Having trouble adjusting to role as hospice nurse

bessiepig1 · Oct 17, 2009

wow sounds like you are very intuitive and compassionate towards the minute details that matter most to your patients at the end of their life. it may not be feasible for you to get past it but you are in the right arena....good luck

leslie :-D · Oct 17, 2009

i'm not sure how to put this...

but have you faced your fears/concerns about death?

i've worked with nurses who haven't done so.

and ea one struggled with role of hospice nurse.

also sharing pt's struggles at eol.

truly, something to think about.

you really need to deal with it head on.

if you can't come to any resolution (from within), then hospicie probably isn't for you.

when you see your pts with these symptoms, how do you handle it?

maybe they're on the wrong meds, need adjustment, need more...

but something's off.

there are certainly an excess of 'growing pains' in hospice.

i pray you work this out.

leslie

jonesecho, RN · Oct 17, 2009

Have been a nurse for about 15 years now, and always wanted to do hospice. So, I made a career change recently, and started as a nurse case manager in hospice. I love caring for the patients, supporting them and their families. I am having a terrible time adjusting to the look in their eyes once they become active. I have yet to experience the "peaceful" joy of passing. They look terrified to me. I am haunted by those faces/those eyes. Is this something that is going to pass, is it a "normal" conflict of new hospice nurses as they adjust. They are being medicated - usually roxanol and ativan. Their physical bodies look relaxed and comfortable, it is just the look in their eyes. I have discussed it with my co-workers, my team, they say they have not experienced this and don't see it. Thanks for your insights.

I think you still need to talk to the right person. Preferably a true expert on death and dying. Look up the psychological term of projection please. Make sure you are not seeing what you are feeling so to speak. I think you need to discuss with someone your feelings on death and your beliefs or dis-beliefs. In order to be the most effective nurse you need to be able to be there totally to give them the most comfort and support you can during this transition. I think the most important thing is knowing their wishes before they get to this stage as far as who do they want with them -etc. This would be very important. good luck. I think there are certain people who should be in this type of nursing. I am not saying one way or another if you are it, I am just saying be sure you are in this type of nursing for the right reasons.

tewdles, RN · Oct 17, 2009

Please bear with me as I have several thoughts...

The first thing that came to my mind was ...these people who have the "terrified" look in their eyes, did you speak with them about death and dying prior to their transition to the active phase of the process? Did they express a particular fear about death or dying? Did they have spiritual conflict about death?

The second thing is...what did you do to try to "fix" that terrified look?

Third...are you sure that this perception of a terrified look is not "transference" of your own ambivalence about death?

Imitation of Life · Oct 17, 2009

I did have conversations with some about the dying process, what their beliefs were/fears were/expectations....some I did not becuse by the time I was involved in their care they were non-verbal. I spoke with the family/support person when possible. I did different things for different people....holding hands, music, reading favorite poems/passages from books, prayer, medications, just dependent on what they wanted and needed. I am not at all sure that it is not my own projections/transferrence...that's what I want to figure out because I don't want to do a disservice to any one or their loved ones. I am working with an individual that is a grief counselor...and I thank you all for your input/responses.

jonesecho, RN · Oct 17, 2009

i wrote once to you. i think sometimes there is a look when we cannot breathe. it is uncontrollable. if you have ever even had pneumonia and can't breathe well it is a feeling full of fear that a person cannot control. it may just be a look from being hypoxic also.

Werblessed · Oct 17, 2009

Well, to be honest, there is a 'look' that patients have when they are close to death. Many of the contributors to this board know this to be true. You come in and you don't have to be within 10 feet of the patient to know they are close to death. The staring that accompanies this time is what I interpret as "visiting". Their bodies are still here but their essence (soul) is visiting where they are going to next....home. Many times dying patients will see people we cannot see. They can talk with them out loud but mostly it is a connection that you can just see....they are looking beyond those physically present and connecting with others that are spiritually present. Where do they look when this happens? In almost every situation, my experience is they see these visitors where the wall and the ceiling meet - that seam - that's where they see them (and it will be MY first question of "why THERE?" when it's my time). The look that you're interpreting as 'fear' may be an intense non-verbal communication that they are having with unseen visitors. This all sounds fairly metaphysical to all non-hospice providers but those of us who've worked in this field live and breathe the reality of death and dying. It is a process...a journey. And it is unique for every person who makes this transition in their own way, in their own time, and who let go when they decide it's their time. We, who are blessed to be working in this amazing field, get to walk along side our patients and families, educating and supporting but mostly respecting that their journey is uniquely their own.

I applaud your efforts in unveiling the etiology of your concerns. I will echo the sentiments of other very talented nurses that have already replied by stating the basic truth...you must be at peace with your own mortality to help assist your patients and families be at peace with the inevitable outcome of death. And I'll ask you one little favor...the next time you are with a patient who is actively dying, deep breathe and look for something that is not fear in their countenance. Step back...you may see a non-verbal, non-physical reaching out to touch eternity instead. And that, to me, is uncountable blessings to all us of still on this side of living.

:heartbeat

tewdles, RN · Oct 18, 2009

Thank you Weblessed, for bringing this up...

I consider this look a part of the transcendence (this word reflects my personal belief in life after death). The person is clearly still living but spends long periods of time apparently engaged with persons unseen to us. Sometimes they can tell us about those experiences before they die. It had not occured to me before that this look could be what you are interpreting as "terrified".

leslie :-D · Oct 18, 2009

maybe i'm misreading your post, werblessed, but that familiar 'look' on our pts faces, is never one of terror...

or even amazement.

when my pts are seeing 'others', it has always been a look of pleasure, contentment, comfort.

honestly it bothers me to think of 'looks of terror'...

the times i see that, is when s/s are poorly contained, i.e., air hunger...

which doesn't seem to be the case with imitation's pts.

i strongly suspect there's a bit of projection/transference going on.

hospice nurses who open themselves up to the hospice 'experience', will be privileged to witness events that some dare not to even talk about.

imitation, you say that you are working with a grief counselor?

have you lost a loved one recently?

it just may be that timing is off, and hospice isn't for you at this moment and time.

perhaps you need to struggle with a healing process now?

(clearly, i am guessing here)

i commend you for wanting to work this out...

and am confident that you will.

may peace be with you.

leslie

Werblessed · Oct 18, 2009

Hey, Leslie! No...I don't interpret the 'look' as terrified or fearful when our patients are communicating with unseen visitors but it sounded like imitation might have been misreading what she was seeing. Also, she reported not just seeing this 'terrified look' once but seemingly with all of her actively dying patients which is why I was more inclined to consider that imitation was misreading what was going on vs. poor symptom management. I'm hopeful that she can understand what is driving this issue and come to peace with what is truly transpiring vs. probable projection of own fears (which I agree is likely). Thanks!

psvec · Oct 24, 2009

I have been a hospice nurse for 10 years. These feeling that you are having will pass as you get used to the job. You will soon feel a sense of relief when one passes due to the suffering that they have had. You will never forget the look in their eyes but remember that towards the end of their life , they are '' looking '' but are really not there. You are helping them when no one else can and making them comfortable so that they can have a '' good'' death.. I hope this helps..Pat