Wednesday, November 10, 2010

Honoring Hospice Nurses

HFA Operations Consultant Jennifer Carlson, RN, CHPN, wrote about the role of hospice nurses for the Hospice and Caregiving Blog last December - in honor of all the wonderful nurses who work in the hospice and palliative care field we post it again for National Nurses Week (May 6-12).

What Do Hospice Nurses Do?

A hospice nurse cares for all types of patients; young, old, pleasant, belligerent, educated, and uninformed. The Registered Nurse (RN), often called the Case Manager, provides oversight to the patient’s care while working collaboratively with all members of the hospice team. Hospice nurses see an opportunity to help people meet their end-of-life goals, by providing compassionate, highly-skilled care. Hospice nurses have extensive knowledge in symptom management, a team approach to end-of-life care, federal and state regulations, and hands-on patient care.

A hospice RN always works collaboratively with all members of the hospice team. The hospice RN is trained to assess the patient’s overall condition through dialogue, a physical exam, and reviewing past treatments and medication. The RN is usually the first person who visits a potential hospice patient, and continues to visit the home as often as necessary to assess the patient’s status and address issues as they develop.

Discussion regarding past medical history, including previous attempts to manage symptoms, is a significant part of the interaction between the nurse and the patient. Part of a hospice nurse’s role is not only to ensure that a patient’s symptoms are controlled, but that the patient feels in control. The hospice nurse develops a trusting relationship, so the patient and family knows that the hospice nurse will be present and effective throughout the experience.

Utilizing extensive knowledge and skills, the nurse teaches patients and caregivers how to administer correct doses of the medications ordered by the physician and what to watch for in terms of effectiveness or adverse reactions. The RN reports those findings to the physician, obtains orders for all care and treatments, and evaluates the effectiveness of the medications and treatments.

The RN also educates the patient/family about what to expect as the disease progresses. Often just knowing what might happen can ease the mind of a tired caregiver or an anxious patient. The RN provides pertinent information, such as nutritional requirements at the end of life, care of the bedbound person, wound care if necessary, and ways to ease suffering. This information includes both the use of medications as well as other suggestions as simple as the power of a soothing touch or peaceful atmosphere, ways that can be as equally effective in managing pain and bringing relief.

If the patient is not in hospice at home, the hospice RN collaborates with facility staff in Nursing Homes, Assisted Living Communities and hospitals. In addition to supporting the family, the hospice nurse can provide guidance and emotional support to staff.

All core members of the interdisciplinary team, including the RN, gather at least every 15 days to discuss areas of concern or achievements in managing the patient and family’s physical, emotional and spiritual issues. These meetings support not only the family and patient goals, but provide an essential time for the staff to support each other in this difficult work.

An RN is not the only type of nurse that can be found on a hospice team. A Licensed Professional Nurse (LPN) may also provide care, under the direct supervision of an RN. Additional personal care may be provided by a Certified Nurse Assistant (CNA), who also operates under the supervision of the hospice nurse. Hospice nurses, RNs and LPNs, can become certified in hospice and palliative care, a specialty achieved through hard work and dedication.

Hospice nurses are compassionate, skilled, and comfortable being surrounded by the dying. Their idea of a successful day is to have a much loved patient die peacefully, symptom free and surrounded by caregivers that feel a sense of accomplishment in providing the best care they could. A hospice nurse’s mission comes with many tangible and intangible rewards that make it all worthwhile.

Jennifer Carlson, RN, CHPN
HFA Operations Consultant