In Our Last Moments, Hospice Nursing

Chelsea Kwong, senior

At some point in everyone’s lives, one will have to face the death of a loved one, and eventually, their own death. During this time, it is critical to have adequate support and guidance in the various phases of the end-of-life stage. Some nurses voluntarily put themselves in this position, caring for those with a terminal diagnosis and their grieving loved ones. These nurses, known as hospice nurses, aim to provide maximum comfort for those whose treatments have ended, and provide support and education for the loved ones that the patient will leave behind.

Hospice care, by definition, is a type of care that “focuses on providing compassionate care while maximizing a person’s quality of life”1. Nurses in this field work to manage pain and assess the patient’s condition, rather than performing aggressive measures to keep them alive. Major duties of the hospice nurse lie within the “Gold Standards Framework”, which is a tool to guide healthcare professionals in the care of the terminally ill. The concepts within this framework (also known as “the 7 C’s”) include: communication, chospiceoordination of care, control of symptoms, continuity of care, continued learning for nurses and other professionals, caregiver support, and care of the dying2.

Hospice nurses not only provide care for their clients, but also for their clients’ families. As a terminal illness diagnosis also takes a toll on loved ones, nurses must prepare to educate the families on expectations during the end-of-life phase, and support them during the grieving process. One way that the nurse may do this is by educating the family on performing comfort measures (such as oral care) and encouraging the family to tell stories or perform family rituals2.

The concept of hospice nursing is relatively new, having been developed within the past 25 years. Care is primarily provided in the client’s home, but can also be provided in an in-patient hospice unit, a nursing home/long term care facility, etc3. Those who wish to become hospice nurses need not have additional certification beyond an RN degree, however, organizations such as the Hospice and Palliative Nurses Association offer various certifications (including providing care for pediatric patients)4. Master’s degrees in hospice and palliative care nursing exist at New York University and Ursaline College (in California)3.

Hospice nursing can require a great deal of vulnerability when providing care. One nurse provided a statement about grieving a patient’s death to Linda Norlander, author of To Comfort Always: A Nurse’s Guide to End-of-Life Care, saying, “I cry with the family. I also try to take some quiet time-sometimes I just sit in my car. But I need the time to remember that patient”2. After providing care to a client and their family for a great deal of time, it can be easy to form a bond, and hard to let the patient go.

During the end-of-life stage, many uncertainties can arise. It is a very emotional and confusing time for the patient and their loved ones. With a hospice nurse, these people will not have to go through this journey alone.

1Crusse, E.P. (2014). Hospice care is comfort care. Nursing Made Incredibly Easy!, 12(3), p. 40-49. DOI-10.1097/01.NME.0000445322.70273.8c

2Norlander, L. (2014). To comfort always: A nurse’s guide to end-of-life care. Indianapolis: Sigma Theta Tau International.

3Nurses for a Healthier Tomorrow. (2015). Hospice/palliative care nurses. Retrieved from http://www.nursesource.org/hospice.html.

4Hospice and Palliative Nurses Association. (2015). Certifications offered. Retrieved from http://hpcc.advancingexpertcare.org/competence/certifications-offered/

Photo from Georgia Mountains Hospice

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