What Is A Hospice Nurse
Outside its noisy along the houses on a street in the suburbs of Denver. But inside one tidy living room, all is quiet except for the sound of a woman’s raspy breathing. The patient is huddled in an easy chair under a handmade pink-and-blue afghan, a knit cap on her head and booties on her feet. Her cancer has returned with a vengeance and she has only a few weeks to live. A Front Range Hospice nurse kneels down beside her, listens to her breathing, and then checks her blood pressure. The nurse has already had oxygen tanks delivered to the home, the nurse shows family members how to work them, organizes the medicine, and assesses how her patient has been eating and sleeping. The nurse now takes a moment to connect one-on-one with her patient. The nurse wraps her hands around the woman’s hands and rubs them together to warm them. She looks into her eyes and asks softly, “are you feeling a little better today?”
Getting to know our patients and families, and helping them through the toughest time of their lives is what Front Range Hospice nurses appreciate most about being a hospice nurse. We don’t know of another place or position where we can do more for people.
The patients at Front Range Hospice have all been told that they have six months or less to live. Rather than continue with often-difficult or painful treatments that probably won’t extend their lives, they have decided to stop trying for a cure that most likely won’t come. Instead, with the help of hospice care, they’ll focus on comfort and living whatever they have left of their lives to the fullest — usually in their own home.
Being able to die at home is a major part of the appeal of hospice, but patients and family members may not see it that way at first. A lot of people still view hospice as giving up and letting the disease win. That’s why the decision to call in hospice care can be an incredibly difficult one for a family to make. Once they do, though, most patients and their families soon understand the value of having a team of dedicated professionals — including social workers, certified nursing assistance, chaplains, and nurses — work together to provide not only physical but also emotional and spiritual support.
When a nurse takes their first job in hospice care they have the same fears as anyone about hospice. A veteran nurse, who’d worked in operating rooms, expected it to be unbearably sad. But on her first day, she was surprised that the family members were relaxed and sharing funny stories about their dying father. There’s still happiness in the sadness of it. She realized that hospice is not just about death– it’s about life. The life of one’s past, present and future.
By spending time inside patients’ home the nurse gets to witness the blessings of a peaceful ending to life. The nurse may have seen family members resolve longstanding, hurtful disputes and be reunited. For some patients the victories have been smaller but equally profound: a visit to a hair salon or being able to sit outside on a nice day. But getting patients and their relatives to that place of peace and acceptance can be tough. Some families are divided or resistant to the idea of hospice. A family may ask the nurse to cover her badge and not mention hospice to the patent, thinking that if their grandmother saw the word hospice or heard it she’d give up and die.
Others may unnecessarily worry about drug addiction and won’t give their sick relative pain medicine when it’s needed. Some patients are afraid of taking morphine, thinking it will stop their breathing or make them feel out of it. “Did you take your pain medicine?” The nurse asks her patient, who is holding her rib cage in agony. The nurse squats beside the hesitant woman and assures her she’ll stay with her while she takes it, to make sure she’s okay. The patient is worried she’ll just sleep away the time she has left, but pain medicine often allows a person to feel better and actually do more.
Many days Front Range Hospice nurses are busy juggling crises — one patient may have fallen down, another may be vomiting, and another is close to dying. Other days our nurses delicately navigate the fears of patients and families with their gentle, grounded spirits. During and after visiting patients our nurses find that people want to know the same things: how long they have left and what the final moments will be like. Some only want to know if the nurse can keep them calm and out of pain. They can. Others want details, so the nurse explains that after they stop eating and drinking, for example, they will become semi-comatose and just gradually slip away.
Some still wonder if they could be the rare person who survives. “Has there ever been a case where somebody walks away from this?” one 75-year-old grandfather asks the nurse hopefully. “I don’t know,” the nurse says after a moment. She explains that it’s hard to say with his kidney disease. “Live each day,” the nurse tells him. Then, noting his jokes about eating whatever he wants and having his daughter and wife wait on him, the nurse adds with a smile.
Because many people see hospice care as the end of hope, there are even some doctors who are reluctant to bring up the option. As a result, more than a third of hospice patients don’t start hospice care until they have just days left to live. Ironically, some patients who get hospice care live longer than those who don’t, studies show. But many wait until it’s nearly too late, and those people often sacrifice the chance for closure.
More often than we like the nurse gets a message: The man she’d just seen for the first time two hours earlier has already died. “Ooh,” the nurse says, letting out a long, frustrated sigh. The nurse knows what we could have done for him if we had more time — the same thing we all want for ourselves when our life is ending: a chance to have those last conversations, to be comfortable, at home, surrounded by loved ones.
That’s why the nurse tries to focus on what patients want and need. And when a terminally ill person hangs on longer than seems possible, nurses learn from experience that the patient may be waiting for something to be resolved. An example of this is a dying woman’s adult children are gathered at her bedside. One of the daughters, in particular, is heartbroken and distraught. The chaplain leads them in prayer and then the children, leaning on each other, leave the room. “Look, they’re together”, the nurse whispers to her patient. Sensing she is worried about them. “If you want, it’s okay to go. They’re going to be okay.” Within minutes, the patient dies with the nurse holding her hand.
“People are so afraid of how it’s going to end but when you’ve been there and held their hand and watched them take their last breath, you see that it’s a really powerful moment — powerful and peaceful.”
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