Mental Health Nursing-Hospice Paper

7/24/2019 Mental Health Nursing-Hospice Paper

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Running head: NURSING AND HOSPICE CARE 1

Nursing and Its Role in Hospice Care

Kaylee Blankenship

California State University, Stanislaus


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NURSING AND HOSPICE CARE 2

Nursing and Its Role in Hospice Care

Hospice care is a vital part of the nursing role and is defined as a program that provides

palliative and supportive care to meet the special needs of people who are dying and their

families (Townsend, 2012). Even if a nurse may not specifically become a hospice nurse, he or

she will at some point in their career deal with death or dying. Knowing how to provide

palliative and supportive care to patients is an important part of fostering physical,

psychological, social and spiritual well-being of those individuals and their families when they

need it most. This paper will compare hospice care with palliative care, explore the nursing

experience of a family using hospice care, and analyze the experience and views of end-of life

care.

Hospice versus Palliative Care

As previously mentioned palliative care is actually an element of hospice care, but there

are some differences between the two. Both entities provide physical, psychological, social, and

spiritual support to the patient and their families, however, with hospice care, the patient has

been given a diagnosis of a terminal illness with a 6 month or less expectancy to live (Villet-

lagomarsino, 2000). Whereas with palliative care, patients can qualify at any stage of their illness

whether they are terminally ill or not. As far as treatment goes, most hospice program tend to

focus more on promoting patient comfort rather than aggressively treating the disease process so

that the patient can get the most out of life in the time that they have left. Palliative care on the

other hand, since there isnt a requirement of the illness to be terminal, the program provides

both comfort care and life-prolonging therapies to patients depending on their illness (Villet-

lagomarsino, 2000). Hospice programs can be inpatient, outpatient or home care. Some of these

programs are hospital affiliated while others are provided through private organizations or


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institutions. Palliative care is most often provided in an institution (i.e. nursing home, hospital,

extended care facility) rather than at home (Townsend, 2012). Both palliative and hospice care

provide this support through interdisciplinary teams that include nurses, social workers,

physicians, and attendants (i.e. home health aides) just to name a few. Nurses play a huge role in

providing this type of care, because the nurse is the one out of the entire interdisciplinary team

who is typically spending the most time with the patient (Dobrina, Tenze & Palese, 2014). In

these situations the nurse is truly the patients advocate promoting the best possible life the

patient could have until the end.

Patient Observation

During this hospice experience there were many families that stood out. Although every

patient was receiving end-of life comfort care, each patient was going through their own end-of-

life story in their own unique way. There was a specific family that stood out the most during

this hospice observation, because the patient was so young. He was a 50 year-old African

American man who had been diagnosed with terminal colorectal cancer that had also spread to

his liver. The patient was receiving hospice care at his home where he lived with his wife, their

deaf 20 year-old daughter and their 3 year-old granddaughter. It was an amazing experience

being able to observe the patients hospice nurse help him with each and every element of

hospice care.

As promoting the patients physical well-being, at the beginning of each visit the nurse

takes the patients vital signs, has them rate their pain, and performs a focused assessment. With

this particular patient, the nurse focused more on his pain level since it has been an ongoing

battle for the patient. The nurse had been coming more frequently than just once per week to see

this patient, because they have not been able to get his pain under control. The wife tries her


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hardest to help her husband, but she hasnt been able to fully grasp her husbands pain

medication schedule. She seemed frightened that she might accidentally give him too much of

the medications leading to an early demise. So, the nurse and myself came up with a modified

medication schedule for her that listed each medication, the amount to give, and the time she

should administer them. There was also a spot where the wife could document this and write

down what her husbands pain level was before and after giving him the pain medication. Both

the patient and his wife seemed to really appreciate this because during previous visits the patient

wasnt very talkative or interactive with his care due to high amount of pain he was

experiencing. Now that the pain seems to be slowly coming under control the patient was much

more talkative and discussed his feelings openly with the nurse.

Another element to the patients care that the nurse assessed was his psychological well-

being. The patient confided to the nurse that having his granddaughter living with them has been

mentally draining for him. It was clear to see that the child was very high energy and rarely

disciplined for her behavior which could be attributed to the fact that her mother is deaf so she

cannot hear what the child is saying and cannot tell her what to do in words. This has

unfortunately created somewhat of a chaotic and stressful atmosphere that anyone dealing with a

terminal illness would find hard to deal with. The nurse asked the patient if there was any other

place that his daughter and grandchild could live to which the patient responded no. I suggested

that the family look into a day care or Headstart program for the child to attend during the day so

that the patient could at least have some reprieve. Some of these programs are free so the family

wouldnt have to worry about an extra expense either. The nurse like this idea and was willing to

look into it in order to potentially promote the patients psychological well-being during his end-

of-life care.


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It is also the nurses job to promote the patients social well-being. This includes

financial or legal issues and bereavement concerns (Townsend, 2012). There are actual social

workers at the organization that the nurse works, however, it is the nurses job to recognize these

concerns and then present them to the social worker since the nurse is the one who sees the

patient frequently. In this case, the nurse made sure the patient and his family had the supplies

that they needed and that the home environment was conducive to caring for the patient. This

part ties in with the psychological problem that the patient was facing. The nurse could talk to

the organizations social worker assigned to this family about finding a program for the child to

attend for the day to help the patient with that area of his psychosocial well being.

Spiritual well-being is another element to hospice care. This particular patient had a very

strong spiritual foundation and it has been really hard for him not to be able to attend church as

much as he would like to. So, to accommodate for this patients needs, the nurse scheduled a

visit for one of the hospice organizations pastors to come our and visit the family. The patient

reported that her really liked the pastor and would like for him to come again. It was clear that

the patients religion is what was giving him the strength to deal with his diagnosis and his pain.

He said it also gave him the strength to be patient with his granddaughter. This was an amazing

element of hospice care to observe, because it was clear to see how much it truly helped to

patient cope with his current situation.

The nurse clearly plays an important role in promoting each of the above-mentioned

elements of hospice care. She performed physical assessments, focused on the patients pain,

encouraged the patient to discuss his feelings, found ways to promote the patients psychosocial

well-being, and had a pastor visit the family for spiritual support. The nurses interaction with

each and every family was amazing tot observe, because it was obvious how much she cared.


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She definitely took her role as a patient advocate seriously, recognizing what the family needed

even if they didnt specifically verbalize their needs. She also had a great way of teaching the

family new things without making them feel bad about themselves and providing positive

reinforcement.

Views on End-of-Life Care

Through this experience, my views about end-of-life care were really changed. I have

always been interested in oncology, which is involved with many aspects of the death and dying

process, but nothing like hospice care. I didnt know if I could really handle the end-of-life care

when the aggressive treatment has stopped instead of the actual on going aggressive treatment

stage where there is still hope. I was definitely a little wary of this observation day, because it

had only been like a two months since my grandfather passed away after being on palliative care

for two weeks from a two-year battle with leukemia. So, I was scared that I might let this

experience cloud my judgment and make me feel sympathetic instead of empathetic during this

observation. However, this experience ended up being truly amazing because I really got to see

how big a role the nurse plays in these patients lives. I never thought I would ever consider

becoming a hospice nurse, but after this experience I see it as a legitimate option.

During this observation I learned that a hospice nurse is truly the patients advocate and

helps families cope with end-of-life care. These nurses can promote optimum quality of life and

comfort to patients during what time they have left, even if it may be short. They do this by

supporting physical, psychological, social, and spiritual well-being which are all important

aspects in anyones life. Hospice care is an integral part of the health-care system that patients

and families sincerely appreciate when it comes time for end-of-life care.


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References

Dobrina, R., Tenze, M., Palese, A. (2014). An overview of hospice and palliative care nursing

models and therories.International Journal of Palliative Nursing, 20(2), 75-81. Retrieved

from http://content.ebscohost.com.ezproxy.lib.csustan.edu:2048/ContentServer.asp?T=P

&P=AN&K=2012492222&S=R&D=rzh&EbscoContent=dGJyMMvl7ESeprQ4zdnyOL

Cmr0yep7JSsai4SbGWxWXS&ContentCustomer=dGJyMPGptkqwq7BIuePfgeyx44Dt6

fIA

Townsend, M.C. (2012). Psychiatric mental health nursing: Concepts of care in evidenced-

based practice(7

th

ed). Philadelphia, Pennsylvania: F.A. Davis Company.

Villet-Lagomarsino, A. (2000). Hospice and palliative care: A comparison. Educational

Broadcasting Corporation/Public Affairs Television, Inc. Retrieved from

http://www.pbs.org/wnet/onourownterms/articles/versus.html

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