1. Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN

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Code Lavender

In every aspect of palliative nursing, I increasingly am sensing rising anxiety about the future of health care, given the overwhelming demands of an aging society, the growing awareness of palliative care as essential in previously uncharted areas such as neonatal care or critical care, and a long overdue recognition by consumers that they deserve better care at the end of life. Nurses' natural response to this anxiety is often to work harder, do more. On this unceasing treadmill of providing care to the seriously ill and dying, any intention by nurses to practice self-care is replaced by the ever-present message to work harder and faster, as the treadmill incline steadily rises.


At a recent ELNEC course as nurses were sharing examples of innovation in patient care, I asked the participants if there were any examples of model self-care programs. I was impressed with the responses. Ashley Strubhar from Lurie Children's Hospital in Chicago shared that her colleagues are in the process of instituting a "Code Lavender." The code is called in the Pediatric Intensive Care Unit when staff are having a difficult day or perhaps a death has occurred, and in the aftermath, there is recognition of the need to provide care to those most intimately involved in the death of the child. A Code Lavender call means that the nurse now needs urgent attention, whether that be a hug from colleagues, a few moments alone, or time for a long delayed meal. For a pediatric nurse who has just witnessed the death of a child, bathed the body, and supported the family, is it too much to ask to "call a code" for the nurse? Ashley shared that the hospital hopes to extend this practice into other clinical areas in the future.


Another nurse in adult palliative care, Kristin Fox from St Joseph Hospital in Nashua, New Hampshire, shared a very similar support system in her hospital, which is referred to as "Code Pearl." Code Pearl is called as a family is about to leave the room after the patient has passed, and the nurses line up at the elevator doors to say goodbye to the family. It allows for closure for the staff and the family. The intention is the same-urgent attention to nurses who have with great urgency provided the physical, psychological, social, and spiritual care that is inherent in every setting, for every patient, by every nurse.


There are many examples of self-care described in the literature and shared by nurses at conferences, on blogs, and in staff meetings in every state. What strikes me about these 2 examples is 2 things; first, there is a sense of urgency in the language of "calling a code" regardless if it is Lavender, Pearl, or any other color. There is a critical need for the collective of our profession to see self-care as urgent-not something we do when all else is done but something we must do. Second, I am inspired by these examples to imagine what this might actually look like on these units-a code is called, the treadmill stops, there is recognition that a precious colleague has been depleted and has crossed the line where there is no more to give. That nurse becomes the recipient of palliative care. There is another message here: if we expect self-care, we better do it ourselves.


As you read the pages of JHPN, for every article reporting on an important patient or family concern, such as in this issue describing topics of communication, grief and mourning, and existential/spiritual interventions, pause to also think of the nurse delivering that care. Sustaining the care of patients and families in the era to come begins with urgent attention to the professional most prominent, ever present, and intimately involved in this care-the nurse.


We need to learn from Ashley Strubhar, Kristin Fox, and their colleagues to boldly do what we thought we should avoid in our field: call a code.


Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN




[email protected]


The author has no conflicts of interest to disclose.