UAB Synopsis, Vol. 26, No. 18, May 14, 2007
Providing Practical and Emotional Support
Improving the experience of patients and their families as they cope with crucial end-of-life decisions is how Wendy Walters, LCSW, OSW-C, describes the goal of her newly created position as family support coordinator at UAB Hospital.
“That charge takes many forms. Providing practical information and helping families meet basic needs are important elements, but I partner with bedside nurses to offer grieving families psychosocial support,” she says. “Even when they receive the best medical care, dying patients and their families can feel abandoned and lost in the health care system. I help them process medical information to formulate goals of care and make difficult decisions, which might include ending aggressive life support, tapering nutrition, and considering organ donation. I also try to ease people’s transition through the grief process by helping them make sense of devastating trauma or illness.”
Walters’ position is part of a 2-year pilot project funded through a University of Alabama Health Services Foundation General Endowment Fund grant and designed by transplant surgeon Devin E. Eckhoff, MD; Rodney O. Tucker, MD, UAB Center for Palliative Care; Loring W. Rue III, MD, chief of the Section of Trauma, Burns, and Surgical Critical Care; and the Alabama Organ Center.
Research shows offering compassionate support helps families better cope with long-term grief and increases their trust in physicians and their satisfaction with medical care. Walters attends end-of-life family conferences and remains with the family after the meeting to provide additional support.
A recent study published in The New England Journal of Medicine found that compared with a control group randomized to standard procedures, families who received additional proactive support during such meetings experienced greater relief from guilt, felt more supported in making difficult decisions, and reported fewer symptoms of depression and anxiety at 6-month follow-up (2007;356:469-478).
“We want to do all we can to support families who have loved ones in crisis,” Dr. Tucker says. “Wendy is collaborating with other supportive services and helping patients and families access those resources earlier in their hospital journey.”
Walters, who has 20 years of grief counseling experience as a social worker, including 13 years with UAB Hospice, has developed a family support protocol for UAB Hospital. This protocol brings in other UAB professionals who provide “nonmedical interventions that address families holistically,” she says. These providers include pastoral care, nurse counselors, psychologists, social services, child-life specialists, music therapists, and others.
“Once I’m called — and ideally, that should happen as soon as a patient who is likely to have a terminal outcome is admitted to the hospital — I coordinate with other support services and act as liaison between patients and their families and physicians,” she says.
The door to improved communication between families and physicians swings both ways, Walters says. “I help patients and families interpret medical information, but I also can offer physicians a better understanding of the family’s values, goals, and concerns.”
Any health care team member can refer a patient to Walters, who notes that although she is part of the palliative care consult team, faculty and staff can request independent family support consults, which are reserved for patients who are near death.
Health care team members should refer patients to Walters when:
• The patient is likely to die during the current hospitalization.
• Team conferences with the family are taking place from admission through hospitalization.
• The family needs increased support.
• The family needs links to community resources or grief support services.
Organ Donation
Establishing a relationship with patients and families facing end-of-life issues gives Walters the opportunity to discuss organ donation. “Once it’s clear a patient is not going to recover, I try to help the family reach a level of acceptance where they may consider donating a loved one’s organs as a legacy,” she says. “For many, organ donation becomes a way to find meaning in a senseless situation.”
In 2005 the Alabama Organ Center tested benchmarks for donation and found that offering additional family support to grieving families increased donor conversion rates (the percentage of all suitable donors who convert to actual donors) 6% during a 6-month period.
Bereavement Program
In March Walters and Heart Transplant ICU (HTICU) Advanced Nursing Coordinator Jody White, MSN, RN, a nurse educator, held a bereavement conference for faculty and staff to outline their plans for a hospital-wide bereavement program.
“Some units in the hospital such as the HTICU, CICU, and RNICU already have successful bereavement programs,” she says. “These programs have proven meaningful for patients and staff.”
UAB Hospital’s bereavement program will begin with a point-of-death information packet given to families in the hospital. “This packet will provide practical information about funerals, death certificates, veteran’s benefits, and other pressing issues families must face when loved ones die,” she says.
Five additional contacts follow the initial packet. “Within the first weeks of a patient’s death, the unit will send the family a sympathy card. Two months later the card is followed by information about the grief process and counseling resources and at 6 months families will receive another sympathy card. During holidays we’ll send information about coping strategies for these painful times, and we will send a final card to mark the anniversary of the patient’s death,” Walters says.
“This contact shows we’re here for families and that when they leave, UAB still cares,” she says. “UAB has a stellar medical and scientific reputation, but this program will touch people in a more personal way, which will be an immeasurable and lasting source of goodwill.”
To refer a family, page Walters at beeper number 9419 or e-mail her at wwalters@uab.edu.