Hospice nurses seem to have a fondness for their work that is unique. It is axiomatic that nurses are 'caring' people. If we were not, we probably would not have become nurses in the first place. But I suspect that one of the reasons why hospice nurses enjoy their work so much has to do with what we get back from our clients.
Caring for and being with dying people and their families has changed how I see the world. Specifically, it has changed my understanding of life and death... and for the better I might add.
Spiritual phenomena commonly associated with dying process; e.g. near death awareness, have induced me to stop thinking of death as "end of life." (Whoever thought that term up must have been an administrative type who never actually worked with dying people.) Observing dying process itself has taught me that it is a process that prepares us for continued life and teaches us how to live more gracefully.
Working in hospice has definitely altered my world view, but I also fully expect that it will alter how I die. Knowing what I know now about dying process cannot help but to have a positive impact on my own dying process.
Do you think your hospice experience has altered your personal philosophy? And do you think it will affect how you die?
I was talking to someone at my church about having hospice pts and she said "how can you work with those kind of people?" Before I thought, I heard myself saying "We all are those kind of people!" I guess that is when I realized that I am far more aware....
Similar experience to this recently. My DOCTOR asked what I was doing the and told him I was working for Hospice. He said: Oh, God, that must be depressing". I told him I felt very much the opposite, but that his opinion on the subject DID depress me!
Absolutely not! It is the most rewarding work possible. Our patient's and their families typically come to us in great physical and emotional distress. If we do our jobs right, we turn things around and help them experience true quality of life in their last days.
What depresses us is how many people die without the benefit of hospice care, especially the ones who were sorely in need of it and their physician's didn't refer or recommended against it because they didn't think the patient was appropriate yet.
I must admit, I have gone through some real grieving. I am in home care, so I am with my pts long term. You really get attached. But depressing? Gee. sometimes I have felt myself going that way a bit, but you seem to get stronger with time. I guess it is that the fact of death being part of every life becomes a reality. When that happens, you see the time you have with those people in your care, and even more the time with your loved ones, as a precious privilege. Then, you feel gratitude.
For me, one of the primary reasons why hospice work is not depressing is that the work itself (being around and getting to know dying people) educates a person as to the true nature and meaning of death; namely, that it does not "end" life. Furthermore, dying process is very helpful in stimulating personal growth.
The default, consensus definition of death is that it "ends" life. And the default, consensus definition of dying process is that it's just some bad stuff that happens shortly before you cease to exist. From that point of view, yes... death and dying are very depressing. Luckily, that point of view could not be more wrong. If you spend enough time with dying people you will come to understand this on a very deep level... which completely changes how one thinks about "life" and "death."
Which is not to say that death is not sad... it is... or at least parts of it are. It is sad knowing you won't see someone you love... for awhile. Other parts of it are amazingly uplifting; things like, "near death awareness" for example (dying people interacting with deceased loved ones, angels etc.)
All in all, it would be difficult to imagine a more educational, rewarding and satisfying profession than hospice nursing.
Compare care of the dying in a traditional physician directed setting to being at home, kept very comfortable, surrounded by family and supported by a team. Hospice physicians dont have the same fears of litigation regarding their prescribing habits, for example. They are all about pain control, reducing the anxiety of the entire family and making the dying persons journey as comfortable as possible.
Compare care of the dying in a traditional physician directed setting to being at home, kept very comfortable, surrounded by family and supported by a team. Hospice physicians dont have the same fears of litigation regarding their prescribing habits, for example. They are all about pain control, reducing the anxiety of the entire family and making the dying persons journey as comfortable as possible.
Your hospice appears very different than mine. In mine, we have a medical director, but he is not the primary physician and does not usually prescribe for our patients. The primary MDs for our patients see mostly non-hospice patients, and I believe have very much the same fears of litigation and the attention of the legal system surrounding narcotics. Fortunately, most of them have come to know and trust the clinicians on our staff and as a result getting the orders we need to keep our patients comfortable is seldom a problem. But that's not because "they are all about pain control", it's about having developed good working relationships with them.
At your hospice, do you have MDs whose practice is hospice and palliative medicine exclusively?
Also, I think you may mean that non-hospice care tends to be more physician centered, not physician directed as you said. Hospice care is very much physician directed. They still write the orders just as they do in every other health care arena. In hospice, having an interdisciplinary team that meets on every patient results in the care being more patient centered, but it remains physician directed.
In the several Hospice organisations I've worked with in 2 states, the Palliative care physician if full time and dedicated to only that hospice and he becomes the primary physician most of the time. It could just be a coincidence in the ones I've seen. All your points well-taken. Of course, the physicians write the orders, but what I like most about this model of care is the remarkably respectful relationships between the Palliative care physician and the Nurse. There is an excellent Hospice in Florida that employs full time Nurse practitioners as well as physicians. The NPs precept a lot of the masters students at the local universities. I'm glad to see Hospice a popular setting for up and coming practitioners. The physicians make at least one visit to the patients home along with the NP. All in all, we agree that Hospice care is a wonderful option for patients and families.
chadash
1,429 Posts
I was talking to someone at my church about having hospice pts and she said "how can you work with those kind of people?" Before I thought, I heard myself saying "We all are those kind of people!" I guess that is when I realized that I am far more aware....