Authored by Karin L Ciance
Advocating for hospice care for your loved one sooner than later can
help provide a peaceful passage. When faced with the need to address
end of life patients, families and loved ones this will require a
multidisciplinary approach of care and support. Nurses, particularly
novice nurses
and newer graduates are not comfortable addressing the need to discuss
or explore planning for end of life care options. In today’s high-tech
society, from my observations the basic needs of nursing care are
somewhat lacking. Therefore, the development of the 3 C’s which include:
caring,
comfort and compassion should be utilized in all patient care situations
but particularly in end-of-life hospice care. My theory is that the
nurse
who embraces the 3 C’s who provides direct care and coordinates the
members of the interdisciplinary team to augment part or all of the 3
C’s will
thus assist the individual and family to both a peaceful and meaningful
death.
As a nurse educator for prelicensure nursing students, I have
expanded this care approach to end-of-life hospice care during the
Community
Health Nursing course using case studies. These case studies have been
used in pre and post clinical conference discussions and during class
to augment theory presentation to prepare the nursing student for the
hospice experience. One common theme that continues to surface in my
practice is that often clients referred to hospice services stated they
do not regret it, but rather wish they had started sooner. Hospice
provides
care, comfort, and compassion to everyone; thus supporting a peaceful
passage and death with dignity.
Providing a Peaceful Passage through Care, Comfort and Compassion
Advocating for hospice care for your loved one sooner rather than later can help provide a peaceful passage. As nurses, we need to educate the patient and family members during their illness, when the treatment is no longer working, or when the treatment has completed, and the person’s health and longevity cannot be extended with further interventions. Quality of life versus quantity of life needs to be addressed with the loved one before they are days away from death. Engaging the hospice care team will provide beneficial care, comfort and compassion to the entire family.
Who can benefit from hospice care? According to Bernazzani [1]. Individuals who have been diagnosed with a terminal illness and are medically certified as having a life expectancy of six months or less can receive this type of care. For hospice care to be covered, a patient must decline curative treatments and elect symptom management and comfort care instead (para. 5).
Other life events, for example the birth of a baby, families actively engage in making plans for this significant life event. There is a lot of time and attention devoted to planning for and celebrating the birth of a new life. Certain choices are made, supported and respected by the new mother and families involved. There is not this level of preparation or view held towards end of life care and needs. When faced with the need to address end of life patients, families and loved ones will require a multidisciplinary approach of care and support. Mutual decision making to not prolong life and seek comfort care is important and can be difficult. Advanced directives will guide the decision-making process. Serving as an advocate, team leader, provider of hands-on-care, the nurse has a crucial role in ensuring the patient receives necessary care during this challenging stage of life.
Preparation for this role begins in a nurse’s foundational education for practice. However, although this is an essential component of nursing education curriculums, it can become an underappreciated concept in the high-tech/low-touch health care environment. Nurses, particularly novice nurses and newer graduates are not comfortable addressing the need to discuss or explore planning for end of life care options. Nursing education and nursing has lost a valuable practice concept as defined by Virginia Henderson. Henderson’s (1966) definition of nursing practice states: The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to this in such a way as to help him gain independence as rapidly as possible as cited in Ahtisham & Jacoline [2].
Virginia Henderson focused on individual care. She described the nursing role as assisting individual’s with essential activities to maintain health, to recover, or to achieve peaceful death [2].
As a new graduate nurse over 3 decades ago from a diploma program, I found myself and my family being faced with the decision to make my mother a do not resuscitate (DNR). My mother, diagnosed with lung cancer at 48, received 30 radiation treatments and several chemotherapy courses, even though there was no cure. I recall the doctor stating, “This is treatable but not curable”. Nine months later at the age of 49 she passed away while being intubated and on a ventilator in the intensive care unit.
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