Nanci Phillips has been called an “angel” more than once during her time as a nurse with Heart to Heart Hospice in Texas’s Permian Basin region. She humbly sidesteps the compliment, saying she’s simply doing her job.
But the job of a hospice nurse requires much more than medical knowledge and a distinctive compassion for patients and families during end-of-life care. They serve families during a stressful time, as they deal with acceptance and grief over the realization that their family member will not recover. Hospice provides comfort care, not curative treatments, with an individualized, patient-centered approach. Beyond pain management and medical check-ups, hospice nurses provide caregiver training, a listening ear, comfort, and encouragement to overwhelmed families.
Embracing and Equipping Family Caregivers
“Hospice requires a lot of education for the family,” said Nanci, an RN Case Manager, who recognizes teaching as a necessary part of her job. Nurses help train and instruct family caregivers to provide for their loved one’s daily needs, from medications to equipment to daily grooming.
Nanci was a critical care nurse for a decade before becoming a hospice nurse. She said the mindset is completely different, transitioning from major medical interventions to focusing solely on pain management and comfort care. Nurses help families understand that hospice isn’t aiding death, but making patients comfortable until death naturally comes. It’s often hard for families to embrace the “terminal” mindset, Nanci noted, but hospice nurses gently help navigate that transition.
“I used to get overwhelmed talking about hospice philosophy to families,” said Nanci. “I’ve learned that letting the family speak first can help you know where to start and where to meet them.”
Providing a “good death” has many layers, including individualized medical care, spiritual and emotional support, and guidance for family caregivers. Honoring family wishes and providing a pain-free passing help bring peace to the process. For in-home hospice, the goal is to prevent patients from getting admitted to the hospital. For general in-patient hospital or residential facility patients, hospice watches and manages symptoms, addresses acute needs, and helps families understand why certain treatments aren’t applied under hospice.
Nurses typically visit hospice patients once or twice a week, more often if medically needed, then daily as death approaches. They help prepare the family for the signs and symptoms of what the final days may look like.
Family members have an on-call number 24/7 for questions and concerns. Nanci said the Heart to Heart Patient and Family Caregiver Handbook helps provide an additional hands-on resource any time a family needs to reference something, so they don’t have to remember all of their training in a potentially stressful moment.
Building Family-Like Bonds
While hospice care can last anywhere from a few hours to several months, nurses build strong bonds with their patients and their caregivers. Even if patients are unresponsive, families often share stories from their loved one’s life with their nurses.
Nanci has grown especially fond of Mrs. Iva (who suffers from dementia and Parkinson’s), whom she’s cared for since July of 2020. This is an unusually long time for a hospice patient, but Nanci has gotten to know her sons and daughter, who provide excellent care for their mother. As hospice care lingers over weeks (or in this case, years), nurses understand their patient’s baseline, recognize new symptoms, and provide continuity of care. The frequent visits allow nurses to make special connections with the in-home caregivers.
“You definitely get attached — they feel like family,” said Nanci, adding that a large majority of families express their deep gratitude and appreciation. She also helps prepare nurses who are new to hospice care, telling them they often don’t get a second chance to make a good impression. Being diligent in nursing care while also dealing with families in an understanding way is all part of the job.
Unique Qualities of Hospice Nurses
Comfort, support, and dignity are the guiding principles at Heart to Heart Hospice — and hospice nurses must embrace all three. While all nurses need medical knowledge and a good bedside manner, hospice nurses require unique qualities to do the job well. These include:
- Great interpersonal, communication, and collaboration abilities
- Providing caregivers patient care training, end-of-life education, and emotional support
- Unique training and knowledge of terminal illness and comfort measures
- A good teamwork approach to integrate all aspects of care
- A compassionate, caring demeanor
- Organized with records and scheduling
- Superb analytical and diagnostic skills
- Exceptional ability to manage stress and emotional challenges
Hospice nurses are often the first to reassure families that they are doing a good job. They hold the hands of patients and offer comfort to caregivers. They are often at the bedside during a patient’s last moments. Maybe hospice nurses are angels after all.
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