Nurses’ roles in caring for the Hospice Patient Allison Buehler Samantha Mendez Brittany Bonne

What are the differences between Hospice and Palliative Care? Click to add subtitle

What is Hospice? Palliative care- therapy designed to relieve or reduce intensity of uncomfortable symptoms but not to produce a cure (Mosby, 2005). Hospice care- a system of family-centered care designed to assist the terminally ill person to be comfortable and to maintain a satisfactory life- style through the phases of dying (Mosby, 2005). We would like to focus on the nurse’s roles during the patient’s end of life hospice experience

Nursing Literature Generally nurses feel like they have not received adequate training for this aspect of nursing Studies have found that implementing end of life training (even if its short) has a substantial effect on the amount of knowledge, competency, and comfort nurses have within this nursing aspect (Wallace, 2009).

Nursing Literature Cont…. Knowledge regarding symptom management is lacking for patients with advanced chronic illness (Wallace, 2009). Lack of palliative care information in nursing texts, with only 2% of the books including information on end of life care (Wallace, 2009). One research study showed that seven critical responsibilities of nurses caring for patients in their end of life are: providing comfort, responding during the death scene, responding to anger, enhancing personal growth, responding to colleagues, enhancing quality of life during dying and responding to the family (Pavlish, 2009). Another study showed that providing support to the patient was the primary roles nurses enacted (Pavlish, 2009). Lack of consensus between health care providers and patients on what constitutes a good death (Johnston, 2005).

Concept Analysis Overview

Nurses have many roles in Hospice care Teaching Caring Coordinating Advocating Mobilizing (Pavlish, 2009)

Teaching Preparing patients and families for: – Decision making – Symptom management – Self care – Death – Coping mechanisms (Pavlish, 2009)

Caring Relating to human aspect/experience Support – Physical – Emotional – Spiritual Active listening Therapeutic communication/ touch (Pavlish, 2009)

Coordinating Multidisciplinary approach – Cohesive comfort care plan – Communication between care providers (Pavlish, 2009)

Advocating Assessing and representing patient and families needs – Really getting to know the patient – Be a source of information – Have the patient define the quality of life (Pavlish, 2009)

Mobilizing Attentiveness – Therapeutic communication Assertive Resourceful – Involve other disciplines

So, what are some good traits an end of life nurse should possess?

Nurses think…. Clinical Expertise Honesty Family orientation Perceptive attentiveness Presence Collaboration Deliberateness (Pavlish, 2009)

Families think…. Emotional support for family Symptom management Treating patient with respect Caring attitudes Involving family in care Disclosing information Education Treating the patient as an individual… – These are the best qualities of nurses from the families perspective (Pavlish, 2009)

Families think…. Emotional support for family Symptom management Treating patient with respect Caring attitudes Involving family in care Disclosing information Education Treating the patient as an individual… – These are the best qualities of nurses from the families perspective (Pavlish, 2009)

Keep in mind… Ethics Cultural differences Psychological Social Physical Spiritual – ALL NEED TO BE ADDRESSED IN CARING FOR THE PATIENT! (Pavlish, 2009)

WSU Roles Advocate Change Agent Manager Leader

Resources for Nurses Hospicenet- chat room for grieving nurses Local hospice agencies have counseling available for free or reduced cost for nurses Support groups

Gone from my Sight Henry Van Dyke I am standing upon the seashore. A ship, at my side, spreads her white sails to the moving breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until, at length, she hangs like a speck of white cloud just where the sea and sky come to mingle with each other. Then, someone at my side says, "There, she is gone" Gone where? Gone from my sight. That is all. She is just as large in mast, hull and spar as she was when she left my side. And, she is just as able to bear her load of living freight to her destined port. Her diminished size is in me -- not in her. And, just at the moment when someone says, "There, she is gone," there are other eyes watching her coming, and other voices ready to take up the glad shout, "Here she comes!" And that is dying...

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