I have been a hospice Registered Nurse for about ten years. Hospice is similar to home health except specializing in care of the terminally ill, dying patient. A hospice nurse provides palliative care for the patient during their last months, weeks, days, or hours so they may pass in the comfort of their home and with their loved ones present. I provide comfort and dignity for the the patient and comfort for the caregiver. Following the peaceful passing of the patient I provide postmortem.
The particular employer I took my very first hospice job with, prepared me best they could. Hospice is truly a calling and is not for everyone. It was a very surreal experience, however, mixed with emotions. I was excited to fulfil my calling, be a rock for those left behind, yet I was full of empathy and sympathy and sadness. The reward of the love and respect I gained from being that important role brought an overwhelming calmness and gratitude and peace over me.
I was usually not the only person present unless it was someone who had no family whatsoever or family that was not active in their lives. Unfortunately that happens more than one may think. Part of the job of a good hospice nurse is using your talent and training to recognize signs and symptoms of death and from these estimating the time frame that the patient may pass. Therefore, the nurse calls the family to be with the patient to be with them in their final minutes. It can happen and in this case I would call family and congregate with them and explain that their loved one passed and that they did so peacefully. At this point your primary focus is comfort for the family left behind.
Yes I do! However there are times when someone is ready to pass and they have this close family that for our own selfish reasons we do not want them to leave us, have tendencies to say, "please don't leave me" and these people don't pass as peacefully as I would like. It's my job to educate families on allowing the patient to start their next journey they are tired from this fight. Tell the patient it's okay and you will see them again!! So patients with big families or supportive ones have a higher increased good spirit which keeps them peaceful and calm and reasons to hold on longer!
Yes they do. This is usually discussed between physician and patient prior to the referral to hospice being made. It is still a challenge for the hospice nurse to help the patient cope with this fact at admission and for a short period after. Noone wants to die and most people are scared not to die but of the unknown. That's a hospice nurses job to explain and ensure the patient that all things will be discussed with them until they are unable to make their own decisions. Also to answer any questions honestly. It's important to explain death and dying to the caregivers and patient and ensure the patient of your competence and experience and that they will NOT die in pain. Most people are afraid and yet become very accepting and at peace with this fact closer to death. I personally have had a few patients that were never afraid and these families often were the once that had celebrations of life versus copious amounts of tears upon the passing of the patient.
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If a homeless person wants to use your bathroom, are you supposed to stop him?More times than one would want to think. One that stands out was a gentleman and his common law wife of nearly twenty years was having seizures and as I ran towards his bed to relieve his symptoms with a hope of peaceful passing his son stopped me and the children two against two began to quarrel about calling an ambulance! The SO was holding his living will up and said that their father didnt want this.....one called 911 and one was fighting trying to get the phone and everyone yelling!! I yelled at this point and everyone got quiet and I said "I took an oath to be a patient advocate, hang up the phone and you sir move so I can take care if your father!!" I did what my patient needed and thank goodness I wa able to stop paramedics before initiating CPR due to him being a DNR. The family was thankful later but still unfortunate ! And I have seen families fighting over material things before the patient passes! Breaks my heart when nurses fail to educate the family so well that death is not a surprise and they beg the patient not to leave them!! The dying patient needs to be given permission to go.
Well any hospital or health facility is obligated to keep a patient alive. Families can over ride living wills in some instances, which is unfortunate. However, hospice patients are usually at home or in an inpatient hospice facility and have opted for hospice benefits and also have desire to no longer have life prolonged and resist the inevitable death. Normally hospice patients and the family is very educated about the hospice philosophy and what's to come that they choose to die at home and remain a DNR. Do Not Resucitate.
Yes after three years of on call 7 on and 7 off, which on call is rarely good news or a minor issue, I found it having effects on me emotionally. Dealing with death daily and nightly and caring so deeply definitely had its effects on me. For good it really makes me thankful and appreciative my family are safe and healthy at this time. It also enables me to see things that we take for granted. However, it also effects my home life in a negative way in such a manner that I may be at a ball game etc and that call comes in that patient or tht family may need me and that pulls me from my family! They understand and admire what I do but need me just the same. On call is hard being a single mom also!! I find it very helpful to maybe every three years or so take a break from hospice until that point you miss it so bad that you can refrain from getting back to it.
Patient can refuse it absolutely!! Usually that's because if not accepting the shape they are in and/or fear of dying. I have went and admitting a patient later that has refused when they finally accept the inevitable or when the patient is non responsive at the request of family members.
Not usually. Not from a terminal illness unfortunately! However there are those that give up of the disease is way more than they can fight.....and there are those that have a very strong will to survive and fight. It's amazing to see what people "hold on" for, like usually mothers not wanting to leave children or men not wanting to leave his wife behind to care for herself. I have had to discharge patients from hospice and refer to home health for what is called a failure to decline. Which means the disease did not run its natural course and cause death within what guidelines are placed on the retention of a patient!! But in a sense that's a good feeling and doesn't happen very often.
No not usually, it happens, but most of my patients are general somewhat comatose at the point they start to pass and usually this is predicted and a time frame predicted using the training a hospice nurse receives! Therefore they family is aware and normally at the bedside as they take their last breath. I have had patients pass in their sleep and the family find them. But if its a natural death nothing acute NORMALLY the family is educated by the RN of the sign and symptoms of impending death and know its occurring. Most families also tend to take shifts at the bedside which I personally tell them isn't necessary because often I have seen patients especially mothers not want to pass with their children looking on. Better for family to keep routines as close as possible for the patient sake.
Honestly usually we are successful in managing all the symptoms necessary that there is not alot of suffering. However, people with bone cancer or colon cancer can be hard to manage pain. COPD patients are difficult or me personally because I always felt as though I was suffocating. I think the worst deaths to witness so far have been cirrhosis when the patient develops esophageal varicese and bleed copious amounts. Although the RN prepares for possibly bleeding out by placing darker sheets on the bed and darker clothing to camouflage amounts of blood in case it happens. The family is educated prior to the potential so they are not shocked.
That depends because there are hallucinations which come with impending death! I have had a couple of patients confess to being in love with a spouse that passed prior to them yet they have a new spouse they love dearly. One man confessed to not always being true to his wife but other than that nothing but regrets or wishing they were closer to certain family. Alchoholics wishing they had lived life different and hadnt ran family off. In the case of confessing a murder that would be an obligation on my part to call in social worker and us team together to assess this further. But I'm sure it would have to be reported and investigated.
I have had families report this to me and ask that I speak with them and educate on the fact of whether or not the patient is competent enough to be doing such, however, I have seen families fighting over things before the patient ever passes. Very sad.
One old man asked me why I remarried twice being such a sweet lady with amazing calling in life.......I told him I was afraid to die alone! In his final few hours he told me while holding my hand that noone dies alone!! Amazing! I had a military vet in a nursing home and I never met any family, as I approached his bedside for a visit he looked at me so lovingly that I asked him what is it? He said I thought you were my wife, she came to see me last night, looked just like the day I bought her wedding dress, she was wearing it, hair black as coke like yours. I said oh my how wonderful did she come to get you? His reply with a sad look on his face was "she says its not time," I have so many!! I learned true love can exist and even on the other side.
Well nurses that have been in hospice for years make more due to many companies paying based on experience. In Alabama I am unsure what our pay is compared to other states, but I made $48,000 annual I think per year. That's salary with some in call also. Another job I made $42,000 as a newer hospice RN and that was on call only 7 on and 7 off. I worked PRN in the office for extra money if they needed me and they just broke my annual down into an hourly rate!
Any RN can be a hospice nurse actually. It's just that it really is a calling. I have gotten other friends involved and they didnt last because of the constant dealing with death and dying. LPNs are limited in the field but can do it as long as an RN sees the patient and meets the Medicare guidelines. Even a new graduate RN can do hospice but it truly is a calling. Palliative care certifications are a plus and can be gotten through your company.
My thoughts are that euthanasia is not a natural way to pass and could be considered murder, however, I do sympathize with a terminally ill person that is in constant agony and is tired of fighting a battle. I am a hospice nurse and with easing of symptoms we allow the patient to have a natural death in its own due time. We do not hasten nor prolong the dying process. But again, I do not have an opinion on whether or not it should be legal because I also believe people are in charge of their own personal bodies and I have not suffered a long battle with cancer etc.
Me personally, 15 year old leukemia patient. He planned his funeral and was very accepting of his illness.
I personally don't get scared and I haven't had colleagues that do. It really is a calling and also we are specially trained to assess and implement care related to death and dying. Agitation and anxiety are only a few, I would comfort the patient in a calm quiet manner and if not resolved assess if meds were necessary and give those at that time. Usually utilizing Xanax, Ativan, or haldol as needed. These meds are normally on board ahead of time because we would anticipate this type behavior and order it before symptom arises usually.
In my experience in hospice most of my patients were at home surrounded by loved ones in their last days. There are elderly people in nursing homes that I have cared for also. We do not have in patient hospices here in northwest Alabama, which is somewhat unfortunate for those with no family because I have also had these patients at home and noone with them around the clock, in an inpatient hospice they would have around clock presence of others. Other ethnic backgrounds where elderly live with children is wonderful and those that live here still utilize hospice and it is a better overall experience when family is supportive and present.
Honestly I have had lots of conversations during the final days but I did have one gentleman was even experiencing the Cheyenne stokes breathing an discoloring of extremities and he was barely able to utter and said, "honey can you please help me" and smiled and I explained I couldn't do anything like that and he Laughed. I had one stubborn little lady patient that was closest to death than I had seen most patients just holding on.....this was third time and just as I said " well you all know how miss M loves to make a monkey out of me?" The patient replies, after being non responsive all day, she said " lil lady you can't predict when I'm gonna die" and winked at me haha she was a funny lady!
Yes they can and do. I have had patients wait for soldiers to arrive from over seas and wait for family to arrive in town. Absolutely and it never stops amazing me!
Extremely easy to obtain RN jobs. Hospice is a little more difficult, depending on how many companies you have in your area. Also I said in the previous question it is truly a calling. Just any nurse cannot just apply to hospice because they want an RN job and successfully succeed rather the reasons be that they just cannot grasp the concept and philospophy due to nurses being geared towards nurturing and healing and sending a well patient home and with hospice that is never the case. Or the nurse is "simply" not called to do this profession.
Well sorry to just now answer your question but I have been battling MS and Narcolepsy myself. Honestly it is just a matter of people that are not afraid of death or when they finally get to what is referred to as the acceptance stage and they see death is inevitable. However, my personal opinion, I have noticed that people who have a strong religious lifestyle, regardless of the religion, seem to deal with death in a more positive way, therefore, their families seem to cope with the passing with more ease. Also children for some reason are so resilient and seem to cope with inevitable death with a better perception than most adults. Hope this answers your question.
Normally a couple weeks, BUT when the person stops eating and drinking completely usually death occurs within 72 hours. And i discourage IVs when death is inevitable also. Families that are not well educated think the loved one is dehydrated, which they are, but think they are suffering. Once the patient gets to a certain point they do not feel the urge for food and drink. IVs simply prolong the inevitable death that is to occur dragging out the dying process and it makes the brain more aware of pain and discomfort. If a family insist of course we have to do it but we educate educate educate to discourage and allow the body to die a natural death.
No we did not keep pets. However, there is a place locally called Therapy Dogs and they will visit if you call. And yes I have heard it and I do believe it. I have had multiple patients with pets and I do believe they sense death. Also some pets I have noticed are very saddened with the passing of a patient and will not leave the bedside until the funeral home picks the patient up. I had one young man and he had a giant dog. the dog had laid in the floor in the patient's room for two days until he passed. Last time I spoke to the patient's mother the dog spent and spends alot of time in the patient's room. Animals have a very keen sense of illness and dying before most humand. Howver usually a hospice nurse in trained to somewhat predict the death as well but the animals are normally very aware.
I am so sorry for this delay. I have been dealing with MS. You may not even need an answer to this question. As crazy as it sounds this varies for each patient. Just as we are all born differently, some easy births, some difficult, some come into the world screaming, some never cry, we also die uniquely. For instance, in this case, pending this person has no fluids, as you stated, no feedings running, and not even minimal sips of fluids, normally they survive up to two weeks or so. Without any type fluids, food, etc normally death will occur within 72 hours. However, in my experiences with hundreds and hundreds of patients, it depends. It depends on the persons will to live, like a mother having fear of leaving her children. A father not wanting to leave his children but much more not wanting to leave behind the wife who never worked and stayed home rearing the family. Mothers of small children seem to fight death to a point that has amazed me and it goes way beyond any type of education and experience I have ever recieved. Also people with very stubborn personalities and very strong willed people tend to survive longer. So sorry for the delay hope this helps.
A number of circumstances warrant the use of morphine. Palliative care providers are trained and certified in the palliative care and again this profession is a calling and you just "know" when the time comes. But when the patient has uncontrolled pain not being relieved by other means of pain control I will occasionally switch to morphine. Also when a patient becomes unable to swallow the sublingual drops of morphine are the most effective pain treatment. Not all hospice patients get morphine that is a misconception. I have had a number of hospice patients that were not in need of morphine but simply sublingual Ativan, Valium etc for terminal agitation related to the changes in the body and lack of oxygen and blood being pumped to the brain as the heart begins to weaken. Also pain patches are effective for those not in severe pain but do require steady pain control. I like this method because SL Morphine is fast acting short lived and doses have to be repeated frequently. This occasionally is stressful for the caregiver too. So with an anxious caregiver I may use other methods. You have to evaluate the situation and it is a holistic approach with the patient being first priority but the caregivers and family being right next in line. You treat the patient and the family is ALWAYS involved in the careplan for the patient. I like to have decisions made while a patient is still alert and oriented and document their wishes and preference for pain control and usually have caregivers present during the discussion so that we have no question of which method to provide. Hope that answers your quesiton. Sorry for the delay I have been dealing with MS. So sorry
Well both honestly. yIts very easy to get cauht up and become very involved with your patient and their families. It does have a very profound effect on the psyche. It is truly a calling. That is why I am so proud to have been involved in such a profession. I know I am a nurse but all nurses have a calling. You have bad nurses and great nurses. The difference is the ones that truly seek their calling and do THAT as their career are the BETTER nurses per say. Not just anyone can do hospice. The fact that it is a calling, in my opinion, is what makes us resilient and able to rebound and turn sadness into such a profound feeling of gratification for helping your patient and being the support and educator for their loved ones that you do have a sense of fulfillment. It is hard to explain but YES it gets depressing. I had to break from it temporarily after four years of strictly seven on and seven off on call duty. It became hard for me because naturally as a nurse your job is to nurture and heal, thats why most get into the profession anyway. As a hospice provider your not healing and sending a well patient home. You know from the day of admission that you will lose your patient. Our job is to make them comfortable until inevitable death occurs. And as only a oncall RN you are the rescue in the middle of the night, weekend, and holidays, which was so very rewarding but at the same time not many "good calls" or "good visits" occur during those hours. So I missed the daily, weekly visits and bonding with the patients and the families and was only getting to deal with the death part of the process. Very sad at times.
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This is very interesting. That is hard to answer because I am not familiar with this invention or how it is used. A hospice patient, at a certain point would not be able to use the device, depending on how it is used. The reasons being weakness, disorientation, and eventually a comatose state. However, it probably would be a wonderful thing to present from a caregiver standpoint. Normally hospice patients in the end state are not going to catch "bugs" etc and normally at this point it is of no concern. I know that sounds horrible but what I mean is, at the point of inevitable pending death and as it nears, the focus is NOT whether or not they catch a cold or anything else, it is to have loved ones around and proper palliative care to ensure a peaceful passing. Make sense? BUT if you wanted to present that to hospice companies, try the approach for the hospice patient that is alert and oriented with lung issues, pneumonia etc to prevent spread to a caregiver and present it to suggest to caregivers. Also I would suggest to promote it for the employees, especially your CNAs that spend MORE time with the patients and families due to the job they do. It is more up close for more time due to bathing the patient etc. We all know we cannot call in everytime we have a simple cough or cold and this could easily be a good thing to be utilized by hospice providers to prevent spread of "bugs" to a patient. Use the phrase, to prevent facilitating the dying process secondary to spread of germs and infecting your patients. :)) hope this is helpful to you. Also I am a Multiple Sclerosis sufferer, our treatments break down our immune system and almost every single thing we come into contact with makes us sick. Present this invention to doctors that treat patients with autoimmune disease and cancer. Reasons, chemo and medications for autoimmune disease break down the immune system. Best of luck with this :)
I had to come back and edit this answer because if you could later come up with an idea to push for chronic lungers etc that cough even while comatose, a gadget that can be utilized for them, almost like an oxygen mask with a filter or whatever you use in the cup in a bag? Like an ambu bag? Just FYI I am no inventor haha Just hospice nurse ;)
Oh my, it happens so frequently. As protocol we get the Social Worker involved and meet with the family. We can choose to report to authorities but normally, unless it is a major issue and habitual, we opt not to have others involved. The reason is because the last thing a dying person needs is chaos and drama. They do not need to have loved ones being shipped off to jail during the dying process. One company I worked for we would remove all narcotics etc from the home and an on call nurse HAD to make visit each time the patient needed medications. I have had to resort to a pain pump in the past to prevent such. Also the transdermal patches help because it is quiet difficult to turn a patient and remove a patch for self gratification. I placed the patch on my patient normally on the backside somewhere and initialed and dated it. Also I always always make the families aware that I monitor my patients' medications each visit and count them. The patches normally are five to a box and I monitored those as well. Sorry for the delay I have been dealing with my MS and treatments.
When I worked we had in services constantly to ensure compliance with state! All hospices or any medical field must provide info on how to report non compliance! I am not sure of how to ensure you get to the correct people without possibly checking that particular companys website. But there is a link
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