Hospice home care: a nurse’s perspective

January 7, 2016

By Rebecca Ashling, MSN-RN, Hospice Program Director

Walking up the drive to visit a hospice patient, I check the address and make sure I have the supplies I will need. This appointment will require my stethoscope, wound care supplies, some paperwork about medications, and most important, that I be present to my patient and the family. I stop to take a deep breath and focus my thoughts and energy on the task at hand.

A hospice nurse never knows what to expect on the other side of the door. Is the patient facing the end of their life as a surprise or as the expected outcome of a long battle with illness? Is the family shocked or relieved, overwhelmed with their loved one’s care or eager to help? Is the patient scared or confused or unaware of the finality of their prognosis?

Meeting the family

Today, the family is all together and very open to learning as much as possible from my initial visit. They have already selected who will take the lead in their father’s care, which is a very important first step as it helps the “team” start envisioning the roles they will play while hospice is involved. The family has a list of questions and within the hour almost all of them have been answered: How will I know he’s in pain if he is not able to speak? How much and how often should food and liquids be given? How will we know when he is actively dying? These are some of the questions almost everyone who has a loved one on hospice home care is concerned about.

It is important for the family to know that the answers are as different as the patients themselves and that their hospice home care team is there to help them determine the best course of action for their loved one. In this initial conversation with the family, caregivers, and when possible, the patient, I listen to their unique needs and determine which services (personal care aide (CNA), social work, spiritual care and/or volunteer) this patient will need to allow for the most comfortable end of life care possible. Discovering these needs is like discovering yourself and your own family in the midst of all that is going on, and I continually receive so much from this work, its effects radiating out into other areas of my life.

What a hospice home care nurse offers

I know the support I bring is for everyone involved, not just the patient and that this is a time when families can come together, or not. Resolve problems, or not. Uncover love they thought they lost, or not. My job is not to have an agenda except to be present, offer my expertise and to facilitate the greatest path of comfort for the patient, family and/or caregiver. What I hope to bring is an awareness that hospice care is not about dying, instead, it’s all about living each day to the fullest extent possible.

“because every day matters”

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