Hospice Nursing: End-of-Life Care Roles and Patient Cases
This paper examines the professional experience of a community hospice nurse, exploring the unique challenges and rewards of end-of-life care. Drawing on peer-reviewed literature and a firsthand interview, the paper discusses the nurse's interdisciplinary collaboration, 24-hour availability, and patient-centered responsibilities. Two patient case studies — Linda, a 64-year-old with metastatic cancer, and Franklin, a 53-year-old with stomach cancer — are analyzed using Neuman's Systems Model to identify stressors and recommend interventions. The paper also addresses broader policy concerns around palliative care workforce development, equitable access, and the emotional demands placed on hospice nurses navigating patient death and family support.
- Introduction to Hospice Nursing: Overview of hospice nursing's unique demands and rewards
- Community Health Research and Competencies: Literature on community SPCs and competency alignment
- The Hospice Nurse's Role and Responsibilities: Interdisciplinary duties, patient connection, and daily tasks
- End-of-Life Care: Challenges and Policy: Costs, policies, and workforce needs in palliative care
- Patient Case Studies: Linda and Franklin: Neuman's model applied to two terminally ill patients
- Conclusion: Reflection on hospice nursing's emotional and professional impact
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What makes this paper effective
- Combines primary interview data with peer-reviewed literature to ground personal experience in academic evidence.
- Applies Neuman's Systems Model concretely to two individual patient cases, demonstrating theoretical framework use at a practical level.
- Maintains a clear, compassionate tone that reflects the emotional demands of hospice nursing without becoming anecdotal.
Key academic technique demonstrated
The paper effectively uses a nursing framework (Neuman's Systems Model) as a lens for analyzing real patient stressors and recommending targeted interventions. By identifying specific stressors — such as pain management, malnutrition, and psychological depression — and mapping interventions to each, the paper demonstrates how theoretical models translate into actionable clinical practice, a core skill in undergraduate nursing writing.
Structure breakdown
The paper opens with a literature-supported introduction to hospice nursing, then narrows to a specific nurse's experience, duties, and interdisciplinary role. It expands outward to address policy-level concerns before returning to the clinical with two patient case studies. The conclusion synthesizes the emotional and professional dimensions of the field. This funnel-and-return structure moves effectively from broad context to specific cases and back to general reflection.
Introduction to Hospice Nursing
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 stronger connections to patients, to the job, and to oneself. Many nurses working in hospices have detailed their work experiences in reflective essays and journal articles. As Thompson (2013) noted of her own professional reflection: "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" (p. 673). This paper explores the experience of one community health nurse and her struggles and triumphs in hospice nursing.
Community Health Research and Competencies
Significant research has been conducted on hospice care and community specialty palliative care services (SPCSs). An article by Levin, Swider, Breakwell, Cowell, and Reising (2013) reveals a strong 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" (p. 557). These clinical strategies emphasize viewing patients and nursing practice holistically, and they encourage creative approaches to emerging problems and concerns.
Research in related fields, such as home nursing, has also been instructive for understanding the costs and outcomes associated with hospice care. An article by Luckett et al. (2013) 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" (p. 279). Like home care, hospice care involves an in-depth, patient-centered approach that extends beyond clinical treatment.
The Hospice Nurse's Role and Responsibilities
The hospice nurse described in this paper explains that her role involves constant collaboration with other healthcare providers, including social workers, chaplains, and physicians. She functions within an interdisciplinary team composed of volunteers and specially trained professionals, with her main focus on end-of-life care. Her duties often require 24-hour availability, as well as consistent management of pain and other symptoms. In terms of patient connection, she describes herself as a compassionate listener who has also developed counseling skills to support both patients and their families. Although some hospice nurses hold subspecialties, she practices as a generalist and also participates in demonstration grants that advocate for the terminally ill.
Additional day-to-day responsibilities include administering medications, notifying family members when a patient's condition worsens, assisting with bathing, and feeding patients who have difficulty keeping food down. She also performs daily checkups related to blood pressure monitoring and pain assessment. Research on the transition into hospice nursing has identified five major themes relevant to these experiences: "expectations, personal and professional development, professional respect, mentorship and support" (Rosser & King, 2003, p. 206). These themes resonate throughout the daily work of caring for terminally ill patients.
Conclusion
Although the two patients she cares for are difficult to manage, she is grateful to have the experience of helping and caring for them. It is difficult for her at times to deal with the deaths of her patients, but she explains the impact palliative care can have on patients and the wonderful memories she shared with them during moments when they were able to forget their pain and their condition. Although being on call around the clock is demanding, her family supports her decisions. Hospice care is not for everyone — patients will die, and some will be in extreme pain and discomfort. It is up to nurses committed to this work to ease that pain and provide end-of-life care that offers at least some measure of comfort to terminally ill patients and their families.
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