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| Hospice and Hope: How to encourage and support your patients |
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by Cassie Ruhnke RN BSN - February 28, 2011
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Over a year ago I met a wonderful man who was diagnosed with a horrendous disease which overtook his body. When I say this, I mean that it drained every ounce of who he once was-energetic, a hard worker, supporting the family, the care taker, the “man” of the house.
He was also a jogger, a reader, lover of animals. All of this became too much for him. He was so tired from his illness, could not read because of his metastatic lesions to his brain that caused his eyes not to work appropriately. He also could not focus on his computer, so that meant that he also could not work as he once did.
His family had three dogs, and it became a concerted effort to let the dogs in and out and even to feed and walk them. He was a shell of who he once was. But, in his voice, you could feel that somewhere in there, his spirit, his heart, he was still there, somewhere.
I had been working with him for over a year when he began to have the excruciating pain that typically accompanies metastatic lesions to the bone. He was adamant about not taking pain medication because he thought he would not be able to function.
After a discussion with him about pain issues and a call to the MD office, a duragesic patch was ordered because he did not like pills. I truly thought at that time that he actually would forget to take them, and that is why he did not want pain meds ordered.
He did well with the patch, and his pain was tolerable for him. Then, he began to not do so well on the chemotherapy regimen. This was the moment that we needed to sit down and Dr. Phil it and “get real”.
Calling with my motive to discuss his other options, I wanted to speak to him and his wife, as he was a bit forgetful at this time. She had said that the Oncologist had informed them that of course he had another treatment that he could use for him, and if that did not work, then he could look into a clinical trial.
This was a man who was once very strong, in shape, healthy, and as his wife said “beautiful”. Now, he was reduced to a wheelchair, weak, unmovable, and in constant pain, anorexic, and withdrawn because of all this.
Speaking with him and his wife, I banked on our relationship of over a year, and that I had never let them be surprised by anything that was going to be happening. I decided it was time to discuss where his health was, where his stage of cancer was, and what hospice was.
This is never an easy conversation with anyone. Say “hospice” and everyone thinks two days and dead. Unfortunately, this is what the perception is, and this is so far from what we need to educate the population about what it really is.
Hospice is care that is designed to provide supportive care to people in the last phase of a terminal illness. The focus is not on aggressive treatment, but rather comfort and quality of life, supportive care for the patient and the family. They are generally home based, but sometimes do provide services in nursing homes or hospitals. Hospice addresses a patient’s emotional, spiritual and social concerns and needs as well as making sure their pain is under control, even if that calls for aggressive treatment.
Hospice will address medical symptoms that occur as long as they are making the person comfortable. Usually, there is a Social Worker, Doctor, and some type of religious person/clergy who comes to address personal and familial needs. This support aids in many areas of care that may not have been addressed during active treatment.
Another hospice benefit is respite care. That is either an inpatient stay at a free standing hospice facility, or a volunteer coming for a few hours in the day to give the caretaker a break. Hospice is meant to go over months not days, and add a support to the care that is going on, not to interfere. It is a wonderful service that is used, in many occasions, unfortunately, inappropriately.
We had the discussion on the phone, and he and his spouse did decide to talk with a hospice RN. They thought it was a good idea. After they met with the RN, they enrolled in hospice. He was in hospice for about 3 months and, as sad as it is, he did pass away. But knowing that he passed away pain free and his family had support in a time of crisis was rewarding. He could have received more chemotherapy and died earlier.
Hospice for this patient was what he needed. There is a growing population of people who are aging and living longer. As such, they too will be needed more treatments for diseases and have multiple co morbidities. When do we decide to discuss with them what hospice is? When do we educate our doctors to recognize those signs as well, and how? I know that this is an uphill battle, but this is something that we need to advocate for our patients. They deserve to die peaceful and respectfully, without fear. That is what hospice can do.
 Cassie is an eleven year cancer nurse with inpatient and outpatient experience as well as case management and managed care experience. She has also utilized the skills and compassion that it takes to be an oncology RN to work as an inpatient hospice RN. Cassie has a true love of nursing and her patients.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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