A Career As A Hospice Nurse
In every profession a person’s own perceptions and life experiences shape how they perform and function at that job. Nurses find this to be true more so than other professions, especially when it comes to treating someone with a terminal illness. Cancer has affected many people in my life,
I lost my grandmother and a close friend. But I have also dealt with end stage cancer first hand as a hospice nurse. In the case of my family, I watched my grandmother battle aggressive brain tumors called glioblastomas. As the cancer spread the chemotherapy and radiation had to intensify, which in turn caused her to become weaker. She needed more help with basic activities of daily living, including preparing meals. She also would
occasionally …show more content…
have seizures due to the increased pressure from the tumors in her brain. This meant she required someone to stay with her at all times.
She had to move in with my Mom who mostly works from her home, only traveling out of the house 1-2 days a week. On the days my Mom was out of the house my grandmother would go to a local adult day care, where she would socialize with other seniors. As the disease progressed she required more assistance with activities of daily living and was no longer able to go to the adult day care. This additional need for care became difficult for my Mom who needed to continue to work and she had to place her in a skilled nursing facility to assure she received the care she needed. She was enrolled in hospice care which added another level of support in the last 3 months of her life. As our family watched her decline we relied on each other, and the hospice team for support. The decisions my Mom had to make were difficult and she needed the support of her family and her friends. The difficulties that my Grandmother faced were difficult to watch, but she was not alone in the process thanks to her hospice nurse. The closeness that her nurse had with her and the expertise she brought with her regarding symptom management and end of life care not only helped my Grandmother feel more comfortable but also our family. She also needed our support and love to
help her cope with the depression associated with a terminal illness. Her experience led to my transition from hospital nursing to hospice nursing. I was able to use my personal experience in facing difficult end of life decisions, and help others with the challenges they would encounter at during the transition to hospice care. Not only did I become a hospice nurse
I continued my education and sought out certification as a certified hospice and palliative care nurse. With this certification comes with it a knowledge and understanding of end stage disease processes and how to help manage
symptoms.
My personal experience with hospice and my family helped mold me into a caring and knowledgable hospice nurse. My current role is as a charge nurse in the hospital where I act as a resource and patient advocate.
This is also the case when patient's are given a less than favorable diagnosis. I value the difficult decisions patient's and families have to make when deciding to initiate hospice care. One of the crucial components in hospice and palliative care is that the plan of care in patient driven. This means that as a nurse advocating for patients wishes is of the utmost importance. With personal and professional experiences, my view of a patient's quality of life not only encompasses their physical well-being, but also psychological and spiritual. Even though the end stage disease processes can be very similar, each patient is unique and should be treated as such. This means that not one terminally ill patient would have the same care plan as anyone else. My view on caring for a patient in their final stages of life, focus on improving their quality of life for whatever time they may
have …show more content…
left.
Both Mr. and Mrs. Thomas need help to improve their quality of life, as a community nurse there are strategies to help assist them with making positive changes.
The first strategy to help improve Mrs. Thomas’s quality of life includes referring her to a support group for other women with breast cancer. At a support group with other women suffering from breast cancer she can express her feelings in a safe place, and seek encouragement and empathy from the group. Discuss with her if it is okay to contact her oncologist’s office and see if they help facilitate any such groups. The support from other women with breast cancer could help her feel that she has someone to talk to about how difficult the diagnosis and treatment have been. She does not have any close female relatives and this support could help with her emotional or psychological well being. Talking about her struggles with cancer at a support group could possibly help her open up to her family and improve communication between her husband and sons.
The second strategy to help improve quality of life is to focus on Mr.
Thomas and encourage him to seek out support for his depression and make sure he is taking his depression medication. Set aside some time during the visit and let him know that you want to spend time in helping him while you are there. Discuss with him about approaching his physician regarding medication and making sure that the dosage is correct. Once on the correct medication and dosage, he may benefit from a reminder system for taking his medication. There are several ways of doing this whether it is an application on a smart phone, or simply creating a chart and checking off each day that you have taken the medication. Stress the importance of regularly taking his medication for optimal effects. Also encourage him to share his feelings and his wife’s terminal illness with his physician so that his
MD has a better understanding of how to help him. Discuss with him that when he does not care for himself emotionally it makes it difficult for him to be there for his wife. Help him identify some coping strategies he could use in dealing with his emotions in combination with his medication. Finally
assessing his communication needs and ask where he would like to improve.
Assist him in communication strategies to better express his feelings to his wife without being a burden on her.
The third strategy is to help Mrs.Thomas plan a schedule for taking her pain medication. A schedule for taking medication can enable her to be able to function throughout the day. Explain to her how pain medications are more effective when taken on a regular basis. Help her understand that when someone is taking medication for actual pain, addiction is not a concern and that it is appropriate to take it on a regular basis. With her permission help her put medication in a pill box and set a timer when it is time to take the medication. Coordinate with her and encourage her to keep a pain log that includes when she took the medication and how bad her pain was a that time. Instruct her on using a pain scale whether it is a number scale or just writing better/bad/worse/worst. This will help her MD or nurse assess how well the medication is working. This log is a key that can help them know what changes in medication is appropriate. It could help to show if there is a need for a long-acting pain medication or possibly less medication. It is also important that she keep a journal of how she is feeling once she starts taking the pain medication on a regular basis. Better pain control could help her function better and engage in her life. Help her understand that when taking narcotic medication on a regular basis, she will also need to take a stool softener daily since one of the most common side effects of narcotics is constipation.
In collaboration with her physician, adjustments could be made to help aid in her pain management problems.
Discuss the positive aspects of palliative care and/or hospice care and encourage Mrs. Thomas to accept the help. She could benefit from the expertise of the nurses and their knowledge regarding symptom
management. Hospice provides for not only support for her physical well being but also emotional support. Her main problems include pain and emotional stress secondary to her physical changes. Help her contact her physician to ask for a hospice referral due to the multi-disciplinary approach.
Encourage her to involve her husband with the decision of initiating hospice services. Provide information on all of the services that hospice encompasses. Hospice care includes: RN(medication and symptom management, collaboration with MD), Home Health aides(help with ADL's and bathing), Social worker(assist with financial resources in the community, caregiving resources, emotional support for patient and family, aid in final arrangements, advance directive information, assist patient and husband
in communication between each other and possibly sons, and provide communication tools), Chaplain(not only spiritual support for patient but for family if needed), Volunteers(company for patient, can do small household tasks not relating to patient care. Also discussion with oncologist regarding prognosis and coordination with hospice care. Stress importance of involving patient's sons and sharing what decisions are being made about her care.
Emphasize the importance of having difficult conversations while she is still able. The hospice team will evaluate on each visit how the plan of care is working and make adjustments accordingly.
As discussed earlier improved pain management will also improve her functional ability to do the important tasks she wants to do. Teach her important energy saving techniques, such as something simple like napping when her husband is at work. Currently she is staying in bed and crying because of the pain, so if pain can be helped she would feel better and may have more energy to do other things. A hospice nurse would be able to continually assess her pain and energy level. As she declines she may also need assistance with durable medical equipment. A hospice nurse is trained
to anticipate what equipment she may need as she declines. Also the home health aide available from hospice to help with bathing needs as she needs it. Having help from people she trusts and encouraging her to open up about the help she needs. Friends could wash dishes, do light housework to help both her and her husband.
With any decline there comes a time when she will no longer be able to provide self-care. Again the support from hospice is crucial here as the social worker will have community resources to help with caregiving, including lower cost alternatives. Volunteers from hospice can also help with some household tasks. If care at home is not possible with hired caregivers.
The social worker from hospice can help with placement to one of several different types of facilities, including board and care, assisted living, and skilled nursing facilities. Unfortunately all caregiving options come with them a financial component, but with proper planning and discussing what all resources are available. Even if this includes discussing with sons the need for some financial assistance for their mother's care. It is so important to have the difficult discussions regarding caregiving before the need arises.
Mr. Thomas’s depression is also an important issue to address. Ask her if it is okay if you discuss her concerns about his medication and suicide with him. Approach him with genuine concern and empathy regarding the difficult changes his family has been facing. Ask him if he has any intention of taking his life. Refer him to his physician for medication changes or support and assess how he feels about continuing the medication. Help him to identify some coping strategies with the changes his wife is facing. Encourage him to use the support that hospice provides.
A person facing a terminal diagnosis is faced with not only physical changes, but emotional changes that not only effect them but also their family. As a community health nurse you are not only assessing and helping develop a plan for the patient but also the family.
I lost my grandmother and a close friend. But I have also dealt with end stage cancer first hand as a hospice nurse. In the case of my family, I watched my grandmother battle aggressive brain tumors called glioblastomas. As the cancer spread the chemotherapy and radiation had to intensify, which in turn caused her to become weaker. She needed more help with basic activities of daily living, including preparing meals. She also would
occasionally …show more content…
have seizures due to the increased pressure from the tumors in her brain. This meant she required someone to stay with her at all times.
She had to move in with my Mom who mostly works from her home, only traveling out of the house 1-2 days a week. On the days my Mom was out of the house my grandmother would go to a local adult day care, where she would socialize with other seniors. As the disease progressed she required more assistance with activities of daily living and was no longer able to go to the adult day care. This additional need for care became difficult for my Mom who needed to continue to work and she had to place her in a skilled nursing facility to assure she received the care she needed. She was enrolled in hospice care which added another level of support in the last 3 months of her life. As our family watched her decline we relied on each other, and the hospice team for support. The decisions my Mom had to make were difficult and she needed the support of her family and her friends. The difficulties that my Grandmother faced were difficult to watch, but she was not alone in the process thanks to her hospice nurse. The closeness that her nurse had with her and the expertise she brought with her regarding symptom management and end of life care not only helped my Grandmother feel more comfortable but also our family. She also needed our support and love to
help her cope with the depression associated with a terminal illness. Her experience led to my transition from hospital nursing to hospice nursing. I was able to use my personal experience in facing difficult end of life decisions, and help others with the challenges they would encounter at during the transition to hospice care. Not only did I become a hospice nurse
I continued my education and sought out certification as a certified hospice and palliative care nurse. With this certification comes with it a knowledge and understanding of end stage disease processes and how to help manage
symptoms.
My personal experience with hospice and my family helped mold me into a caring and knowledgable hospice nurse. My current role is as a charge nurse in the hospital where I act as a resource and patient advocate.
This is also the case when patient's are given a less than favorable diagnosis. I value the difficult decisions patient's and families have to make when deciding to initiate hospice care. One of the crucial components in hospice and palliative care is that the plan of care in patient driven. This means that as a nurse advocating for patients wishes is of the utmost importance. With personal and professional experiences, my view of a patient's quality of life not only encompasses their physical well-being, but also psychological and spiritual. Even though the end stage disease processes can be very similar, each patient is unique and should be treated as such. This means that not one terminally ill patient would have the same care plan as anyone else. My view on caring for a patient in their final stages of life, focus on improving their quality of life for whatever time they may
have …show more content…
left.
Both Mr. and Mrs. Thomas need help to improve their quality of life, as a community nurse there are strategies to help assist them with making positive changes.
The first strategy to help improve Mrs. Thomas’s quality of life includes referring her to a support group for other women with breast cancer. At a support group with other women suffering from breast cancer she can express her feelings in a safe place, and seek encouragement and empathy from the group. Discuss with her if it is okay to contact her oncologist’s office and see if they help facilitate any such groups. The support from other women with breast cancer could help her feel that she has someone to talk to about how difficult the diagnosis and treatment have been. She does not have any close female relatives and this support could help with her emotional or psychological well being. Talking about her struggles with cancer at a support group could possibly help her open up to her family and improve communication between her husband and sons.
The second strategy to help improve quality of life is to focus on Mr.
Thomas and encourage him to seek out support for his depression and make sure he is taking his depression medication. Set aside some time during the visit and let him know that you want to spend time in helping him while you are there. Discuss with him about approaching his physician regarding medication and making sure that the dosage is correct. Once on the correct medication and dosage, he may benefit from a reminder system for taking his medication. There are several ways of doing this whether it is an application on a smart phone, or simply creating a chart and checking off each day that you have taken the medication. Stress the importance of regularly taking his medication for optimal effects. Also encourage him to share his feelings and his wife’s terminal illness with his physician so that his
MD has a better understanding of how to help him. Discuss with him that when he does not care for himself emotionally it makes it difficult for him to be there for his wife. Help him identify some coping strategies he could use in dealing with his emotions in combination with his medication. Finally
assessing his communication needs and ask where he would like to improve.
Assist him in communication strategies to better express his feelings to his wife without being a burden on her.
The third strategy is to help Mrs.Thomas plan a schedule for taking her pain medication. A schedule for taking medication can enable her to be able to function throughout the day. Explain to her how pain medications are more effective when taken on a regular basis. Help her understand that when someone is taking medication for actual pain, addiction is not a concern and that it is appropriate to take it on a regular basis. With her permission help her put medication in a pill box and set a timer when it is time to take the medication. Coordinate with her and encourage her to keep a pain log that includes when she took the medication and how bad her pain was a that time. Instruct her on using a pain scale whether it is a number scale or just writing better/bad/worse/worst. This will help her MD or nurse assess how well the medication is working. This log is a key that can help them know what changes in medication is appropriate. It could help to show if there is a need for a long-acting pain medication or possibly less medication. It is also important that she keep a journal of how she is feeling once she starts taking the pain medication on a regular basis. Better pain control could help her function better and engage in her life. Help her understand that when taking narcotic medication on a regular basis, she will also need to take a stool softener daily since one of the most common side effects of narcotics is constipation.
In collaboration with her physician, adjustments could be made to help aid in her pain management problems.
Discuss the positive aspects of palliative care and/or hospice care and encourage Mrs. Thomas to accept the help. She could benefit from the expertise of the nurses and their knowledge regarding symptom
management. Hospice provides for not only support for her physical well being but also emotional support. Her main problems include pain and emotional stress secondary to her physical changes. Help her contact her physician to ask for a hospice referral due to the multi-disciplinary approach.
Encourage her to involve her husband with the decision of initiating hospice services. Provide information on all of the services that hospice encompasses. Hospice care includes: RN(medication and symptom management, collaboration with MD), Home Health aides(help with ADL's and bathing), Social worker(assist with financial resources in the community, caregiving resources, emotional support for patient and family, aid in final arrangements, advance directive information, assist patient and husband
in communication between each other and possibly sons, and provide communication tools), Chaplain(not only spiritual support for patient but for family if needed), Volunteers(company for patient, can do small household tasks not relating to patient care. Also discussion with oncologist regarding prognosis and coordination with hospice care. Stress importance of involving patient's sons and sharing what decisions are being made about her care.
Emphasize the importance of having difficult conversations while she is still able. The hospice team will evaluate on each visit how the plan of care is working and make adjustments accordingly.
As discussed earlier improved pain management will also improve her functional ability to do the important tasks she wants to do. Teach her important energy saving techniques, such as something simple like napping when her husband is at work. Currently she is staying in bed and crying because of the pain, so if pain can be helped she would feel better and may have more energy to do other things. A hospice nurse would be able to continually assess her pain and energy level. As she declines she may also need assistance with durable medical equipment. A hospice nurse is trained
to anticipate what equipment she may need as she declines. Also the home health aide available from hospice to help with bathing needs as she needs it. Having help from people she trusts and encouraging her to open up about the help she needs. Friends could wash dishes, do light housework to help both her and her husband.
With any decline there comes a time when she will no longer be able to provide self-care. Again the support from hospice is crucial here as the social worker will have community resources to help with caregiving, including lower cost alternatives. Volunteers from hospice can also help with some household tasks. If care at home is not possible with hired caregivers.
The social worker from hospice can help with placement to one of several different types of facilities, including board and care, assisted living, and skilled nursing facilities. Unfortunately all caregiving options come with them a financial component, but with proper planning and discussing what all resources are available. Even if this includes discussing with sons the need for some financial assistance for their mother's care. It is so important to have the difficult discussions regarding caregiving before the need arises.
Mr. Thomas’s depression is also an important issue to address. Ask her if it is okay if you discuss her concerns about his medication and suicide with him. Approach him with genuine concern and empathy regarding the difficult changes his family has been facing. Ask him if he has any intention of taking his life. Refer him to his physician for medication changes or support and assess how he feels about continuing the medication. Help him to identify some coping strategies with the changes his wife is facing. Encourage him to use the support that hospice provides.
A person facing a terminal diagnosis is faced with not only physical changes, but emotional changes that not only effect them but also their family. As a community health nurse you are not only assessing and helping develop a plan for the patient but also the family.