TranquilityRN
Tuscumbia, AL
Female, 40
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.
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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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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.
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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.
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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!
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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.
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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.
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