My experience with hospice

mlynn · Nov 11, 2006

I'm so glad that you enjoyed your first hospice experience. Hopefully, you will carry that with you and maybe think of working in this wonderful field of nursing someday. I've worked in several different fields and have been a hospice nurse now for 3 years. I love it and can't see myself doing anything else.

Good luck to you.

mc3, ASN, RN · Nov 11, 2006

Me neither! I feel like I'm so fortunate to be able to have this job, and I look forward to going to work every day..how many other nurses can truly say that?

mc3:)

aimeee, BSN, RN · Nov 12, 2006

I am also grateful and proud to be able to serve in this field.

EmptytheBoat · Nov 12, 2006

Dear StudentNurseBean:

Thank you for sharing, it's refreshing to read about

your positive experience, nurse J is to be commended

for taking the time to make sure of that and I hope

you shared your appreciation with her/him.

Death & dying is truly a phenomenon, as is life itself.

Physicians don't usually work hard to keep an actively

dying patient alive, but usually the entire Hospice

team works hard to keep the actively dying patient

comfortable so that the transition from this life to

the next may be peaceful for patient and family.

Best wishes on your studies and career!

CityKat, BSN, RN · Nov 12, 2006

thank you:) It was a very wonderful experience. I never thought I would walk out of there thinking that I would want to be a hospice nurse. I've always wanted to work in critical care and do detailed things in nursing and help people in their most critical states. It was definitely a change for me after Tuesday. Nurse J was really great and she was very aware of my feelings and knew exactly how to handle everything. It felt really good. As far as the doctors trying to keep the patient alive from yesterday, I was told from the nurse that he was dying, so I just thought actively dying? Maybe he was in the beginning stages of dying?

leslie :-D · Nov 12, 2006

thank you:) As far as the doctors trying to keep the patient alive from yesterday, I was told from the nurse that he was dying, so I just thought actively dying? Maybe he was in the beginning stages of dying?

everyone in hospice is dying.

there's typically a 6 month prognosis to be hospice-eligible.

i'm pretty certain the doctors were managing a new onset of symptoms and doing everything to make him comfortable.

the pt very well could have been in the beginning of the terminal phase, but symptoms can appear at any and all times throughout the process.

some are more acute than others.

welcome to the privileged world of hospice nsg.

leslie

clemmm78, RN · Nov 13, 2006

In our palliative care residence, patients are generally admitted if they have a prognosis of three months or less.

Our place is a happy place. Full of light, handmade quilts, a living room with a fire place, and tons of home comforts. We've had weddings there, baptisms and other celebrations.

The thought behind palliative care is not only the comfort and pain relief that we can provide, but the idea that we live every day that we are alive. It truly shines through in our home.

cookie102 · Feb 20, 2007

don't know if this is the right place to post this, but i don't know how to start a new posting...i work HH, but our agency has HH and hospice share call....this weekend i had a call from a patient that is followed by the hospice team, terminal diagnosis, 38 yo, but does not want to officially sign in with hospice, in pain, anxious, could not sleep, so i made a visit, she did not want her PCA increased, so i asked to see all the other meds she had, thinking perhaps she is not taking them as should, she told me she had NO other meds in the house, i have over heard many conversations in the office about this patient so i had some knowledge of her before i even met her. i called the on call MD and asked if she could call in some ativan and something for sleep for her.......i am far from a hospice guru but would not common sense dictate that this patient should of had these meds in the home for prn use. believe me she did not experience anxiety and difficulty sleeping for the first time this weekend....when i mentioned it in the office this morning, the director told me --well she's not hospice so we would not have the "emergency pak" out there, i said she's 38 yo and dying i think someone should have had these meds out there long ago....!!! please advise me. thanks

windsong · Mar 18, 2007

Hi, I am new here.

I have 5 years experience in hospice nursing.

You are right about the patient needing the meds in her home long ago.

Here is a solution for future problems. The nurse who admits a hospice pt.

should anticipate that pt's . needs in advance. Look at the DX. Ask yourself

does this pt. have the potential to have a increase in the need for pain meds? Will this pt. have anxiety? Will this pt. experience nausea?

You would assume the pt. will need some meds in the home to take care

of these needs when they arise. It is better to be prepared in advance than

waite until someone calls you at midnight and tells you they are in pain and

nauseated. It is difficult to contact a doctor and pharmacy at that time of the night.

Make a emergency kit for each pt.s needs and keep it in a lock box in their

home. Then there will not be the worry about having to deal with it in the

midnight hours.

I would also make sure you speak with the nurse who admitted this pt. I would find out before hand , if the nurse made sure the pt. got everything

they needed. That way you won't be caught by surprise when you make

your visit. I have been stuck many times in terrible situations after hours, because the previous nurse did not take care of the pt's needs or failed to inform the on call nurse. It is difficult also when you the nurse who is visiting lives a long way from that pt. The drive is hard enough to deal with

much less the problems you may encounter because someone else failed to complete their assignment. This can be very frustrating for the pt. and

add even more anxiety to all their other problems that they are dealing

with. It all comes down to plan and oraganize. These two things will head of a world of problems and help increase the comfort and care of your pt's.

Blessings, Windsong

EmptytheBoat · Apr 1, 2007

cookie102, the fact that the patient (and/or family) does not want to officially sign on with hospice may have been the cause of your frustration.

If taking call, you should of had access to the patients medication profile before your visit to determine what medications were available at the house.

You handled the situation well by calling the physician for orders. I believe that your agency needs to discuss the patient's needs and wants, develop

a plan of care, and communicate. It appears that this patient fell

in a crevice between HH and Hospice, and is not being adequately managed.

The patient (and/or family) need to be educated on pain management.

JSCOOBY · Apr 2, 2007

I took a huge pay cut to go into hospice nursing. I find it sometimes draining, but immensely rewarding. My family remarks that I am no longer in a bad mood after work.

This week, I have had three patients die - two at home where they wanted to be - surrounded by an extraordinary amount of love from their families. One of my patients was an avid SA Spurs basketball fan. The game started at 1900 hrs, his TOD of 1855 hours. He made it just in time to root the Spurs onto a 23-point victory over Utah!

I don't see myself leaving hospice nursing - ever!!!