Although the medical intensive care
unit (MICU) at Ronald Reagan UCLA Medical Center is designed to combat clinical deteriorations and save lives, it is also where some patients will unfortunately spend their final moments. "We see adult patients of all ages who succumb to the effects of a variety of medical conditions, such as cancer, respiratory infections, sepsis, heart disease and organ failure," says MICU director Sherry Xu, MSN, RN.
To improve the end-of-life experience for patients, loved ones and their care teams, the MICU introduced the 3 Wishes Project in December 2017. "Wishes are elicited from patients and their loved ones to celebrate and honor the lives of those who are dying, while supporting those who are grieving," says Thanh Neville, MD, MSHS, a pulmonary and critical care physician who serves as the principal investigator along with project leads Xu, palliative care physician Peter Phung , MD, MBA, and MICU clinical nurse specialist Yuhan Kao , MSN, RN.
During the first year of the project's inception, the MICU staff completed over 400 wishes for over 100 patients (at an approximate cost of $30 per patient). Some wish requests don't have any associated costs. "One patient wanted to spend his last dying moments outdoors, and we were able to move his bed outside where he passed away with his wife by his side," says Xu. "Some patients want to return to the unit where they spent much of their hospital time, such as oncology, so they can be surrounded by the nurses and doctors who cared for them for so long."
Loved ones have asked for mementos, such as a lock of hair or a thumbprint keepsake. One popular request is a framed image called a word cloud. "Family members provide us with words that describe their loved one, such as 'mom, sister, brave, compassionate, creative, " says Dr. Neville. "We surround the patient's name with these meaningful descriptive words to create a beautiful piece of art that can hang in the patient's room and eventually goes home with a loved one."
Findings from McMaster University in Canada where the program originated suggest that this type of intervention can greatly improve the bereavement process for family members and bolster the morale of the health care team. "It can be extremely stressful to work in an environment where unfortunately many patients die,” says Dr. Neville. “The 3 Wishes Project helps the clinical staff find closure too. It really provides 360 degrees of healing—for the patient, the family, and the clinical team.”
The program was originally funded by a $10,000 seed grant from the California State University Institute for Palliative Care. Currently, it is philanthropically supported and sustained by various grants and donations. To gauge the program's efficacy, the project team members are conducting ongoing surveys of clinical staff and interviews with family members of deceased patients. The goal is to make this service available throughout the UCLA Health System.
To make a donation for the 3 Wishes Project, visit: giving.ucla.edu - 3 Wishes Project in the Medical Intensive Care Unit.