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?
It really is interesting to hear how the "other half lives." The idea of a full-time hospice physician who actually visits patients in their homes is something my mind can hardly grasp. My hospice was so rural and remote that I sometimes drove over 100 miles (one way) to see one patient, and that was way down along the Mexican border where you could expect to see more illegal aliens and antelope than residents.
Like Katillac, I had to nurture relationships with each and every local physician in order to gain their trust. The "medical director" was sort of an honorary title bestowed upon whichever doc you could sweet-talk into accepting that dubious distinction. He put in his two cents worth at IDG but was loathe to buck any of his peers. The patient's attending physician was in charge, so each one was handled with TLC according to his or her peculiarities. We actually did a pretty good job learning how to 'handle' each doc. But when one of my nurses did an interview with the local press and expressed her support of euthanasia I hit the ceiling! Getting orders for large doses of narcotics was hard enough without the local MD's worrying about us pushing someone over the edge.
There were situations and patients that required industrial strength doses of narcotics. There were times when we were giving as much as 500 mg of morphine per hour. But that did not knock the patient out, it just made her comfortable. She could still carry on an intelligent conversation. Once, when I was loading up for a weekend PCA pump delivery, the hospital pharmacist told me I had more morphine in my pickup than they had in the whole hospital!
All of which is to say, small, rural hospices working with local MD's can provide adequate pain control even in unusual circumstances... as long as the hospice pays attention to nurturing trusting relationships with local physicians.
Be that as it may, it was not the pain control that interested me so much as the psycho-social, emotional and spiritual aspects of the job. I had one little ol' gal who had an intrathecal pump, plus she sipped on Brompton's mixture (American version; i.e. MSO4 instead of heroine) more-or-less constantly. She was virtually wall-papered with Duragesic patches and ate morphine tabs like M&M's. None of that ever knocked her out, and she probably did not weigh over 85 pounds soaking wet. All of that was interesting enough, but what blew me away was how the interaction between herself and her husband and kids seemed to dominate all other issues.
Pain control is a fine thing. No one disputes that, and it could be convincingly argued that hospice has created a revolution in pain control (my dentist doesn't know that yet, but it is so none-the-less.) But for my money, the major, long-term contribution of hospice will lie more in the arena of a deeper understanding of the human psyche and spirituality than anything else. Pain control is indeed a critical aspect of hospice care, but it is still just a means to and end. You cannot get to the real meat of dying process without first controlling the pain, but if you stop there you have missed the boat.
Specializes in critical care; community health; psych.
Not a hospice nurse here. In fact, I'm an RN student about to graduate and work in an ICU as a tech. These are my first experiences with dying patients. It is such a privilege to help "birth" these souls as they are freed from the suffering and the tubes and technology. They should have had their family members surrounding them but this is the real world so us nurses have to make due. I sing to them. I tell them that they are going to a better place and they will see their loved ones. I hold their hand and touch their faces. I cry. Not because it is sad, but because my heart is filled with an indescribable energy that overwhelms my own soul with a sense of completeness, and a gratitude that I was able to share in this kind of birth. Not death, but birth.
I would say that working among the dying has brought me much enlightenment and peace. I have chosen trauma ICU as a career, at least for now. I have a job waiting for me. Nevertheless, I'm wondering if maybe hospice is more my calling.
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It really is interesting to hear how the "other half lives." The idea of a full-time hospice physician who actually visits patients in their homes is something my mind can hardly grasp. My hospice was so rural and remote that I sometimes drove over 100 miles (one way) to see one patient, and that was way down along the Mexican border where you could expect to see more illegal aliens and antelope than residents.
Like Katillac, I had to nurture relationships with each and every local physician in order to gain their trust. The "medical director" was sort of an honorary title bestowed upon whichever doc you could sweet-talk into accepting that dubious distinction. He put in his two cents worth at IDG but was loathe to buck any of his peers. The patient's attending physician was in charge, so each one was handled with TLC according to his or her peculiarities. We actually did a pretty good job learning how to 'handle' each doc. But when one of my nurses did an interview with the local press and expressed her support of euthanasia I hit the ceiling! Getting orders for large doses of narcotics was hard enough without the local MD's worrying about us pushing someone over the edge.
There were situations and patients that required industrial strength doses of narcotics. There were times when we were giving as much as 500 mg of morphine per hour. But that did not knock the patient out, it just made her comfortable. She could still carry on an intelligent conversation. Once, when I was loading up for a weekend PCA pump delivery, the hospital pharmacist told me I had more morphine in my pickup than they had in the whole hospital!
All of which is to say, small, rural hospices working with local MD's can provide adequate pain control even in unusual circumstances... as long as the hospice pays attention to nurturing trusting relationships with local physicians.
Be that as it may, it was not the pain control that interested me so much as the psycho-social, emotional and spiritual aspects of the job. I had one little ol' gal who had an intrathecal pump, plus she sipped on Brompton's mixture (American version; i.e. MSO4 instead of heroine) more-or-less constantly. She was virtually wall-papered with Duragesic patches and ate morphine tabs like M&M's. None of that ever knocked her out, and she probably did not weigh over 85 pounds soaking wet. All of that was interesting enough, but what blew me away was how the interaction between herself and her husband and kids seemed to dominate all other issues.
Pain control is a fine thing. No one disputes that, and it could be convincingly argued that hospice has created a revolution in pain control (my dentist doesn't know that yet, but it is so none-the-less.) But for my money, the major, long-term contribution of hospice will lie more in the arena of a deeper understanding of the human psyche and spirituality than anything else. Pain control is indeed a critical aspect of hospice care, but it is still just a means to and end. You cannot get to the real meat of dying process without first controlling the pain, but if you stop there you have missed the boat.