Hospice nursing can be difficult. Many times nurses transitioning into hospice care face struggles they would not encounter in other specialties. However there is a level of recognition involved in hospice care as it necessitates better care of patients and a stronger connection to the job and self. Many nurses working in hospices have detailed their work experiences in reflective essays and even journal articles. "Chapter members are nominated by peers in recognition of their contribution to oncology nursing and to ONS, both locally and nationally. The timing of the award prompted me to reflect on my nursing values and the steps that led me to where I am today" (Thompson, 2013, p. 673). This essay will include the experience of one community health nurse by the name of Rosalind and her struggles and triumphs in hospice nursing.
Research has gone into hospice care and community SPCs. An article by Levin, Swider, Breakwell, Cowell, & Reising reveals a correlation with Quad Council competencies. "Results indicate strong alignment of community-based specialty competencies with Quad Council competencies. Community-based specialty-specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps" (Levin, Swider, Breakwell, Cowell, & Reising, 2013, p. 557). These clinical strategies discuss viewing patients and nursing in general, in a holistic way using creative approaches in dealing with emerging problems and concerns. Rosalind herself has stated she has done some research in other fields like home nursing to see the costs of hospice care and home care.
An article by Luckett et al., examines home nursing and its impact on patient deaths. "A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies" (Luckett et al., 2013, p. 279). Hospice care much like home care, involves a more in depth care of patients. Rosalind explains her role as a hospice nurse involves constant collaboration with other health care providers such as social workers, chaplains, and physicians. She functions within an interdisciplinary team composed of volunteers and specially trained professionals. She also stated her main focus is on end-of-life care.
End-of-life care can be difficult to manage and at times, very costly. Normally terminally ill patients suffer from cancer and other serious diseases that become expensive to treat. Policies must be enforced to deal with the strain of such costs. "Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions" (Meier, 2011, p. 343).
Rosalind mentions her duties are often involving 24-hour availability on her part as well as consistent and constant management of pain and other symptoms. In terms of patient connection, she tells me she is a compassionate listener and even learned counseling skills to deal with and console the patient and family of the patient. Although some hospice nurses have subspecialties, Rosalind is a generalist. She also explains she participates in demonstration grants advocates for the terminally ill. In hospice care several themes were identified in relation to end-of-life care. "Five major themes were identified: expectations, personal and professional development, professional respect, mentorship and support" (Rosser & King, 2003, p. 206). These themes, Rosalind experiences each day when treating and caring for patients.
Some other job duties involve giving medications to the patient as well as calling and notifying family members if patient's condition worsens. Rosalind also explains she bathes her two patients and feeds one of them who has trouble keeping down food. She also performs daily checkups in relation to blood pressure and pain assessment.
Rosalind has two patients that she is caring for. One patient is named Linda and she has metastatic cancer and is 64 years old. She is in chronic pain from medications and treatment. Using Neuman's model with Linda, the identified possible stressors contributing to Linda's condition are as follows: pain management, personality, and attitude. Rosalind explains Linda cannot handle anymore the constant medications to manage her pain. They are making her nauseous and tired all the time. Without intervention from the family, Linda fell into a depression bringing instability into her mental system. To prevent depression, the family could visit her more and provide her with physical interaction and increased emotional support.
The other patient, named Franklin. He is 53 years old and has stomach cancer. His problems are mainly pain management and malnutrition. Because of his condition he cannot eat very much and gain the nutrients he needs. He also experiences gastrointestinal symptoms. A lot of his pain medications cannot be taken unless he has something to eat. Including nutritional therapy for Franklin will allow him to get more nourishment and be able to take his pain medication to manage his pain. A dietician can come to the house and communicate and identify daily caloric goals and what food causes the least gastrointestinal distress.
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