Field Experience in Hospice Gives Nurse a New Perspective

April Hartzog
Louisiana State University Health Sciences Center School of Nursing

Although I was hesitant at the idea of encountering hospice nursing first hand, the experience proved to be enlightening, enjoyable, and much more than I had imagined. On the morning of Thursday, March 4, 2003, I received a call from Adele Hayes, RN, BSN, the hospice nurse who would be showing me the ropes. “There’s been a change of plans,” she said. “I’m at a death. Instead of meeting me in the parking lot, why don’t you just meet me here?” She proceeded to give me directions to the residence, and I proceeded to feel a huge lump in the pit of my stomach. The idea of seeing a dead person was not what troubled me. (I assisted with postmortem care in the hospital setting the previous summer.) What troubled me was the idea that I would enter the home of complete strangers and share with them a very troubling and frightening time in their lives. Who was I to just barge in?

A short drive and a few deep breaths later, I arrived at a home in a modest neighborhood in Kenner, LA. Hayes met me outside and greeted me, telling me that the patient’s family noticed she was dead about an hour earlier. I entered the home and greeted the family members, who were teary-eyed and quiet. It was not long before I assisted Hayes and two of the patient’s adult grandchildren in carrying her body down the hallway and placing her on a funeral home stretcher. Her body was put in the back of a white Suburban as her family looked on. All the while, Hayes offered words of encouragement to the family. She gave them her shoulder to cry on, literally, and made sure that they knew they could call her if needed. She reminded them of arrangements that needed to be made and that a bereavement counselor would contact them.

Hayes’ respect for the family and the patient, even after death, and their respect and appreciation for her, gave me the impression that she had been part of their family for years. It was not until later in the day that Hayes told me she had only known the family since the week prior. Nothing could have more clearly explained the profound connotation of hospice care, especially hospice nursing. At that moment, I knew the importance of this Hospice care has greatly affected nursing practice. Issues of palliative care, end of life, pain management, and even such taboos as physician-assisted suicide and euthanasia make up all that is called “hospice.” Hospice nursing is truly a holistic practice. Nurses and other hospice caregivers not only care for patients and their physical symptoms but their psychological beings, spiritual beings, and those of their families as well. Patients die with dignity and comfort, usually in their own homes, with the company of their family and friends. Families continue to receive hospice care in the form of bereavement counseling after their loved one has died.

When I observed Hayes, she had been a hospice nurse for only seven months. However, the impact she has on her patients, their families, and others she interacts with will last a lifetime. Hayes works closely with patients and their families, the primary caregivers. She alters patients’ medications whenever needed and contacts the pharmacy for refills and the like. Hayes spends a significant amount of time educating all of her clients, patients, and families regarding end-of-life care, palliation, pharmacology, disease processes, the grief process, and anything else they may need to know. She is exceptionally honest, but reassuring, regarding end of life to those who are in denial, both patients and family members. She calls family meetings whenever she sees a need for an open forum of discussion regarding the patient. At these times, she and a social worker not only instruct clients on hospice care but also listen to any concerns the family has. Hayes, and any hospice nurse, must interact with many other professionals and nonprofessionals to provide the level of care involved in hospice.

Clients’ responses to hospice care vary. However, most of Hayes’ patients and their families seemed to react positively to her. One of her clients, a woman in her 60s or 70s who was diagnosed with rectal cancer metastasized to the colon, lived alone. She was very dependent on Hayes and the other hospice staff. She denied that she was at the end of life. When Hayes reminded her of her terminal cancer and the need to take care in doing things she once did quite easily, such as walking up stairs, the patient replied, “Why do you have to be so mean to me?” She then winked and gave a little grin. Upon leaving, Hayes pointed out the intense involvement of psychiatric nursing in hospice care. She noted that sometimes, such as in this case, patients just want to know that you care and understand what they are going through.

In another situation, an elderly man diagnosed with Alzheimer disease and breast cancer needed total care. His wife and son took outstanding care of him day and night. This family, as Hayes stated, “[was] not ready to let him go.” Hayes explained a need for patients to be comfortable to die peacefully. She also added that a patient often will “hang on” until a family member arrives from out of town or until the family seems to okay to continue on without him or her. In this family, the patient’s wife took a lot of pride in taking care of her husband. She always asked students to put on gloves and feel the lump on her husband’s breast. She understands the importance of experiencing things first hand. She asked, “You wanna know what it feels like, don’t you?” Upon leaving, she was pleased to show us some photos she recently acquired from a friend. She was in the first graduating class of Booker T. Washington High School in 1943. The photos were of the graduating class, all dressed in long white gowns and carrying flowers. She was so excited to share them with us that we ended up also looking through a family reunion album. This family can trace their lineage back to the early 19th century, during which only three children of the first generation were born free, and not into slavery. It was amazing to see how pleased the family was to share stories with us. They accepted Hayes as extended family and wanted to share this information with her. I was lucky enough to be along for the ride.

From this field experience, I gained only positive perceptions of hospice care. Hospice nurses have independence above and beyond that of other areas of nursing. They have very meaningful relationships with their patients and the family members. Hayes has even been recognized at funeral services for her contribution to the life of her patients. Perhaps most impressive was Hayes’ sincere love for her job and her clients. She is very happy as a hospice nurse. She said, “It’s funny how things work out. I would’ve never picked out this field for myself when I was in nursing school. Now, I can’t imagine doing anything else.”

I see no need for improvement in any area of hospice care at this time. Of course, my hospice experience is a short, three hours of observation. Perhaps further involvement in hospice, as a volunteer or otherwise, would indicate some room for improvement. For now, I see hospice as a very positive and necessary healthcare service. It allows patients to die peacefully and comfortably, surrounded by the ones they love. It also allows families time to grieve and become at ease with the idea of a loved one’s death. From a nursing perspective, hospice is extraordinarily rewarding and equally draining. Nurses and other caregivers must know when to draw the line, not to bring their work home, and take time for themselves. With all of these things in consideration, hospice nursing is the most respectable and passionate field of nursing I have experienced.