Experimental analysis of hospice care practices

Public Health - Hospices

THE HOSPICE ENVIRONMENT: EXPERIMENTAL ANALYSIS

hospice is a facility intended to maximize the comfort and well-being of terminally ill patients. In many respects, it resembles a residential hospital or nursing home, because the facility includes a full medical staff. The essential difference between hospice and a hospital is that much of what hospitals do relates to treating illness whereas hospices focus on providing comfort only (Humphry 1991).

Perspective of Patients and Patients' Families Toward the Hospice:

Hospice patients are tremendously appreciative of their care, even though they understand that they are dying. In some respects, hospice patients (and their families) report achieving a peace of mind greater than they experienced before they came to the realization that their medical conditions are terminal rather than curable (Humphry 1991).

The acceptance stage of the psychological response to dying brings with it a renewed appreciation for life and a calmness that is not possible when the prognosis of a disease is still unknown, and where every laboratory result or blood test carries the potential for hope or despair (Abrams & Buckner 1989).

According to hospice patients, one of the most beneficial aspects of advanced knowledge of a terminal condition is that the last stage of life can be devoted to meaningful relationships with friends and family members. In this respect, ending life in hospice is conducive to a much more fulfilling use of one's remaining time than ending life in an environment where the thoughts and energy of the patient and his family are consumed with finding a successful treatment. Naturally, where treatment still holds promise, struggling to the bitter end often is the only option. Unfortunately, in those situations, death may come shortly after those efforts fail, without any period of time devoted to expressions of love and without an opportunity for everyone involved to achieve closure. One of the most common themes expressed by hospice patients and their families is that continued life would be preferable to death, but if death is imminent, ending life in a hospice situation is more comforting and less traumatic to all involved than ending life more suddenly (Abrams & Buckner 1989).

Hospice Employee Feedback:

Hospice employees are as dedicated to their patients as hospital employees. In fact, the design and purpose of hospice facilities promotes more focused attention from staff members than most patients receive in traditional medical facilities. Mostly, this is a function of the fact that patient comfort and dignity are of secondary concepts when the essential purpose of the hospital's role is therapeutic treatment. Likewise, hospital facilities are, by necessity, organized and staff roles defined by the degree and seriousness of patient illnesses. By definition, this means that sicker patients receive more attention from staff than less sick patients. By contrast, hospice patients all receive much more similar attention.

Whereas the medical treatments provided by hospitals are often complicated, requiring numerous types of medical specialists, their concern for their patients' psychological state is not their specialty. Hospice staff function as, and often consider themselves "specialists" whose specialty is the emotional well-being of their patients. Many hospice staff have considerable previous experience in traditional nursing; according to them, hospital settings provide even the most caring hospital nurse only comparatively brief opportunities to contribute to their patients' emotional state and their other non-medical comfort needs (Caplan, Engelhardt & McCartney 1981). Within the hospice environment, medical care assumes a much smaller role and staff members devote more effort to their patients' comfort than to any other responsibility.

Many hospice staff members relate that much of their original motivation for entering the medical field was that they enjoyed caring for others. Some of them express that working in a hospice allows them to focus more on this aspect of their vocational choice. On the other hand, hospice staff members also describe the challenges of their position: specifically, under most circumstances, hospital patients spend much less time in the facility and when they leave it is to return home, not to die. Hospice staff form longer relationships with their patients, they get to know them much better, and all of them eventually die at the facility. In many cases, hospice staff cannot help going through a mourning process when patients die, and this is one of the reasons that some of them do choose to return to traditional nursing.