Running head: NURSING AND HOSPICE CARE

Nursing and Its Role in Hospice Care

Kaylee Blankenship
California State University, Stanislaus

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Nursing and Its Role in Hospice Care

Hospice care is a vital part of the nursing role and is defined as a program that provides
palliative and supportive care to meet the special needs of people who are dying and their
families (Townsend, 2012). Even if a nurse may not specifically become a hospice nurse, he or
she will at some point in their career deal with death or dying. Knowing how to provide
palliative and supportive care to patients is an important part of fostering physical,
psychological, social and spiritual well-being of those individuals and their families when they
need it most. This paper will compare hospice care with palliative care, explore the nursing
experience of a family using hospice care, and analyze the experience and views of end-of life
care.
Hospice versus Palliative Care
As previously mentioned palliative care is actually an element of hospice care, but there
are some differences between the two. Both entities provide physical, psychological, social, and
spiritual support to the patient and their families, however, with hospice care, the patient has
been given a diagnosis of a terminal illness with a 6 month or less expectancy to live (Villetlagomarsino, 2000). Whereas with palliative care, patients can qualify at any stage of their illness
whether they are terminally ill or not. As far as treatment goes, most hospice program tend to
focus more on promoting patient comfort rather than aggressively treating the disease process so
that the patient can get the most out of life in the time that they have left. Palliative care on the
other hand, since there isnt a requirement of the illness to be terminal, the program provides
both comfort care and life-prolonging therapies to patients depending on their illness (Villetlagomarsino, 2000). Hospice programs can be inpatient, outpatient or home care. Some of these
programs are hospital affiliated while others are provided through private organizations or

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institutions. Palliative care is most often provided in an institution (i.e. nursing home, hospital,
extended care facility) rather than at home (Townsend, 2012). Both palliative and hospice care
provide this support through interdisciplinary teams that include nurses, social workers,
physicians, and attendants (i.e. home health aides) just to name a few. Nurses play a huge role in
providing this type of care, because the nurse is the one out of the entire interdisciplinary team
who is typically spending the most time with the patient (Dobrina, Tenze & Palese, 2014). In
these situations the nurse is truly the patients advocate promoting the best possible life the
patient could have until the end.
Patient Observation
During this hospice experience there were many families that stood out. Although every
patient was receiving end-of life comfort care, each patient was going through their own end-oflife story in their own unique way. There was a specific family that stood out the most during
this hospice observation, because the patient was so young. He was a 50 year-old African
American man who had been diagnosed with terminal colorectal cancer that had also spread to
his liver. The patient was receiving hospice care at his home where he lived with his wife, their
deaf 20 year-old daughter and their 3 year-old granddaughter. It was an amazing experience
being able to observe the patients hospice nurse help him with each and every element of
hospice care.
As promoting the patients physical well-being, at the beginning of each visit the nurse
takes the patients vital signs, has them rate their pain, and performs a focused assessment. With
this particular patient, the nurse focused more on his pain level since it has been an ongoing
battle for the patient. The nurse had been coming more frequently than just once per week to see
this patient, because they have not been able to get his pain under control. The wife tries her

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hardest to help her husband, but she hasnt been able to fully grasp her husbands pain
medication schedule. She seemed frightened that she might accidentally give him too much of
the medications leading to an early demise. So, the nurse and myself came up with a modified
medication schedule for her that listed each medication, the amount to give, and the time she
should administer them. There was also a spot where the wife could document this and write
down what her husbands pain level was before and after giving him the pain medication. Both
the patient and his wife seemed to really appreciate this because during previous visits the patient
wasnt very talkative or interactive with his care due to high amount of pain he was
experiencing. Now that the pain seems to be slowly coming under control the patient was much
more talkative and discussed his feelings openly with the nurse.
Another element to the patients care that the nurse assessed was his psychological wellbeing. The patient confided to the nurse that having his granddaughter living with them has been
mentally draining for him. It was clear to see that the child was very high energy and rarely
disciplined for her behavior which could be attributed to the fact that her mother is deaf so she
cannot hear what the child is saying and cannot tell her what to do in words. This has
unfortunately created somewhat of a chaotic and stressful atmosphere that anyone dealing with a
terminal illness would find hard to deal with. The nurse asked the patient if there was any other
place that his daughter and grandchild could live to which the patient responded no. I suggested
that the family look into a day care or Headstart program for the child to attend during the day so
that the patient could at least have some reprieve. Some of these programs are free so the family
wouldnt have to worry about an extra expense either. The nurse like this idea and was willing to
look into it in order to potentially promote the patients psychological well-being during his endof-life care.

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It is also the nurses job to promote the patients social well-being. This includes
financial or legal issues and bereavement concerns (Townsend, 2012). There are actual social
workers at the organization that the nurse works, however, it is the nurses job to recognize these
concerns and then present them to the social worker since the nurse is the one who sees the
patient frequently. In this case, the nurse made sure the patient and his family had the supplies
that they needed and that the home environment was conducive to caring for the patient. This
part ties in with the psychological problem that the patient was facing. The nurse could talk to
the organizations social worker assigned to this family about finding a program for the child to
attend for the day to help the patient with that area of his psychosocial well being.
Spiritual well-being is another element to hospice care. This particular patient had a very
strong spiritual foundation and it has been really hard for him not to be able to attend church as
much as he would like to. So, to accommodate for this patients needs, the nurse scheduled a
visit for one of the hospice organizations pastors to come our and visit the family. The patient
reported that her really liked the pastor and would like for him to come again. It was clear that
the patients religion is what was giving him the strength to deal with his diagnosis and his pain.
He said it also gave him the strength to be patient with his granddaughter. This was an amazing
element of hospice care to observe, because it was clear to see how much it truly helped to
patient cope with his current situation.
The nurse clearly plays an important role in promoting each of the above-mentioned
elements of hospice care. She performed physical assessments, focused on the patients pain,
encouraged the patient to discuss his feelings, found ways to promote the patients psychosocial
well-being, and had a pastor visit the family for spiritual support. The nurses interaction with
each and every family was amazing tot observe, because it was obvious how much she cared.

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She definitely took her role as a patient advocate seriously, recognizing what the family needed
even if they didnt specifically verbalize their needs. She also had a great way of teaching the
family new things without making them feel bad about themselves and providing positive
reinforcement.
Views on End-of-Life Care
Through this experience, my views about end-of-life care were really changed. I have
always been interested in oncology, which is involved with many aspects of the death and dying
process, but nothing like hospice care. I didnt know if I could really handle the end-of-life care
when the aggressive treatment has stopped instead of the actual on going aggressive treatment
stage where there is still hope. I was definitely a little wary of this observation day, because it
had only been like a two months since my grandfather passed away after being on palliative care
for two weeks from a two-year battle with leukemia. So, I was scared that I might let this
experience cloud my judgment and make me feel sympathetic instead of empathetic during this
observation. However, this experience ended up being truly amazing because I really got to see
how big a role the nurse plays in these patients lives. I never thought I would ever consider
becoming a hospice nurse, but after this experience I see it as a legitimate option.
During this observation I learned that a hospice nurse is truly the patients advocate and
helps families cope with end-of-life care. These nurses can promote optimum quality of life and
comfort to patients during what time they have left, even if it may be short. They do this by
supporting physical, psychological, social, and spiritual well-being which are all important
aspects in anyones life. Hospice care is an integral part of the health-care system that patients
and families sincerely appreciate when it comes time for end-of-life care.

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7
References

Dobrina, R., Tenze, M., Palese, A. (2014). An overview of hospice and palliative care nursing
models and therories. International Journal of Palliative Nursing, 20(2), 75-81. Retrieved
from http://content.ebscohost.com.ezproxy.lib.csustan.edu:2048/ContentServer.asp?T=P
&P=AN&K=2012492222&S=R&D=rzh&EbscoContent=dGJyMMvl7ESeprQ4zdnyOL
Cmr0yep7JSsai4SbGWxWXS&ContentCustomer=dGJyMPGptkqwq7BIuePfgeyx44Dt6
fIA
Townsend, M.C. (2012). Psychiatric mental health nursing: Concepts of care in evidencedbased practice (7th ed). Philadelphia, Pennsylvania: F.A. Davis Company.
Villet-Lagomarsino, A. (2000). Hospice and palliative care: A comparison. Educational
Broadcasting Corporation/Public Affairs Television, Inc. Retrieved from
http://www.pbs.org/wnet/onourownterms/articles/versus.html