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Namah Code Krishna

Considering that a hospital is a place of healing, team should be involved. Third, since holistic
Code Krishna aims to offer quality care that end-of-life care is essentially attitude- and
facilitates the sharing of deeper individual and behaviour-centric, systematic training and
collective feelings arising from the event of death. sensitisation of the staff are necessary to raise
The words, actions and gestures involved are the standards of such care. Finally, there is
intended to help everyone find meanings in the growing recognition of collaborative wisdom
larger dimensions of life and death. in care, based on a scientific, social, spiritual
and cultural understanding of the process of
While introducing Code Krishna, we ran into death. Collaborative wisdom should be used
several implementation-related difficulties. For as a framework to bring about a paradigm
example, we had to convince the healthcare shift in the care of patients.
team about the practice, persuade it to
participate whole-heartedly and try to make it To sum up, we have made a small beginning
consider the practice as a priority in the totality and aim to go further by making end-of-life
of care. Constraints of time, e.g. due to the care an integral part of holistic healthcare, as
need to attend to other patients, were another a continuation of the critical care component.
important obstacle. Incorporating this practice
in the standard operating procedure (SOP) References
for end-of-life care helped in overcoming these
difficulties to a great extent. We hope that our 1. Quill TE, Cassel CK. Nonabandonment: a central
innovation will foster introspection among all obligation for physicians. Ann Intern Med. 1995;
those concerned with providing humane care 122(5): 368-74.
to patients, whether living, dying or deceased.
We also hope it encourages them to evolve 2. Back AL, Young JP, McCown E, Engelberg
practices appropriate to their own setting to RA, Vig EK, Reinke LF, Wenrich MD, McGrath
achieve the same goal. BB, Curtis JR. Abandonment at the end of life
from patient, caregiver, nurse, and physician
Epilogue perspectives: loss of continuity and lack of
closure. Arch Intern Med. 2009; 169(5): 474–9.
In the light of our experience with Code doi:10.1001/archinternmed.2008.583.
Krishna, we would like to make the following
observations. 3. Dickinson GE, Tournier RE, Still BJ. Twenty years
beyond medical school: physicians’ attitudes
First, recognising the fact that death is an toward death and terminally ill patients. Arch
event as well as a process with deep-rooted Intern Med. 1999; 159(15): 1741-4.
emotional, behavioural and spiritual elements,
every effort should be made to address the 4. Periyakoil VS, Stevens M, Kraemer H. Multicultural
physical, emotional and spiritual components long-term care nurses’ perceptions of factors
of care. Second, the task of addressing influencing patient dignity at the end of life. J Am
that which lies beyond death should not Geriatr Soc. 2013; 61(3): 440-6. doi:10.1111/jgs.12145.
be assigned to a team of spiritual support
givers or chaplains; the entire healthcare 5. Periyakoil VS, Noda AM, Kraemer HC. Assessment

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