Transitioning Home Care to Hospice..... hardest part??

leslie :-D · May 20, 2005

i've only worked in an in-pt hospice facility.

pain mgmt is key, and i think you'll do well in managing it.

however being out in the community, you do not have the autonomy of controlling your pt's pain as it is in the hands of the family. and there are families that just will not medicate enough, with many variables. that is frustrating. you can only educate to the best of your ability; duragesic patches stay on for 2-3 days.

there will be family dynamics- denial, anger, anticipatory grieving, and again, sometimes neglect....neglect where they don't administer the pain meds. i've heard stories from my hospice friends where a family member would be taking the meds for themself!

also it's important to address the pt's emotional/mental and spiritual distress.

skin checks are important to prevent breakdown.

ask if they have a pastor/rabbi they want to visit.

the only reason i never did community hospice is i couldn't bear the thought of the pt's pain not being well managed. i guess that makes me a control freak... :) but even working in-pt, i've had families complain to me about 'killing' their loved one with morphine. i had to reassure over and over that it was to relieve their pain/suffering. you'll potentially be the recipient of alot of displaced feelings. do not take it personally.

if i can think of more, i'll post again.

but i always keep in mind that pain comes in many forms and address each segment.

and then,the families.........oy.

you'll do great cardio.

leslie

CardioTrans, BSN, RN · May 20, 2005

Thanks for the info Leslie.

I know that it will be different. Im a very hands on kind of person. I have to truly "manage" my patients. Im the kind of person who rarely takes a day off, if I do, I re-arrange my patients so that no one else will see them. I dont like other people seeing my patients. I know that leads to burn out quickly, but I dont wont the family or patients having to go through "orienting" another nurse to the patient. If someone may have to see them, or will have to see them, I have notes that I give the nurse to let them know things to key in on. My supervisor calls me "a... retentive". I just like to think that I "tuck them in until next time".

I want this transition to be smooth for these patients. The majority of the ones that I will be seeing are going through enough right now, without having to have a "new nurse".

I'll take any advice that you have to offer.

Thanks again.

leslie :-D · May 20, 2005

cardio- are there any specific concerns/advice you're looking for?

then maybe i can help you to the best of my ability.....maybe i'll look for a link about community hospice nsg. i'll be back. but in the meantime, i really would like to know your concerns......

we'll talk.

leslie

leslie :-D · May 20, 2005

wooooooooooooooow!! i hit the jackpot, cardio.

i came across a website that is PERFECT:

http://www.familycaregiversonline.com/mod_12_palliative_care_links.html

definitely check this one out- i too, am adding it to my favorites.

let me know what you think.

leslie

CardioTrans, BSN, RN · May 20, 2005

Hey that link was great. I found a free download for my PDA, with fast facts, med conversions, and Medicare guidelines.

I guess the main thing that Im having a hard time is "fear of the unknown". Im stepping out of my comfort zone of home care and doing something on a regular basis that I have never done before.

I am in Practitioner school, and one of the reasons my supv asked me if I would be willing to do this is "it will help with my clinical component of the NP program". Which is true, to an extent.

Thanks for your help, Im sure that next week when I start doing this, or this weekend when it really hits me I'll be looking for you to stress :)

PumpkinsMami · May 20, 2005

Well, the biggest difference for me is time. When I did home health, we had to see a lot of pts in a little bit of time. With hospice, it is so different because you have time to give. That is what pts and families need most. No hurry, no rushing. You have time to get to know your families and pts. To hold a hand, give a hug. It is tough, getting attached at times, but you learn to deal with it. The biggest reward for me are the families. Knowing that they know what to expect and that they were able to spend those final moments with the pt. And when the time comes, they don't have to worry about who to call and what arrangements to make. We take care of that for them. It definitely takes a special kind of person to be a hospice nurse.

jerseyRN · May 21, 2005

Thanks for the info Leslie.
Im the kind of person who rarely takes a day off, if I do, I re-arrange my patients so that no one else will see them. I dont like other people seeing my patients.
I like to see my own patients, too, but I think you do families a disservice if you set things up so you're their "one and only". They need to know there's an organization of competent people behind them, not just their one nurse and her team.
Plus, believe it or not, sometimes a nurse going in fresh will have good ideas you didn't think of, or connect with a family in a way you have not.

leslie :-D · May 21, 2005

I like to see my own patients, too, but I think you do families a disservice if you set things up so you're their "one and only". They need to know there's an organization of competent people behind them, not just their one nurse and her team.
Plus, believe it or not, sometimes a nurse going in fresh will have good ideas you didn't think of, or connect with a family in a way you have not.

i disagree.

especially for hospice, continuity of care is extremely beneficial and comforting to the pt and their families.

if the nurse does not have a good fit w/the pt and family, then i do agree another nurse should be assigned; and if they are comfortable w/one another, then try and stick w/that nurse. i agree with cardio 100%.

leslie

jerseyRN · May 28, 2005

Can't argue you with you about the value of continuity of care, and I also agree most families prefer to see "their" nurse. But when the system is set up that you have so many patients that you have no choice but to share them with an LPN or a per-diem, you have to make the patient and family comfortable with other nurses, because you can't split yourself in half to be "the one" for everyone.

I wish I had a manageable number of patients so I could be their "one and only," but it ain't gonna happen, so I try hard to help them feel confidence in whoever visits.

And, I call them... even when someone else is going there.

Wren · Jun 17, 2005

CardioTran...hope you have found your transition to hospice to be smooth. I went from home care to hospice and found it to be wonderful and very rewarding. When I worked home care though I cared for many AIDS folks who wouldn't transition to hospice (even though they were dying) because they couldn't continue to get the HIV/AIDS meds under hospice. So I ended up with a pretty good caseload of terminally ill patients even though I wasn't a hospice nurse. We also had a hospice team in our agency and they provided a lot of support to me. They would make "consult" home visits when I needed them and when I got the chance to move to hospice, I knew it was the right choice for me. :redpinkhe I hope you are finding your new job equally satisfying!

CardioTrans, BSN, RN · Jun 17, 2005

Well, Im in wk 3......... one patient absolutely refuses to have any other nurse come and see her now. She wont even call the triage nurse at night if shes having problems. I got to one patients home this am, her hubby was cooking breakfast, while I was assessing his wife, he brings me a plate of breakfast in! (eggs, bacon, grits, and biscuits). One little man wanted me to promise him that they wouldnt change nurses again. Of course I had to tell him, that there may be times when someone else has to come, he was ok with that, as long as it wasnt permanent.

As far as the paperwork goes, I hate to say this, but it is a cake walk compared to home care paperwork. Of course, I always forget about those dang IDG notes. There has not been one day in the last 3 wks that I have had to work past 5pm, and not one night that I had to sit down and do paperwork after I got home. I even had time to take my dog to the vet this afternoon. I was like, so this is what its like?...... and of course my family was just amazed that I didnt have a laptop attached to me.

So far, all of the patients that I have been managing are doing ok. We have to see them all 2x/wk, so it makes it a little easier to catch things before they get bad.

Its going well, just hope that the higher-ups leave me in my area, and dont decide to move me around, not just for me but more for the patients. Its defintely different. After doing home care as long as I have, sometimes its hard to get away from the "skill" thing. But so far so good. :)