Seven Things to Consider When Dealing with Hospice Patients Hospice nurse: if you arrive on scene and the hospice nurse is not present, ask the caregiver if the hospice has been called; the caregiver may have forgotten to do so. Orders: determine if there are prehospital end-of-life orders for the patient such as a ‘Do Not Resuscitate’ document like a Comfort One or a more detailed treatment plan, as in a Provider Ordered Life Sustaining Treatment form (www.polst.org); be familiar with the format your state utilizes. Scale: many of the currently used pain scales, such as the familiar ‘10’ scale, can also be used in the assessment and reassessment of other symptoms, such as nausea or dizziness. Palliate: means to make less severe or intense and for a hospice patient, it means improving the quality of life by decreasing discomfort. ‘Do Not Resuscitate’ does not mean ‘Do Not Treat;’ you should address problems or symptoms that distress the patient. Interpret: view your assessment findings with the understanding that not all terminal disease is cancer and that the patient’s current complaint may or may not be related to the terminal disease. Caregiver: your primary focus is certainly on the patient, but keep in mind that the caregivers are often stressed and fatigued and interact accordingly. Empathy: you have it, be sure to use it; your voice and touch may be the last human contact your patient experiences. |
By Jim Upchurch
I am dead. Nothing anyone could have done. That’s what terminal means, right? It started as a ‘spot’ on the X-ray. That spot turned out to be an infant cancer with a voracious appetite for life — my life, that is. Six months of aggressive treatments failed to alter its destructive march through my body. Enough was enough, no more feeling worse from the ‘cure’ than from the disease. The docs then pronounced the sentence: six months left to live, give or take a few weeks. They mentioned hospice, you know, the end-keepers. But I didn’t want that; at least, not at first.
That began to change after several weeks of witnessing the increasing burden shouldered by my family and friends. They were exhausted. I wanted to die right then. My wife, always smarter than I, figured we could use some help and called the local hospice. I didn’t know we had such a thing in our small rural community. When ‘she who must be obeyed’ first told me a hospice person was going to make a visit to explain what they could offer, I was not happy but clearly outnumbered, especially since my EMT sister-in-law informed me that she works with hospice through the local ambulance service and hospice can help people in my situation.
I was double-teamed from the beginning, as not just one hospice type person showed up, but two — the hospice social worker and a hospice nurse. They were very nice folks who patiently explained their services and answered questions. Turns out, it was a no-brainer to invite them into the family.
My immediate family remained the primary givers of care, but now they had help. I had regular visits from the nurse and social worker to help deal with the ongoing and increasing mental and physical distress we all experienced. They arranged some R&R time (that’s Rest and Recuperation time for you non-military types) by hospice volunteers; they call it ‘respite.’ Everyone was getting so tired, and now they could get away for awhile without carrying any guilt along during their absence. The hospice chaplain even stopped in to cover any last minute spiritual needs I had.
I never realized how much unfinished business I had left laying about. It actually gave me some purpose during the time remaining. I could mend a few fences, find all the important papers she’ll need when I’m gone, and leave last minute instructions and advice (like anybody listened).
I was scared of dying, having pain, leaving my family. Hospice helped educate us all about how to best live until you die and about the actual dying process and what to expect. The information was not presented all at once, as that would have been overwhelming, but with each visit they provided information, reassurance, direction, and encouragement. They helped ease that fear of the unknown.
When you lose control over your life and need help with everything you do — from eating to using the john — you need someone or a group of someones to help you adjust, accept, and transfer from this life to the next, what ever you believe that next life to be. And for us, that was hospice. Hospice has a team of volunteers and professionals that provide care to you directly and through your circle of family and friends, who do the work that allows you to stay home during your final experience. And not only does that labor of love help you stay home, but it helps your quality of life survive in the face of diminishing life days.
At the end, I wanted no grief, no tears, no sadness. Life was what I made of it. I came to terms with that before I left. And when I left, I went quietly, surrounded by my family, friends and some of those hospice folks.
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‘I am Dead’ featured Jim Upchurch’s views on death from the perspective of a hospice patient. What experiences have you had with hospice? Share your thoughts in the comment section below.
