1. Thomas, Jeri MSN, RN

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Just as there are seasons in nature, there are seasons in life. In the spring, trees and plants bud into life and everything is new and fresh; new discoveries amaze the eyes of the young. During summer, nature explodes with beauty, life, and growth. During the summer of one's life, the focus is on having fun and enjoyment. As summer passes into fall, one might focus on the changes of life, like the leaves that have changed from green to bright red, orange, and yellow. Finally, as winter approaches, the first gentle snowfall may produce awe as the observer marvels at the individuality of each snowflake. Similarly, one may stand in wonder at what occurs in the winter of life.


Lakeland Regional Medical Center is an 851-bed, acute-care, community hospital in Lakeland, Florida. The Intensive Palliative Care Unit specializes in care of patients who are in the winter of their lives. Staff members recognized the unique needs of these patients and their loved ones and were searching for a way to honor these patients. In addition, a tactful and delicate way to communicate a patient's status among all caregivers was desired. The manager initiated the practice of hanging a simple white snowflake ornament on the outside door of the patient's room. Explanations to the loved ones were as follows: the snowflake is a symbol for all staff that the patient in that room is special. No two snowflakes are alike-and this concept was embraced as an individualized plan of care was developed and implemented[horizontal ellipsis] one that provides for a comfortable, dignified, and peaceful season of life. When the "snowflakes" leave the unit, whether they pass from life or are discharged with hospice care, the snowflake from the door is given to the loved ones as a memory of his/her life.


The concept has been very well received by the patients' families and is now a standard practice on the 27-bed palliative care unit. The snowflakes, purchased in quantity from discount retail stores, are stored on the unit until needed.


Further information or questions can be addressed to Nursing Manager Jeri Thomas, MSN, RN ( For more information about the Lakeland Regional Medical Center, visit their Web site at


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Jeri Thomas, MSN, RN