Living Better with Hospice

jeastridge, BSN, RN

"I am having a good day today!" My patient's greeting was a warm welcome as we started our visit. She was on the front porch, in her wheelchair, oxygen tubing snaking discretely behind her, the compressor's noise muffled and distant. The sunshine was warm and the blue sky was enough to lift any sagging spirits. Her caregiver excused herself and went on inside. Stella, the patient, went on to tell me that since starting our new regimen for treating her dyspnea, she experienced less "smothering" and felt a little more energy, especially in the morning.

"Hospice has been good for me," she went on. "Who would have thought?" she gave me a sweet sideways smile, her leathered hand reaching out for mine as I sat in the rocker beside her chair. We went on to talk about her medication regimen, her current status, but along with that we discussed her plans for her beloved cat, Misty, and for her home of 50 years. Toward the end of the visit, I offered to have our chaplain stop back by in the next few days and she readily agreed. "That would be good. She is so friendly, and I can say anything and she never seems shocked!" We laughed together as I collected my things and zipped up my computer bag.

A number of recent studies have shown positive outcomes for patients who enroll in hospice and for patients who choose palliative care options. "Among the patient populations studied, the mean survival was 29 days longer for hospice patients than for non-hospice patients. In other words, patients who chose hospice care lived an average of one month longer than similar patients who did not choose hospice care." (Journal of Pain and Symptom Management, 3/2007)

While the story above is an especially positive one that highlights the benefits of hospice, there is great overall satisfaction in knowing that our work as hospice nurses can produce life-changing results, especially as relates to helping people find good closure. In an ideal hospice organization, the team works in concert to help with symptom management and to promote true honesty in person-to-person connection.

What are some possible reasons that good hospice care prolongs life?

Less fatigue from treatment routines

Treatment for chronic conditions can result in a parade of doctor visits and tests-so much so that everyone involved begins to feel the exhaustion set in. At hospice admission, we talk about bringing medical care to the patient and no longer having to keep routine appointments, or go for blood tests and scans. Rarely do patients and families object. Most are very happy to see that cumbersome part of their routines left by the wayside. The energy expended in getting to appointments is no small matter. For the chronically ill, a single doctor's visit often wipes out their energy reserves for the day, leaving little for the things that bring them true joy.

Medication management expertise

Hospice care can help bring "wholeness" back to the end of life. By becoming a liaison between the patient and the physician, the hospice team stands to take away a whole list of worries from the patient's plate. Getting those refills, helping to decide when to "up" the medication, improving patient/doctor communication all these services help take a burden off the hospice patient.

Acknowledging the elephant in the room

NOT talking about death can be a great burden to the patient. As the care team delicately dances around the subject, the patient may begin to feel like a failure for not getting well, a misplaced feeling a guilt laying on their weakened shoulders like a heavy, wet blanket. The patient, the family and sometimes the care team, so desperately want to succeed in defeating disease that they end up causing "dis-ease" through the treatment process. When the patient elects hospice, death normally becomes part of the initial conversation and plans for helping with end-of-life closure begin. The relief can be subtle, slowly allowing for better sleep and less anxiety. It can also be accompanied by floods of tears and emotional release as patients and caregivers change gears.

Feeding the spirit

One of the great parts of hospice is the freedom to talk with one another about spiritual matters-about the things that are truly important to the patient. Whether or not the patient and their family practice a particular religion, this is a time in life where people often want to express themselves on spiritual matters, when they want to re-connect with old friends and long-lost family, when they want to meditate and to pray- or be prayed for. "We are spiritual beings having a physical experience," (source unknown) is a phrase that resonates during the time approaching death. By having a terminal diagnosis, the patient becomes a subject matter expert, an often unaccustomed position that has the potential to be liberating. As nurses, we can choose to become listeners and learners, allowing our patients to share their hearts with us, if they wish.

I waved good-bye to Stella as her caregiver pushed the wheelchair inside, carefully maneuvering around the oxygen tubing, working to get her charge inside and back to bed for a long nap. While we might not necessarily extend Stella's life, I had the strong feeling that we were doing much to make her remaining days better. And that was worth celebrating!

Living Better with Hospice

Less fatigue from treatment routines

Medication management expertise

Acknowledging the elephant in the room

Feeding the spirit

About jeastridge, BSN, RN

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