Having trouble adjusting to role as hospice nurse

[Imitation of Life]

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.

[Marshall1]

I am a nurse tho' not a hospice nurse but what was written about the "look of terror" just happened to me this past July - with my own mother who was on hospice. When the time came for her to pass her eyes were HUGE & somewhat bugged out - I've witnessed death before both personally & professionally & have not ever seen anyone look like this - I did see someone struggle whose life support was turned off but with her it was different - she looked exactly as the poster described - terrified. We had talked about her dying, she accepted what was to come - the few days before she died she would follow directions but didn't talk at all. She also, before going mute, did talk to people who had passed on before and seemed to see them but she was not afraid - this is one of the hardest things I'm dealing with with her death - is how she looked - all I could do was place her head on my shoulder until she passed - I talked to her quietly the whole time but still..so I don't know but I do know the poster is correct about this look.

[tewdles, RN]

CLW2350...I am so sorry that this happened for you and your mother. I hope that she did not struggle with symptoms in the final hours of her life.

[mizally]

A few disclaimers: I'm not a nurse yet, not even a nursing student. I start my prereqs and a CNA course next semester. In the meantime, I'm a home hospice and a hospital palliative care volunteer. (Short story, I was laid off from my previous career; idled my way into volunteering and fell in love with patient care, decided to change careers entirely.)

I've been there for at least two patient deaths, spent time with several in the active phase and lost at least five that I'd connected with over time as their home volunteer. I've seen the look in the eyes and found it more of a questioning look. It was as if they were asking, "What now?" I always have to remember to check my own immediate reactions at the moment. I see my job as a comfort at that point. I hold their hands and just reassure them of things being OK: OK to go, OK to wonder or just OK that he or she isn't alone.

After that, either the patient passes or I have to leave before death but amid the active stage, that's when I process to people who can understand the emotions that wash over you. For me, that's the volunteer coordinator, nurses on the floor, the patient's immediate nurse, the bereavement counselor, the chaplain.

The "eye" thing doesn't haunt me, per se. It stays with me, however. I don't fight the image; I just process it and match the possibilities of their thoughts with what I knew about the patient's personality to answer the question of what was going on. What's harder, I suppose, is when their eyes are tightly shut and it looks as if tears have welled in their eyes. That happened with the first patient that died practically in front of me. Her eyes weren't that way when she was still breathing; closed, yes. Wet, no. That was difficult.

Like grief, I guess, I just let whatever thoughts and feelings I have of the patient run their course. Sometimes, it involves shock and maybe tears. I tend to bounce back with the next patient. He or she is a new person to help along the journey.

I hope you don't think I'm oversimplifying. I'm learning that my method of dealing with death, imminent death and the dying seems easier than it is for others. I don't know if that means a nursing specialty has chosen me at this stage in the game; but it's something I consider. Do any of you hospice nurses ever "burnout" a little at knowing almost all of your patients won't recover? That's my fear if I chose hospice as a specialty; what if I'd NEED somebody to live?