of bringing ourselves into a state of loving-kindness has ripple effects we may not see. All we know is that our peaceful, positive state is a contribution to the world around us. We can make choices from hope, not fear.

And finally:

A Blessing for You, the Caregiver

May you be blessed with loving-kindness, resilience and perseverance.
May your strength be renewed as you create and sustain healing and hope.

 

SOURCE: Adapted from Chaplain Angelica Zollfrank at McLean Hospital.

How to Find a Patient’s Religious Tradition in EPIC

1. Find the patient’s name and unit location in your “Lists.”
2. Click on the information bar until the “Patient Profile” comes up at the bottom of your screen.
3. You should see a section titled “Demographics.”
4. Look at what is listed under the Religion category (lower right-hand side).

 

Many people follow no formal faith tradition these days. Even if the patient is listed as “none”, you can assume that they will hear and appreciate your caring words. Your presence, care, and commitment are the greatest gifts to patients and their loved ones at the end of life. Thank you for offering a tender spirit in their time of need.