DiversityNursing Blog

The Nurse Who Admits Patients to Hospice Care

Posted by Pat Magrath

Thu, Mar 30, 2017 @ 03:39 PM

stethoscope-black-white-antique-doctor-medicine-healthcare.jpg
Are you a Hospice Nurse or have you thought about becoming one? Perhaps you’d like to understand what this job entails. This article is written by a Hospice Admissions Nurse and she explains her role very honestly. She’ll tell you what her days and nights are like. The questions she’s asked by families and patients.
 
She emphasizes the importance of doing what the patient wants. She’ll ask how they want to live their final days. What they’d like to see and do. I appreciate her candor and would love to hear your comments.

Pamela Moss Blais, 55
Hospice Admissions Nurse
Norfolk, Virginia

As a hospice admissions nurse my job is to explain the process to new patients. I’m the very first face they see as they embark on their journey. That’s what I call it, a “journey.” Since I admit patients I don’t carry a caseload. I meet them once and then they float out of my life.

I was an ER nurse for 18 years. I saw patients who were resuscitated whether or not it was ethically correct. I saw families get hope when there was clearly none.

In hospice, the family is your patient. They’re truly living their darkest days. For many of them, this admissions meeting is an overwhelming process. Every emotion that they have inside of them that maybe even hasn’t ever surfaced might come to the top. But I don’t want families to cry.

During that first meeting I don’t say: “So this is what we do for people who are dying.” I say: “Hospice is not about dying. It is about living the remainder of your life how you want to. Not how I want you to, not how your husband, wife, daughters, or sons want you to, and not how the doctor wants you to, but how you want to.”

If you think about the last time you went to the doctor, he probably said, “Okay, this is what I think. These are the tests I want to run.” Nobody asks you, “What do you think? Does this sound reasonable? Do you want to do it?” Nobody tells patients how their quality of life is going to go down the toilet when they get chemo. So it’s sometimes hard for patients to wrap their head around the idea that everything is their choice now, they’re driving the ship. That’s the mission of hospice.

I encourage my patients to live because I want them to know: This is not about assuming the sick role. This is about getting up every day, taking a shower, getting dressed — if you can do that — eating, going out with your family — whatever it is you want to do. I recently met with a patient who was a plane enthusiast. He wanted to go to some Top Gun show in Delaware. I encouraged him to go …

I believe that the people who are most successful at hospice are good observers. They can read vibes and figure out the situation before they say a word. Sometimes I meet with patients in the hospital. Sometimes they’re in a nursing home. Often they are in their home. Before I even begin to discuss hospice, I try to figure out the patient’s faith. Do they even have a faith? I don’t ask directly … I do some detective work. If I’m at their house I look for crosses or iconography. I’ve seen people from all walks of life: Jewish, Buddhist, Jehovah Witness, Wiccan.

I think hard about my physical presentation. I don’t want anything too flashy or festive. Today I have on blush and lipstick and a little bit of eyeliner, but it’s very conservative. So is my dress. I make sure there’s no cleavage exposed or anything that would offend. I’m Jewish, but I don’t wear any religious jewelry. When I see someone dressed in scrubs that have Froot Loops on them or something, I say to myself, “Really? You look like you are in pajamas.”

My dad a pediatric allergist/immunologist in Norfolk. I used to go with him to the children’s hospital to watch. But the pivotal moment came the summer just before I graduated college, this was during the Carter administration. I was sitting by the local pool and overheard some women talking about all the cuts to education and how they might lose their jobs. I had studied special education and taught art at camp for mentally challenged kids, and I loved it. But would I have a job?

Then my brother who is a year older than me broke his neck when he was body surfing in the sea. He was 25 and home for the weekend from college. He suggested that I become a nurse, I spent so much time caring for him.

The other night I admitted a woman who has metastatic bladder cancer. I was instructing the family to give medicine, but I could tell they were nervous. They said they knew how to do it, but the mother was refusing. You could sense the stiffness and the fear in the room. And once I showed them how to do it, it was like an immediate Aha! Immediate relief. Because they realized, I can do that. I did that. These little tiny steps are big.

There’s so much information that has to be explained, I have to use my words very carefully. I want them to know there is a light. I want them to see that and feel it when I do my mission.

Sometimes the family members will ask, “Well, what do I say to my mom? I can’t say, ‘Hey how was your day?’ I can’t ask questions about the future.” I say, “Talk about the past. Talk about stories, trips you went on together. Ask them to tell you stories you have never heard. Talk about fun times. That’s how you comfort your loved ones when you don’t know what to say.”

There was a patient I admitted who had two daughters who work in the health-care field. They said something like, “I checked her blood pressure.” I said, “Why did you do that? I don’t want you to feel you have to assume the role of a nurse. I want you to be the daughter.”

I want to know when I leave the house or the hospital or the nursing home that the family and the facility staff feels okay. Not great. Because they’re not going to feel great. But that they feel okay with the situation and that if anything happens, they’re going to reach out to us and we’re going to be there. If you sense a problem, even if it’s tiny, even if you’re not sure it’s a problem, call us. We would rather you call us 20 times a day with a little tiny problem than let it escalate.

I spend a lot of my time alone in my car, traveling to see patients. Sometimes I’m putting in over 100 miles a day, driving all over Virginia. On an eight-hour shift, I usually process two admissions. On a 12-hour shift, I can do three.

I’ve been in the trenches. I’ve worked in labor and delivery, I’ve worked in the pediatric ICU, I’ve worked in Medserv, I’ve worked in home health, I’ve worked for a cardiologist in an office setting. I worked in the ER. You can’t be a nurse unless you care about people. It’s exhausting in every way. Spiritually, psychologically, emotionally. Nursing has been my life. This is the unfortunate thing about nursing. I love nursing, but it’s extremely hard to find a work-life balance.

I’ve been a nurse for 25 years and I don’t even make $40 an hour. You’re on your feet for 12 to 14 hours a day, and rarely do you get a lunch or even a bathroom break. Most nurses work their entire career and never get a break. When people say,”There’s such a nursing shortage,” this is why. It’s a struggle for the nursing profession as a whole and they still haven’t figured it out.

My hospice-admissions job is the first I’ve ever had where I actually can say, “Y’know, I’m hungry. I’m going to go to a WaWa and get a cheesesteak.” But still, the only thing that gets me through the work week is that I’m off Fridays, Saturdays and Sundays.

I work Monday through Thursday, 40 hours — on paper. When I come home at night, I start in on the homework. Each admission is two to three hours of paperwork. That’s the killer. I spend the night buried in paperwork.

The company I work for is trying to rethink the flow of the documentation, but some of this stuff is based on federal requirements, the Medicare/Medicaid requirements, and all the insurance companies follow federal guidelines. They’re not going to rework the wheel. These things have to be done right if we want to get reimbursed. There’s no shortcut.

But I cannot work 12 hour shifts anymore. I have a daughter in college and a 15 year old who I rarely see during the week. I told my boss, I need to be home at dinner time so I can get organized, so I can talk to my daughter. She’s a teenager. She needs her mother.

We struggled to be parents. I had seven pregnancies but I only have two children. Being a mother is still my dream. I don’t want other people doing my job. Our other daughter was very sick a couple years ago. That was actually why I left the ER. And I told my husband, “You might put your job before us. But I’m never going to do it. I’ll be working at McDonald’s before I put my job before my family.” Luckily right now, my boss understands the struggle.

A lot of nurses feel like they don’t have value. I will admit it’s hard when you feel worthless. I’ve tried to make an impact with every job I’ve ever done but rarely got accolades. A couple of weeks ago, I really thought about leaving hospice. I’m tired. I’m fed up.

And then all of a sudden, people are telling me I do a good job. People have started copying the way I put my notes in. I got a little promotion and was asked to be a mentor. It’s been hard for me to accept it. It’s just so odd after so many years trying to climb the ranks in health care. I called my husband and said, “Something suspicious is going on.” People are complimenting me. Why all of a sudden now? I took it as a sign that, for now, I will stay in hospice. Maybe I’m truly having an impact.

Sometimes, I’m taking care of people who are my age or younger. Imagine being robbed of your life during your 50s. You have every right to be the angriest person in the world. You’re going to die, you see it. The end of the tunnel — you can see it. I can’t see the end of my tunnel. I’m not dying. These people know it’s coming. It might not be next month, but it’s going to be in the next six months. If you were told today you had six months to live, just think how differently you would look at your life … That gives me perspective. I regularly think, “Is my life really that bad? I’m having a bad day, but is it that bad? Am I this person? Am I dying?”

sign up for newsletter

Topics: hospice, hospice nurse

Medical Volunteers Help Terminally Ill Patients Visit Their Favorite Destinations One Last Time

Posted by Erica Bettencourt

Wed, Mar 11, 2015 @ 02:48 PM

A Dutch organization called "Ambulance Wens" (Ambulance Wish) fulfills the last wishes of terminally ill patients free of charge thanks to its 200 medical volunteers.

The company says, "There are still too many patients who die without getting to close everything. One of those reasons is the inability to achieve certain desires because the patient is no longer mobile and other existing facilities are inadequate for this purpose."

Special ambulances and stretchers help transport the patients safely and comfortably. Typical excursions include a visit to the beach, a visit to a neighbor who is also no longer mobile, and various places where the patient has special memories.

This woman's final wish was to visit the Rijksmuseum in Amsterdam.

1d91x final wish1 resized 600

Another woman enjoys the view from her favorite vacation destination in Tuscany.
dyjgi wish4 resized 600

This gentleman asked for one last view from the Euromast observation tower.
rrp7p wish2 resized 600

And this man asked to see the mills in Kinderdijk one last time.
bzn5d wish3 resized 600

Amsterdam is not the only place doing such wonderful things. A hospice outside Seattle made an old forest ranger's dying wish come true.

"Ed expressed one last hope to the hospice chaplain: He wanted to commune with nature one more time."

kvq2i final wish2 resized 600

As the hospice wrote on its Facebook page, "People sometimes think that working in hospice care is depressing. This story ... demonstrates the depths of the rewards that caring for the dying can bring."

Source: www.sunnyskyz.com

Topics: life, health, healthcare, medical, hospice, terminally ill, patient, treatment, care, wishes

The Benefits Of Horse Play

Posted by Erica Bettencourt

Tue, Feb 10, 2015 @ 09:05 AM

By Jodie Diegel, BSN, MBA, RNC, LNCC

bilde resized 600

Laura* is severely disabled, but when she spent time with Lunar, her caregivers at Little Angels, a non-profit skilled nursing facility in Elgin, Ill., witnessed something they had never seen. Laura began to move her fingers back and forth. Lunar is not a doctor or a therapist, but a 6-year-old specially trained miniature therapy horse from the Northern Illinois-based non-profit organization Mane in Heaven that I started in 2012. Mane in Heaven specializes in animal-assisted activity and therapy visits. Our horses visit with people with physical, mental and emotional challenges ­— from people with severe disabilities to Alzheimer’s and dementia patients to patients who are undergoing treatment for cancer.

Laura’s reaction was no surprise to me. We witness this type of reaction all the time when Lunar — with her chestnut brown coat and blonde eyelashes and her gentle demeanor — or one of her fellow mini-horses meet our clients. I recall another visit between a young man who was blind and disabled and Turnabout, a 3-year-old mini-horse. Turnabout is the only boy in the bunch and has the biggest personality. When the young man put his hands on Turnabout’s face, they obviously made a connection because the man laughed exuberantly again and again. 

It brings us joy to see the light, laughter and hope our minis provide to people experiencing profound illnesses or disabilities — not to mention that these visits can lead to improved physical, mental and emotional well-being. 

I remember when the idea of working with mini-horses came to me. I was surfing the Internet one evening in December 2011 after volunteering with my two therapy dogs, Buffet and Dudley, when an advertisement caught my eye. “Mini Therapy Horses for Sale,” it said. I thought, “I have two big horses, so I know horse behavior, and I’ve done a lot of obedience training with my two therapy dogs. I can train mini-horses to do the same thing that Buffet and Dudley do.” 

But I knew I couldn’t do it alone. Two months later, I had established a volunteer board of directors, including founding board member and friend Dina Morgan, RN, and had acquired three mini-horses — Lunar, Turnabout and 3-year-old Mystery, our smallest horse. In 2013, 2-year-old Jenella joined the group. 

Mane in Heaven volunteers and mini-horses began site visits in June 2013, and since then our volunteers and horses have visited with thousands of people in need. We have relationships with numerous providers and non-profit organizations in the region, including Marklund, a home for infants, children, teens and adults with serious developmental disabilities; Gigi’s Playhouse, which cares for children and adults with Down Syndrome; Wings, which advocates for survivors of domestic violence, as well as homeless women and children; JourneyCare, which specializes in palliative medicine and hospice care; and Rush University Medical Center, a premier hospital located in Chicago. 

A site visit usually lasts up to two hours and involves an exchange of unconditional love between the horses and our clients. People watch, pet, brush, hug and take pictures with the minis. Rather than thinking and talking about themselves and their problems, our clients focus on the animals. When our horses visit a care facility, the residents laugh and interact more, are mentally stimulated by the entertainment and are able to recall personal memories more readily. 

When Corin Garcia, 19, from Palos Hills, Ill., met Lunar at a Mane in Heaven visit at Rush University Medical Center, it changed her whole perspective on her pending treatment. Corin told me it was a day she dreaded more than anything — admission day for “four tedious, boring days of chemotherapy,” she said. But Corin’s attitude changed when her she met Lunar. “I was in an awful mood, yet when two miniature horses walked through the door my mind cleared all its negative thoughts and my heart instantly melted. Being around these beautiful creatures made the worse day turn into the best I have ever had in the hospital.”

Mane in Heaven does not charge for visits; we rely on donations and fundraising, so fundraising is important work for our volunteers. Interest is growing in our services, thanks, in part, to media coverage by CNN, the Associated Press, and local media outlets. Having the support of volunteers helps us to maximize donations, but we hope to find others who believe in our mission and will also support us financially. While our horses are tiny, there are still significant expenses associated with running our organization. One day we’d love to open our own therapy center and acquire more horses, so we can serve more people. 

Running a nonprofit business is challenging while also working full time, but I really never feel like this is work for me. While I may have had the vision for Mane in Heaven, our volunteers have made it a reality. We have a group of amazing and generous volunteers who help special horses help special people. Everyone has challenges in their lives, but whether we are with the minis at training sessions or on visits, we always feel happier and joyful after some “mini love.” We are the privileged ones to be on the other end of the rope.

Source: http://news.nurse.com

Topics: non-profit, mental, emotional, well being, mini horses, volunteers, nursing, health, RN, nurse, health care, medical, cancer, hospice, hospital, treatment, doctor

National Nurses Week: The high calling of the hospice nurse

Posted by Alycia Sullivan

Fri, May 17, 2013 @ 01:30 PM

hospice resized 600

By: Marsha Van Hecke

People pursue careers in nursing for many reasons: they want to help people, they’re natural caregivers or they want to do some good in the world. The 31 nurses of Hospice of the Carolina Foothills add another reason: It’s truly a ministry.

“Hospice is a calling,” Christina Hughes, RN said, “I knew several years ago that this is what I wanted to do, but watching my father pass that prompted me to make the change.”

Previously, Hughes worked in a skilled nursing facility.

Hospice nurses perform all the tasks you’d expect of nurses in a hospital, clinic or nursing home setting. They draw blood, administer and monitor medications, assess patients’ conditions, review charts, consult with doctors, complete paperwork, and attend staff meetings, among many other typical responsibilities. There’s an added dimension to working as a nurse at hospice.

“Hospice work is more of a team effort, patient and family oriented, putting the patients first always,” says Marla Searcy, RN and Homecare clinical manager in North Carolina.

“And,” adds Monica Pierce, LPN, “we do a lot of education with the families, teaching them how to take care of their loved ones.”

Linda Travers, RN agrees. “HCF allows nurses time to listen to patient feelings and concerns. Teaching family caregivers about disease process, symptom management. Providing comfort and support.”

“Working for Hospice, you are able to spend more time with patients and families,” adds Joanie McDade, RN.

“Having the opportunity to build a relationship with some of the patients here is a gift no other job allows you to have,” says Barry Lowman, RN. “But then when they pass you have a piece of you go with them.”

Developing those close bonds with patients and families is not only an important part of the job, but it’s also one of the most enjoyable. And certain patients find a permanent place in the nurses’ hearts.

“I had one patient who served in Japan for 14 months as a medic. When he saw me, he asked if I was Asian. I told him that my mother was Okinawan and my father American. He began speaking Japanese to me. All throughout his journey of dementia, he continued to speak Japanese to me. There were times he couldn’t remember his wife’s name, but he remembered those few Japanese words,” says Hughes.

Homecare RN, Jennifer Greene tells how a simple gesture of gratitude left a lasting impression on her.

“I was taking care of a patient at the Hospice House and when I would give her any personal care, she would say, ‘Thank you, Mama.’ She would say that to me whenever I took care of her, until she passed.”

Hospice House RN Ashley Crissone fondly remembers the woman with whom she played piano duets.

When Crissy Simpson, RN and Homecare clinical manager in South Carolina, first started at hospice, she found herself facing a potentially difficult situation.

“I was sent to see a patient that lived in a rural community. I was told that he was a very challenging patient, not because of his terminal illness, but because he may not be accepting of my race,” she says, “I went to visit him. He wasn’t rude, but asked a lot of questions to see if I was qualified to take care of him.”

After a few visits, the patient became comfortable with her, and Simpson would give him a big hug right before she left. If she got stuck in traffic and arrived a few minutes late, he would tell her he had been worried about her.

“Every visit he would be sitting in his recliner, facing the door, waiting for me to come, with his beautiful blue eyes,” she says.

As the patient began to decline in health, he asked his wife to buy Simpson a gift, a coffee mug that read, “Thank God for Daughters.”

“From that day, he called me his black daughter and he was my white daddy,” Simpson says, “Some people may be offended by that, but I know I meant a lot to him, and so did he to me.”

On the night he passed away, Simpson sang to him the old gospel song, “I’m Going to Take a Trip,” which she also sang at his funeral.

Just as Simpson goes above and beyond her job duties by singing to patients, other nurses contribute their talents and time outside of work. Jennifer Greene makes jewelry, donating necklaces and bracelets to patients, and Christina Hughes attends special events held at the facilities where she serves.

“One facility had ‘Cowboy Day,’ and the HCF social worker and I dressed up, and attended on our day off. The social worker even brought two of her horses for the patients to see,” says Hughes.

Every nurse has had a special person who inspired him or her to pursue the role of caregiver in life. For some it was another nurse who nurtured and mentored them, or a hospice nurse who ministered to one of their relatives. For others, a special family member encouraged them to follow their hearts. In RN Crystal Mitchell’s case, it was both. Her favorite aunt is a nurse and from a very young age, she would visit her at work in the hospital. Now, it seems, Mitchell is paying it forward.

“I’ve known since I was four I’ve wanted to be a nurse from watching her with her patients,” Mitchell says of her aunt. “I have had a similar role to a family friend who is like a little sister, and she is now a pediatric oncology nurse. I never knew I was the reason she wanted to be a nurse until later. How jaw-dropping it was to find out how much my work had influenced her by God’s grace.”

While working for hospice brings nurses many jovial moments, they also deal with the sobering reality of death every day. For that reason, many people hold them in high regard and wonder how they handle such a job.

RN case manager, Kim Griffey shares how people react when she tells them where she works.

“They always say that it takes a certain person to do your job, that they couldn’t do it. I always reply, ‘It’s very rewarding.’”

When asked what is the most important characteristic or skill needed to be a hospice nurse, one word comes up repeatedly.

Lowman and Travers and Pam Essman, RN, come right to the point.

“Compassion,” they say.

“The most important characteristic you need to be successful in hospice is compassion. It’s not always the physical symptoms that you’re relieving, but also the patient’s and family’s psychological pain,” says Simpson.

When hospice nurses go to work every day, they’re not simply going to a job. They’re going to touch someone’s life. They hold patients’ hands, celebrate patients’ birthdays, play games, share stories, help patients create their life stories to leave for their families, offer comfort, a smile, a laugh, and, in some cases, a song.

“I have had so many patients say they look forward to the hospice nurse’s visit. What greater reward in life can we have than to put a little sunshine in someone’s day, maybe their last day,” Searcy says.

Source: Tyron Daily Bulletin

Topics: nursing, end of life care, patients, hospice, calling

Milkshakes to pigs feet: Hospice volunteer does whatever he can

Posted by Alycia Sullivan

Wed, Feb 06, 2013 @ 11:27 AM

By ANGEL McCURDY 

Covenant Hospice Brice Horwell

On any given day you can see a group of people sitting in a small corner at Emerald Coast Center nursing facility.

Members of the reading club deal with disease, death and heartache, but there are no tears because of the special attention Covenant Hospice volunteer Brice Horwell gives them.

They enjoy their books, some conversation and milkshakes Horwell brings.

Horwell does more than visit with patients. He becomes their friend.

Horwell brings fresh flowers to the nursing facilities he visits each week. He tours the halls to say hello to each person he sees; he knows most by name.

He also visits hospital rooms and people’s homes.

“I feel like I’m doing something,” Horwell said. “I don’t want to see anyone die alone.”

Horwell, who is retired from the Navy, has volunteered with Covenant Hospice for eight years. He visits his clients weekly, runs errands and finds ways to make hard days better.

“I‘ve done some weird things,” Horwell said, laughing. “There‘s a patient that loves pigs feet. I would never eat pigs feet, but I’m happy to go and get them.”

Tim Morgan is a member of the Emerald Coast Center’s reading club. Morgan, who is no older than 60 but suffers from kidney failure, says Horwell’s weekly visits add joy to his day.

“Life wouldn’t be what it is without this guy,” Morgan said. “He brings us outside contact and is a great conversationalist. It means a lot to have somebody come to visit.

“It really makes a difference and lifts your spirit.”

In the last year, Horwell has accumulated more than 350 volunteer hours through his weekly visits, 11th-hour work and Hospice’s We Honor Veterans.

“He is the last face they will see as a measure of comfort,” said Dennis Krebs, Covenant Hospice’s volunteer services outreach assistant. “That means something to him and it means something to the people he’s with.

Topics: volunteer, Emerald Coast Center, Covenant Hospice, hospice

Click me

Article or Blog Submissions

If you are interested in submitting content for our Blog, please ensure it fits the criteria below:
  • Relevant information for Nurses
  • Does NOT promote a product
  • Informative about Diversity, Inclusion & Cultural Competence

Agreement to publish on our DiversityNursing.com Blog is at our sole discretion.

Thank you

Subscribe to Email our eNewsletter

Posts by Topic

see all