Vigil

Last night I worked with a doe eyed young woman who is about to embark on her student nurse training in University.
Our conversations lead us to the subject of the care of the dying and she showed considerable knowledge of the use of end of life pathways,associated protocols and research but had little practical knowledge and experience of what I think a nurse's role in the act of a vigil.

I listed   of my nurse " rules" to her as we mopped and polished the day room

1.  Be clear from the get go who you are and why you are there.Relatives are distressed and seldom are able to listen to long winded explanations and instructions. Give them permission to ask questions and to quiz you about what is happening.
2. Be calm and move slowly. Don't rush. Make sure the bedpace is orderly, clean and tidy. It sounds old fashioned and a bit twee but order and calmness breeds order and calmness
3. If the patient is monitored transfer the digital readouts with its waveforms and noise into sleep mode ( where the nurses at the nurse station can see the monitor readings but the family cannot)
4. Explain everything you do
5. Follow your protocols. They are their to maintain your patient's comfort and dignity. Many medications will combat the more distressing symptoms in the dying process, such as a " wet " chest or cerebral irritation.
6. Encourage breaks out of the vigil room, provide an overnight room to use if available and bring in regular drinks, water and food if possible. Provide teapots and hot water jugs as the process of tea making will give the relatives something to do. Allow family to help with personal cares if they wish to but don't push it if they decline.
7. Find out more about your patient ; often anecdotes  and family stories can be shared at this time especially when the patient perhaps would have had a chronic condition which exhibited itself into a change of personality and abilities.
8. Be flexible . Pets, children and best friend Eddie who can't make visiting until 2 am must be catered for . 
9. Be honest, often through experience you can judge when a patient is going to suddenly deteriorate but that be not always be the case. Patients can hang on for days
10. The dying process can affect personal and family dynamics considerably and conflicts can arise and quickly get out of control. Be sensitive to these, disappear when needed but be prepared to control the situation if needed. Anger is an emotion most readily mobilised in grief 
11. Acknowledge the surreal nature of the situation and be aware that relatives can be affected deeply by the " normality " of life outside the vigil room. 
12. Don't use euphemisms for death . Be clear and unambiguous in the use of your language.Be very sure that patient has actually passed away before you confirm it
13. Be kind....Explain that the patient may be able to hear a loved one's last comment even though they may be hypoxic or deeply sedated. 
14. Be prepared for anything to happen. I have been slapped by one grieving wife and have had dozens of distraught traveller families force their way on a ward to show their respects.
15. At the end of your shift personally introduce the nurse taking over to the family. Don't rush this  and say don't gong nice and positive about your colleague . This is especially important if you have worked alongside the vigil a long time  

" I've never seen a dead body" my co worker admitted as soon as I had finished my speech

1. So I added number number 16...all ways support your junior and less robust colleagues