Spiritual side of Hospice

marachne · Oct 26, 2008

I've been trying to catch up on the thread about a good death and have to say I am feeling a bit overwhelmed. I can do symptom management out the wazoo, no problem, and I love to ameliorate pain and suffering. However, it didn't really occur to me that I would be tending to pain and suffering other than physical.
The simple questions that one poster posed, "will I go to hell?" "what will my death be like?" I have NO idea how to answer. I don't know that I will be able to answer. I don't have a great comfort level myself with spirituality, please don't get me wrong, I WANT to be spiritual but am not exactly sure even what I believe except that I believe in some kind of higher power and some kind of afterlife. But that's about as far as I go right now.
It's been a long term goal of mine to work with hospice, and I am so honored and proud to work for the organization that I started with, it really does have a wonderful reputation and really cares about the clients. But now I'm thinking OMG I really don't know if I should be doing this!
Then I wonder, is the spirituality I see expressed here a direct result of working in Hospice? I don't know the answer, which is why I am posting. Honestly, I dont' even know the question. I am just feeling inadequate and not sure I can serve my patients well.
PH

It is hard, and tricky when you get to these kinds of questions, and I think that part of what happens as you work is you learn what works best for you.

One of the things that I think can help is to turn the question around, and ask the pt questions -- "can you tell me why you're worried about going to hell?" Maybe what they really want is an opportunity to talk about their regrets to someone who they feel is safe and who they can trust.

"What will my death be like?" "Again, what do you worry about?" "What do you think it will be like?" "What do you want it to be like?"

It is also perfectly ok to say "I don't know" and then go into an exploration of what your pt really wants/needs to talk about.

These questions come from a place of fear, and exploring fears and worries can help alleviate them.

Also, remember, you're not alone, and you don't have to do this alone. You don't want to shut down the conversation in progress, but you can also ask if they would like to talk more with other members of your team such as your SW or chaplain.

There's a lot of metaphorical language that people use, I think especially at EOL. I have learned so much from the chaplain I worked with about learning to read those messages so that you can respond to them (and/or share some of that insight w/families) in a way that makes sense.

The most obvious metaphor is about "going on a trip." It can be an indication of readiness to let go and die, but families may not understand that. If you start thinking with a poetical head (heart) as well as that rational brain, it opens things up a lot.

And speaking of those folks, use them as resources yourself. Get some ideas and insight (as well as comfort) from sharing your concerns about dealing with the spiritual pain.

leslie :-D · Oct 27, 2008

marachne made some great points.

it's very helpful to enter the specialty of hospice, feeling comfortable w/one's own feelings about death and afterlife.

it's true...

many pts contemplate their fate- heaven/hell.

and it's the perfect time to explore their feelings.

yet, if my pts persistently throw it back at me, i don't mind sharing my personal philosophy.

because for me, i don't believe in hell.

i believe the afterlife is constructed as a hierarchy.

we grow (in lspirituality) level by level.

for what we didn't learn here on earth, it will not escape us.

we still need to become enlightened and master these powerful concepts of love, peace, tolerance etc.

and so, i do share this w/some who are pleading for comfort.

of course, a stat note for the chaplain as well.

when your pts start speaking non-sensically with much difficulty in articulating their feelings, do suspect their spirit slowing leaving their body.

often, they will 'dream' when sleeping, and struggle to explain where they've been or where they need to go.

do not dismiss this as terminal confusion/delirium or ms changes.

it's very important to support their journey, wherever it may take them.

this is what marachne referred to as traveling.

it comes in many forms, this travel.

and finally, keep in mind that in home hospice, caseloads are such that too often, the nurses have little time to address anything but pt's physical s/s.

too many of these nurses are frazzled from being pushed to their limits.

such converations about afterlife, i would think, are more of a luxury whereas nurses are trying to keep up with the bare necessities.

best of everything to you.

in an ideal world, hospice nsg is the way to go.

leslie

finn11707 · Oct 27, 2008

ph--

relieving pain and suffering is the work hospice nurses are hired to do. once you have symptom management down, the beauty of the spiritual side of the dying process can be heard and seen more clearly. as you work with patients, you will engage more and more in helping them with their process of life review. the journey of acknowledging what was truly meaningful; what was achieved and what was not...then the falling away of the material and the physical to expose the soul. that is the spiritual side of hospice work. it evolves naturally with your heart and ears open. it is the very process we are all on. intuitively, we all know we have something to learn...to gain...from the work. i am sure, as we work with the dying, our beliefs evolve to embrace possibilities beyond what we originally believed, when we first entered nursing. many of us love the work, but some find it to be a time limited commitment in their career.

"i don't have a great comfort level myself with spirituality, please don't get me wrong, i want to be spiritual but am not exactly sure even what i believe except that i believe in some kind of higher power and some kind of afterlife."

you are really in a good place to do this work ph! and, yes, this work does have a way of making one feel more spiritual - even develop more spiritual belief!

it is not a specific belief in afterlife, or god...it is a process of opening yourself to see and learn and embrace. some of this process can be achieved with different tools--marachne had many good tips and insights. you don't have to have 'answers' to give. your task is to be present to their journey of life review and self discovery...to help patients and families frame the dying process as a celebration of their life; death as a wondrous transition, which we all will experience because it is a part of this life. not all hospice nurses are comfortable with helping patients who have deep fears of dying...hell, etc. that is why hospice works as a team, with msws, chaplains and volunteers. i have had patients who could only open up to the hha bathing them! others, refused the msw or chaplain, but spoke freely with the volunteer or the nurse about unfinished relationship issues or religious fears. i use a lot of listen, a few encouraging words and an occasional poignant poem.

have you read any of the books mentioned in the hospice thread "recommended reading for hospice..."? some help to frame, with examples, the spiritual journey of process.

ParrotHeadRN · Oct 27, 2008

Thank you all so much for your words of encouragement and suggestions. As a newbie to hospice, some of the threads I've been reading have such depth that I was totally out of my league and had to reread some things several times before I could start to grasp what was being said. But at the same time, I am glad that I have just an inkling of awarenss before I actually go out into the field that my job is going to be so much more than I ever thought.

I'm still trying to wrap my brain around a "conscious death" and what really means. That is a concept I had never even heard uttered before.

I hope you experienced nurses keep up that kind of dialogue and as I grow in this field maybe someday I can join in.

PH

I was thinking that the title of this thread is wrong, because isn't ALL of Hospice spiritual?

finn11707 · Oct 29, 2008

PH---Yes, I think you are right that Hospice work has a spiritual connection in every part of the process---certainly for us doing the work. We realize that it is a spiritually led process. But, then you meet people who struggle the whole way through; don't embrace any concept of life after death, a greater beyond or anything and so rail through the whole process of dying. Those are the cases you ache for, and breathe a sign of relief when it is over finally.

It is a wonderous process for persons who fully engage the spiritual momentum to learn to deep lessons it can teach and also for those of us walking with them on that journey... as far as we can go. As you become more comfortable with the symptom management part, the stages of process and find what works for your style of approach, you will find your intuition leading you. You will know when to speak, when to be silent, when to engage a family member, when to add a celebration poem or story and when to say goodbye. Thanks for writing. It is hard for most of us nurses to expose a vulnerability. Yet, it is such an important learning in this work.