HOUSE CALL: Alison Guthrie, RN, of Good Shepherd Hospice with patient Steve Prater. (photos by Amber Bramble)

Just days before she was due to start at Good Shepherd Hospice, which serves communities in West and Central Florida, Guthrie received the call: Her mother, back home in England, was hospitalized and critically ill. Guthrie needed to get to her bedside as quickly as possible.

"There was nothing more anyone could do for her, so I flew home and took care of her until she passed away," Guthrie said.

The hospice company held Guthrie's job open until she was able to return, but she wondered whether she could work around "so much death" while her grief was so fresh.

She quickly found her experiences as a hospice nurse would be "quite the opposite."

"Really, it's worked out for the best," Guthrie said. "I know what the families are going through. Little things, like having the time to listen, matter most."

Holistic Care

Hospice nursing provides RNs with the opportunity to offer holistic care, meeting patients' physical, psychosocial and emotional needs. They also help families navigate the grieving process, blending the roles of nurse, educator and advocate to ensure patients and families receive both high-quality care and support.

From the admissions nurses who screen and evaluate patients to field RNs who provide front-line care, the setting brings rich rewards to those who heed its calling.

Typically, primary care nurses like Guthrie and colleague Stacey Foskey, RN, visit patients' homes - the frequency depends on a patient's needs - to conduct assessments, review medication and educate both the patients and family.

They serve as the eyes and ears of the rest of the care team, keeping physicians and other caregivers informed and updated about the patient's condition.

FAMILY SUPPORT: Guthrie reviews medications with Robert Prowant and his wife Dorothy Prowant in their home. After he was diagnosed with COPD, Prowant was repeatedly hospitalized, but Guthrie's visits have helped him improve his quality of life.

Laughter Heals

Guthrie's first call of the day is Robert Prowant, 82, who was diagnosed with COPD.

Before he was referred to hospice, he spent "a lot of time in and out of the hospital," she said. Her visits have helped him regain some independence and improve his quality of life. Although he's oxygen-dependent, he can now go shopping or out to eat with his wife.

Hospice also has helped keep him out of acute care.

Should he experience COPD-related problems such as shortness of breath, Prowant can begin treatment immediately with an emergency kit - antibiotics and steroids - kept in his refrigerator.

"He doesn't have to wait for hours in the emergency department. Once he takes his medications, he calls me and I get on my way," Guthrie said.

Since he entered hospice last fall, Prowant's condition has significantly stabilized. While there is not a running time limit on hospice care, Medicare requirements include periodic evaluations and documentation of the patient's continued decline.

"That's if I don't go downhill," he chuckled. "I don't want to lose Alison and the rest of the staff. I guess I'll have to get as sick as I can between now and then."

Humor becomes a critical part of the healing and support process, Foskey added.

"I just left a patient's home who is prepared to 'go' - he told me so a few minutes ago. He shut his eyes and told God he was ready. When he opened them, he said, 'Well, I'm still here. God didn't take me again.'"

Afterward the man and his wife gave in to humor, and began "cutting up and cracking jokes," Foskey said. "You have to keep the laughter going. Every day is a gift."