Tips and Tricks for Wellness; Grace in End-of-Life Decision Making

“It is in the face of death that the riddle of human existence becomes most acute.” -Pope John Paul II

With Easter on the horizon, we at Ally RN thought that now is a wonderful time to address a difficult subject: Grace and Dignity at End-of-Life.

If there is one thing working in an ICU teaches a person, it is that life is so very fleeting! Things change in an instant. (And wow, do they change in a 12-hour shift!) No matter your age, the time is now to speak with your loved ones about your wishes and priorities for end-of-life care.

These topics can be uncomfortable and overwhelming. But not knowing your unique priorities and desires when your loved ones are called to make decisions for you is infinitely more uncomfortable and overwhelming- even downright crushing! There is peace, grace, and dignity to be found in knowing your wishes or the wishes of those you love. So, let’s dig in!

Note: There are many resources available to assist you with creating Advance Directives and other pertinent legal documents. This blog is intended to help pinpoint your unique preferences in medical decision-making. What one person considers dignified, another person may consider distressing. The following will help you and your loved ones arrive at greater understanding, and therefore, peace.

The Not-So-Basics: Quality of Life vs. Quantity of Life

Some people desire to extend their lives here on Earth for as long as possible, regardless of the measures required to do so, even if these measures sacrifice quality of life. This is considered having a high regard for quantity of life. Other people would forsake extreme measures, sometimes sacrificing time here on earth, in order to live out their lives achieving certain abilities such as communication with family, independent mobility, or any other subjective marker of well-being. This is having a high regard for quality of life. For most people, their desires lie somewhere in the middle, or with some combination of both. Knowing where someone falls on this vast spectrum is hugely important to end-of-life decision making, and can ensure dignity for the sick or dying. Here are some questions to help identify personal values and priorities:

• Think of someone close to you who required care at the end of life. What did you like about it? What would you change?

• Would you want to live for as long as possible, regardless of the medical interventions required to do so?

• List of medical interventions to ponder: CPR, Ventilator, feeding tube, IV hydration, dialysis, blood transfusions, receiving donated organs or other tissues

• Go through the list of interventions, and consider whether they seem extreme or reasonable for a short duration of time in order to restore health, such as in instances of sudden illness, surgical complications, or injury.

• Now go through the list again, considering whether the interventions seem extreme or reasonable for an indefinite and prolonged period of time. Example: Someone may consider the use of a ventilator reasonable in order to recover from surgery or pneumonia, but extreme in order to keep breathing for the remainder of their lives following recovery from surgery or pneumonia

• What aspects of well-being are most important to you? Examples include prayer, religious customs, time spent with family, awareness of the world around you, ability to speak, ability to perform personal hygiene routines independently, etc.

• What spiritual traditions would you like in cases of severe illness or during end-of-life care? (Last Rites)

• If you were no longer able to care for yourself, what routines would be important for your loved ones to continue to maintain for you? (Holy Eucharist, time spent outside)

• If you needed around-the-clock care, is there a particular location you would prefer to receive it such as your home, or a specific nursing home?

• Are there any daily care or other basic interventions you would not want?

• Are there certain medications you prefer not to have?

• If possible, where would you prefer to spend your end-of-life? (Home, hospital, hospice)

• Would you like to be an organ donor?

• What details are important or unimportant to you for funeral services, cremation, or burial?

A Note on CPR

Cardiopulmonary Resuscitation (CPR) is the lifesaving intervention performed when someone’s heart stops beating. Successfully regaining a heartbeat is not guaranteed in CPR (although your healthcare providers will try their hardest!). CPR involves rigorous chest compressions, defibrillation, and rescue breathing. It is important to note that CPR outcomes vary significantly depending on factors such as age, health, frailty, and specific medical conditions. This means that CPR for a 50-year-old, healthy adult is going to look entirely different than CPR for a 90-year-old. Generally, the more medically frail a person is, the greater number of extraordinary measures required to maintain life following successful CPR. At a minimum, patients typically require a ventilator and numerous medications. Because of these factors, the desire to have or not to have CPR may change as a person ages. The conversations surrounding your wishes should not be limited to one instance, but should continue as needed over the lifespan.

Whew!

Take a deep breath, and give yourself a pat on the back! You made it through the tough stuff!

In closing, we want you to know that each human life is so amazingly complex and unique, with its own special family, cultures, spirituality, and experiences, and therefore there are an infinite number of factors that may come into play with these situations and decisions. We invite you to lean on our experience and expertise in order to help simplify this vast subject area. We are happy to guide difficult conversations or to look at existing legal documentation and offer a clinical and/or religious perspective. Sometimes, all that is needed is assistance in “breaking the ice”, and we can help with that too! Contact us today so we can be by your side navigating these subjects, and share with your loved ones to get the conversation going!

Wishing you a Very Blessed Lenten Season,

Kathleen Clark, RN, BSN

Founder, CEO, Ally RN

Speaking From the Heart…

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” -Albert Einstein

February is rapidly approaching and is Heart Health Awareness Month AND Patient Appreciation Month!  As a non-standard healthcare provider, it was distressing to think of writing a heart health post about exercise (boring!).  I decided instead to honor this month by speaking truthfully, from the heart.

As described on our “About Us” page, I am very passionate about the reasons for starting this business and the goals we would like to achieve for our patients.  Additionally, like most entrepreneurs, I had selfish aspirations: a desire to have more energy for my faith, to have a schedule that honors the life of faith that I want to live.  I dreamed up Ally RN as a holistic, faith-based nursing organization.  After conversations with various wonderful, smart businesspeople, the message was clear – as a business, you need a lesser focus on faith.  But now, after successfully operating this business for a number of months, we want to circle back to what’s important, and say it out loud!

Ally RN is a faith-based nursing organization.

And we are so excited to share our faith with you!

I can hear my colleagues commenting: Why would she do this?!  She’s shooting herself in the foot!  Well, here is why:

Because nothing brings greater peace.

In my previous experiences in nursing, I have been honored to work closely with death in a variety of settings.  Oftentimes in these situations families are distraught and overwhelmed.  They go back and forth about whether to call in a chaplain because they are unfamiliar with the process, or about what their loved one might want.  I will let you in on a secret: NO ONE ever regrets it.  Every single time patients and families come away with a greater sense of peace.  You can see the change– the sudden relaxation on people’s faces, the calming of the energy in the room.

I worked once with an amazing nurse who, when speaking to families of a patient on hospice, would talk about the patient’s spirit as if the spirit was as real, tangible, and obvious as you or I standing there.  What a gift!  How important!  To lend acknowledgement to the essence of a person’s being, at a time when believers and non-believers alike sense the leaving of a person’s soul from their body.  As a nurse who advocates for holistic wellness, there is no greater gift I can give to my patients and families- peace.

Because nothing brings greater healing.

Nowadays, studies demonstrate correlation between prayer and healing.  Prayer has been shown to decrease death from despair (1), to improve coping with stress and decrease depression, anxiety, suicide, and substance use (2), to increase rates of pregnancy (3), and to even improve wound healing in primates, negating the placebo effect (4).  There are many accounts of miraculous healings around the world.  I was lucky enough to bear witness to one such extraordinary event.  Many years ago, I knew a sister who was in end-stage kidney failure.  She required dialysis three times per week and was having a torturous time.  She prayed and prayed, and one day, she went to her kidney doctor, who told her that suddenly and quite out of nowhere, her labs were NORMAL!  She was cured!  The only way the doctor could describe it was to call it what it was- a miracle.

And lastly, because nothing in this world is as important, as everlasting, as impactful, as God’s love.

So, what does this mean?

This means that at Ally RN, we take faith seriously.  In Matthew 22:34-40, when Jesus was asked what the greatest commandment was, he responded to love the Lord with all your heart, soul, and mind, and to love your neighbor as yourself.  This is all to say, that for us at Ally RN, LOVE is the most important practice.  We do not intend to insert faith and religion where it is not welcomed, and we will not turn people away who do not believe.  No matter who you are, we will love and care for you.  But if you DO feel that faith is part of YOU, we want to ensure that that huge part of your person is not left out in your healthcare.  We want to speak openly with you about the Lord.  We want to pray.  We want to conduct targeted healing prayer (it really works!).  We want to answer your medical questions with a faith frame of reference.  And we want to make sure that you feel confident that the medical decisions you are making align with your spiritual goals.  As always, we want to be your ally!

Contact us today to see how we can help you!

“Darkness cannot drive out darkness; only light can do that.” -Reverend Martin Luther King Jr.

Many Blessings,

Kathleen Clark, RN, BSN

Founder, CEO, Ally RN, LLC

References

1. Chen Y, Koh HK, Kawachi I, Botticelli M, VanderWeele TJ. Religious Service Attendance and Deaths Related to Drugs, Alcohol, and Suicide Among US Health Care Professionals. JAMA Psychiatry. 2020;77(7):737–744. doi:10.1001/jamapsychiatry.2020.0175

2. Koenig HG. Research on religion, spirituality, and mental health: a review. Can J Psychiatry. 2009 May;54(5):283-91. doi: 10.1177/070674370905400502. PMID: 19497160.

3. Cha KY, Wirth DP. Does prayer influence the success of in vitro fertilization-embryo transfer? Report of a masked, randomized trial. J Reprod Med. 2001 Sep;46(9):781-7. Erratum in: J Reprod Med. 2004 Oct;49(10):100A. Lobo, RA [removed]. PMID: 11584476.

4. Lesniak KT. The effect of intercessory prayer on wound healing in nonhuman primates. Altern Ther Health Med. 2006 Nov-Dec;12(6):42-8. PMID: 17131981.

Tips and Tricks for Wellness; Baby and Toddler Colds

This cold and flu season is unlike any we’ve seen for pediatric illness.  Emergency Departments are overwhelmed, and pediatric beds in hospitals are sparse.  Supportive home care is more important than ever to keep your babies well and out of the hospital!  Here are some tips and tricks to help you through this season’s colds:

• STEAM!-  Steam has so many benefits!  It thins mucous so little ones can clear it up and out.  Give your kiddo a nice, warm bath with bathroom fan off and door closed, or steam the bathroom up with a hot shower, and stand in the room (not in the hot shower), allowing your child to inhale the steamy air for five minutes or so.  (Directly putting steam in a child’s face is NOT RECOMMENDED as it can cause burns.)

• Humidify-  A steam humidifier in your child’s bedroom will help keep that mucous thin throughout the night.  Steamed water is all they need, so if you’ve never tried eucalyptus, menthol, and other vapor oils, the middle of an illness is not a good time to start, since even mild reactions can cause increased inflammation of airways.

• Clear the nose!-  Keeping the nose clear of mucous helps to prevent ear and sinus infections, pneumonia, and keeps your baby breathing normally.  If your toddler is a good nose blower, meaning they can blow all the mucous out so you no longer hear the mucous gurgling behind their nose, encourage them to blow every time you hear the dreaded mucous rumble or see a runny nose, before meals, and before bed and naptime.  With infants and toddlers who are not great blowers yet, use a nose suction device such as the Fridababy NoseFrida® before sleep times and meals and as needed.  If possible, time nose clearing for after spending time in steamy air- you’ll get more bang for your blow!

• Honey (for children 1 year and older) and warm fluids- Honey relieves sore throats from post-nasal drip and has been shown to decrease inflammation.  Warm fluids thin mucous resting in the upper airways.  In our house we mix honey and warm water as a nighttime remedy for colds before bed.

• Percussion (for children without chronic respiratory illness)- If your little one just can’t seem to cough up the mucous in their lungs, percussion can sometimes do the trick!  Best done in combination with steam to really help loosen mucous.  Any sort of light, but firm, rapid tapping of the upper and middle back will help.  What we do: While your child is sitting upright, support their upper body with your non-dominant arm, curl your dominant hand into a fist, and using the broad edge of your palm, firmly but gently tap on your child’s upper back, rapidly and repeatedly.  (Similar to a light massage.)  Percussion should never be painful; if your child shows signs of distress, stop immediately.

• Positioning- For toddlers who sleep with a pillow, adding an extra pillow for bedtime to keep their head above their chest helps drain mucous and prevent overnight coughing.

• Hydrate- Frequently encourage your child to drink additional water; as much as they can tolerate!  Extra fluids in children really helps to thin that mucous!

• Rest!-  The most important thing for sick kids is sleep.  Let them sleep as long as they want- they need it!

Of course, if you note that your child is breathing extremely fast or slow, having retractions of their muscles between the ribs, having trouble catching their breath between coughing fits, or their lips, mouth, extremities, or face are turning blue, proceed directly to your local urgent care or emergency department.

We hope these recommendations are helpful, and we are right there with all of you parents and caregivers struggling through this cold and flu season!  Most important to remember is that sometimes, parent snuggles soothe all pain, sunshine is essential, and laughter really is the best medicine!

-Kathleen Clark, RN, BSN

*These recommendations are intended for parents and children with non-specific medical concerns.  For children with acute or chronic conditions such as asthma or CF, advice may vary.  In either case, always reach out to your primary care provider for questions or concerns!

Bittersweet Ending, Exciting Beginning!

March 16

A couple months ago I started an extremely difficult process- saying goodbye to my patients!  You never realize how important the people and interactions in your life are until they are promised to be short-lived.  It was far more emotional than I imagined it being, for both me and for my patients!  For many of these people, I am their solid ground; a rock in the turbulent waters of their healthcare journey, answering their questions fully, with a knowledgeable mind, and making sure that they are well cared for.  Sometimes it’s as simple as dedicated follow through, which is hard to find in healthcare these days!  What struck me, though, was that many patients cannot afford a concierge nursing rate.  We needed a solution.  When dreaming up Ally RN, I had a long-term, five-year goal of creating a non-profit organization that provided the same care to low and no-income individuals.  But looking into the eyes and hearts of my patients, knowing they felt a little lost without me, really emphasized the importance of accelerating this goal!

So, we are working it out.  And we’re getting there!  We are so excited to potentially offer these services within 2 years of Ally RN’s launch, and sooner if supporters make it happen.

Meanwhile, we are in the process of acquiring state licensure (snooze), and writing all of our policies and procedures (double snooze!), which will help to streamline processes for patients and ensure patient safety, which is important, because it’s all about YOU!

Thank you for reading this blog.  Thank you for visiting our site.  Please bear with us while we get ourselves up and running, and reach out to us anytime with questions!  We can’t wait to hear YOUR story.  We can’t wait to be YOUR rock.

“Love’s the only house, big enough for all the pain in the world” -Martina McBride

-Kathleen Clark, RN, BSN

CEO, Ally RN, LLC