A Protocol for death

In hospital we now have a whole variety of "pathways" which outline a whole set of good practice steps which need to be followed to ensure the best medical and nursing care is given to our patients.
Today I had to implement the somewhat frightening sounding " end of life" pathway for the patient under my care, and I found it interesting to have to "tick a box" in a  set of protocol statements to ensure ( or prove) that I was providing the appropriate care to a dying patient.
Now don't get me wrong, these pathways are excellent tools for ensuring standardised quality care, but a little piece of me balked ever so slightly as I made sure the small pamphlet boxes were ticked after every hour passed by on my 13 hour shift..

Dealing with the dying patient is a skill a nurse should learn to develop very early in their careers. It is often a challenging and sometimes very upsetting experience that can be hugely satisfying when it has been done well and with thought and care and I am passionate that junior staff are supported and mentored in a supportive but no nonsense way in order to be able to deal sensitively with this the ultimate aspect of good nursing care.

"Pathway literature" , like I said, can be useful but they are, in my mind, just a guide to good practice. Excellent practice is only given when the nurse uses, those subtle personal skills of warmth , intuition and appropriate psychological skills  which make the difference. This is where feedback is vital. It is up to the senior nurse to reflect good practice and not only praise it but celebrate it when they see it in the clinical areas.
Unfortunately that doesn't always happen as much as I would like.....

Many years ago when I was a 21 year old nurse, I remember looking after a dying patient who had suffered from dementia for many years. He had no relatives, he had no friends, and I remember thinking that him dying alone, even though he had no idea of "self", was the most awful thing for anyone to go through.
As he was dying I remember taking my drink from the staff room on my break  and I sat with him as he passed away in the corner of a large asylum dormitory. I was not making a point or showing off...I did so as it just felt right to me....and I remember to this day the words of a gruff charge nurse called Johnny Crimes as I left duty for the day.  He said without any fuss " that was a good job today John!"
His acknowledgement of my work meant more to me than anything else...it taught me to accept and to follow my instincts...
that sort of comment is worth more than any protocol
It gives one a sense of validation