Nurses’ roles in caring for the Hospice Patient

Allison BuehlerSamantha Mendez

Brittany Bonne

What are the differences between Hospice and Palliative Care?

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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 SightHenry 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 voicesready to take up the glad shout, "Here she comes!"

And that is dying...

Sites to Check Out!

• www.hospicenet.org• www.aacn.nche.edu/ELNEC• www.nhpco.org• www.americanhospice.org