How Not to Die - new article featured in The Atlantic

[_MORA_]

I found this article fascinating and it increased my interest in hospice as a career choice after I graduate.

http://www.theatlantic.com/magazine/archive/2013/05/how-not-to-die/309277/

It is certainly a physician centric piece, as are most covering healthcare in traditional media, but I especially like that it ends with a hospice nurse saying 'the right thing'.

It made me wonder if you all would agree the assertion that hospice is one area of healthcare, and nursing, that has an ideologically pure mission statement?

Most other areas of healthcare seem to profit off of our dysfunctional system; ER, OR, ICU . . . and surely many hospice patients shouldn't be there in the first place (meaning if prevention was as integral as it should be).

Do you as hospice nurses see the profit motive interfering with care the way it does in other aspects of nursing?

Thanks!

[jeannepaul, BSN]

Yes I do see hospice care be "all about the money". In recent years, I have seen services cut, supplies decreased, medications covered decreased. We used to do the right thing for the patients and meet the patients and the family's needs. Now, as a hospice nurse cannot get the medications I need for a calm and comfortable death. I cannot get a special mattress to prevent bed sores, and I cannot even get crisis care for the pt when it is indicated.

I really hope it is the hospice I work for (for now) and not all hospices participating in all of these cuts to care.

[NursieDP]

Yes I do see hospice care be "all about the money". In recent years, I have seen services cut, supplies decreased, medications covered decreased. We used to do the right thing for the patients and meet the patients and the family's needs. Now, as a hospice nurse cannot get the medications I need for a calm and comfortable death. I cannot get a special mattress to prevent bed sores, and I cannot even get crisis care for the pt when it is indicated.

I really hope it is the hospice I work for (for now) and not all hospices participating in all of these cuts to care.

I have seen the same things. I am about to start with a non profit so maybe things will be better.

[tewdles, RN]

$$ will always interfere with patient care in the health care industry, not everyone is altruistic in their intents or goals.

[DedHedRN]

I work for nonprofit, there are reminders that things cost money, and suggestions that we save in every way possible, but never have I seen a pt not get what they need, unless it was not related to their admitting diagnosis.

[dosamigos76, RN]

I have worked for nonprofit and for profit. I currently work for a company that while we are aware of costs, we do not compromise care for the patient or family. I manage an IPU and we take charity patients there-that is one of the things I am very proud of. It all depends on the company and the Administrator. I love what I do, but I don't do it for free either... The company I work for is not in the top for pay, but they make up for it in the quality of care that is provided.

[ashcarr30]

I read this article recently and have been thinking about it quite a bit and I am so pleased you posted it. To begin with, I think clinicians have varying skill levels (and willingness) of communication with patients and families about the disease process, plans of care and expected prognosis. I also think that patients and families need repeated conversations to better understand what to expect. Having video's to better demonstrate treatment options and manifestations of a disease are underutilized in my opinion.

On a side note, I hear regularly from family members and young adults that if they have advanced dementia they want to be "taken out of their missery" or some joke about ending their life. I have never heard how someone wants everything done so they can stay alive to lay in a bed while their caregivers, as good as they may be, watch tv and talk on the phone all day which is typically what I see even in the best senerios with caregivers of advanced dementia.

Yet, families continue to struggle decisions about treatment and end-of-life decisons for individuals with advanced dementia. I think this highlights the need to have conversations often and early about goals of care with chronic illnessess, particularly with dementia in its early stages.

To go back to your question about "whether hospice is one area of healthcare, and nursing, that has an ideologically pure mission statement?" I dont know if I understand your question completely but in reference to your satisfaction with the hospice nurse "doing the right thing" at the end of the article by telling the man that "it would be cruel" to place a feeding tube in his father who had advanced dementia, I think that hospice nurses undertand the inevitably of death at the end stage of disease. There needs to be more conversations about the anticipation and expectation of death and not what can be done to prolonge the inevitable with uncomfortable and often futile treatments that often come at the end of life. Hospice nurses have end-of-life and goals of care conversations frequently. Despite health care cut backs which are necessary and inevitable, hospice nurses continue to have "The Conversation" with patients and families which is often long overdue at the point that we are having them and this is an intergral and valuable part of hospice nursing.