Working with my preceptor, Jane, a registered nurse, allowed me to observe, research and document what hospice and palliative care entail, but it was a family's personal story that gained my undivided attention.
I was on one of my many rotations at the hospital, and was privileged to witness the admission of Ms. Smith, a terminally ill patient, who had a primary diagnosis of end-stage pulmonary disease, and a secondary diagnosis of end-stage renal disease. Both conditions were advanced with poor prognosis. These factors were considerations for Ms. Smith's referral and ultimate admission to hospice care.
Approaching Ms. Smith's and her family, I could see her daughter was upset about her mother's condition. The hospice nurse liaison, Sam, introduced us to the patient's son and daughter. Ms. Smith, an 88-year-old woman, was lying in bed comatose and hooked up to oxygen after being extubated a few hours earlier. The patient's daughter quickly realized Sam was a hospice nurse, and burst out tearfully expressing relief someone was there to listen, and hopefully understand her plight.
"I don't want what happened to my dad to happen to Mom," Ms. Smith's daughter said. Her father was hospitalized a year ago for approximately 10 days before succumbing to lung cancer. "I wish someone had told me about hospice. Maybe we could have spent time with him without all the machines and tubes," she said.
Mission of Hospice Care
Through her tears and despair, Sam gently rubbed her shoulder, offering tissues and support. Her compassion was quite evident and effective as Ms. Smith's daughter quietly said "thank you." I felt saddened by the family's tragedy but relieved Sam was there for guidance and support, characteristics she displayed quite well.
Sam explained the mission of the hospice center is to provide spiritual, emotional and social support to patients and families facing end-of-life scenarios. This was discussed in a detailed but simple manner to benefit the family members who knew little about hospice.
As my preceptor said, "The benefit of this program is that patients and family would be consistently and routinely provided with palliative care options, which could reduce futile treatments, decrease healthcare costs, and improve patient and family satisfaction with the healthcare system."
Ms. Smith's family was concerned with the availability of the hospice team for their dying loved one. Being a daughter of aging parents, I understood to some degree, the worrisome feeling displayed by the family members. Sam quickly assured the family members skilled nursing care would be provided, and the hospice team would be available 24 hours to offer support or just to answer questions or concerns.
Her daughter sighed in relief. Her son, who was encouraged to express his fears and concerns, remained quiet holding his mother's hand at intervals. As a student nurse you are taught to be empathetic, but it's only human to feel some degree of sympathy. I found myself walking over to him and gently tapping his shoulder. He smiled sadly, yet, appreciatively.
Comfort & Peace
Ms. Smith died 3 days after being admitted to hospice. Her family members thanked Sam and the hard-working hospice nurses for keeping her mother comfortable and dignified during her final days surrounded by her family.
This scenario definitely gave me insight into the importance of hospice care for the terminally ill patient and their family members, who are affected psychologically by this end-of-life experience. Not only is pain management a major comforting experience for the patient, but bereavement counseling is also provided to grieving loved ones after the patient is deceased.
Just like Ms. Smith and her family members, the dying process can be one of comfort and peace, taking place in an environment filled with the presence of loved ones.
Herma Thompson is a nursing student at Bloomfield College, Bloomfield, NJ.