The handbook of hospice care

Through this course, I have been introduced to many topics related to Health and illness. So when asked to read a book on a specific area of the course, I have chosen to read The Handbook of Hospice Care. My reason for choosing this topic is personal.

I know individuals who have gone through this care program and I also have a relative who is a hospice nurse, my mother. When my grandmother was in the last stages of cancer, hospice was the best thing for my family and my grandmother. Although my grandmother was very sick, I felt so much better seeing her in her own home than in the hospital.This may sound strange because when you imagine someone dying from cancer you picture him or her in the hospital receiving aggressive treatment. But this was not the case for my grandmother. We knew that the inevitable was going to happen and we wanted my grandmother to die as peacefully as possible.

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This is the essence of Hospice. “We know we can alleviate human suffering and help relieve mental and emotional anguish. It is our hope that, during the process, we can also further the cause of death with dignity and makes a contribution in the struggle for human rights.Compassion in dying responds to a moral imperative which can no longer be denied by humanists and other compassionate people. ” [Dority 1993] Without hospice, I feel that the passing o! f my grandmother would have been more painful. Hospice allows my grandmother to be with us, her family, in a comfortable and familiar setting, enabling everyone to realize that she would be gone and we would have closure by seeing her die in no pain.

The other experience that I have with hospice is that my mother is a hospice nurse. My mom has not always been a hospice nurse but for the past 7 years it has been a devotion of hers.I feel that is important to mention her because I have asked her on more than one occasion, “How can you do what you do? ” Even when she is not at work, she has constant reminders of her work from the pager that she carries in her pocketbook to the makeshift hospital supply room in the trunk of her car. I truly feel that she is special.

One day she was driving me home, her pager went off and without skipping a beat she drove to her patient’s house. She told me to stay in the car while she addressed the needs of her patient. I was in shock, cause I never really realized how much time that her job took.Back to my original question. How can anyone be a hospice nurse? Every time I asked my mom this question, I got the same stock answer. She says that her job is not depressing. She is helping others. She tells me that she feels comfortable because she is making her patient’s final days as positive and as comfortable as she possibly can.

This attitude and approach to her job helps her to get through the grief of waking up one morning to a phone call saying that she doesn’t need to go to a certain address because her patient has died through the night.This is the point of hospice. It is to make the patient feel as dignified and as comfortable as possible as they near their end. “We need to stand by the dying, and by our actions, say that we believe life has value, right up to the end. ” [Beresford 1995] What is hospice? “The word “hospice” stems from the Latin word hospitium meaning guest house.

” [HTML1 DocumentEncodingutf-8Death with Dignity] The hospitium was intended for sick and weary travelers. A HOSPICE IS NOT A SPECIFIC PLACE.Instead, hospice is a method of care designed for the terminally ill. A hospice does not try to cure a person. Instead, hospice workers try to make a patient’s final days as comfortable as possible. The hospice movement began during the 1960’s “Dr. Cicely Saunders, a British physician, began the modern hospice movement by establishing St.

Christopher’s Hospice near London. ”[HTML1DocumentEncodingutf-8] This was a first in health care business because it was the first time a team approach was taken in health care.Another first was that the patient did not get treated by hospice to get healthy, instead the patient joined hospice to die comfortably. “Hospice is care for the dying.

”[Beresford 1993;3] The purpose of hospice is to work with the terminally ill and their families. Hospice workers do not just care for the patients; it is much more than this. The hospice nurse must become a part of the family and this is very important. Not only is the hospice nurse in the home to care for the needs of the patient but they are also there to comfort and talk to the families of the patients.A hospice patient, as a rule, has no chance for recovery, it is helpful for the family members to have a nurse that is there to care for the patient but also to explain what is going on and to help to reassure the family and get them through difficult moments.

“Hospice doesn’t offer the prospect of cure or recovery to its patients, but when the disease can no longer be defeated, hospice proposes to help make the best of a hard situation. ” [Beresford 1993:3] In these, hospice is helpful. When a patient is going to die, a hospital cannot possibly give the emotional care to the family or the patient.“Once the patient’s physical pain and discomfort are brought under control, attention can be shifted to other problems, such as family conflicts or fears and anxieties related to the impending death. ” [Beresford 1993:6] I cannot stress this enough. It is so important as a family member to be able to openly talk to a caregiver about a loved one who is dying.

This is why hospice is so important. Another characteristic of hospice is their promise to make the patient’s death as painless as possible and when the time is near as quickly as possible.“Hospices can promise their patients that they will be pain free within days of initiating hospice care. ” [Beresford 1993:6] Basically, hospice intends to make the patient as comfortable as possible physically and emotionally. A patient is more likely to open up and talk to their nurse about things that they were not ready to or unable to talk about with their family.

“Hospice can also open the door to talking about difficult issues. Hospice workers do not tell their patients how to die or force them to talk about death.Instead, they provide a sounding board, an opportunity, and a safe haven for patients to talk about whatever is most important to them – even subjects that their family and friends are afraid to discuss. ” [Beresford 1993:6] In closing, the hospice and hospice workers exist to enable the patient to die in a comfortable and dignified manner. Hospice cares for patients who are terminally ill. Patients who have AIDS, heart, lung, or kidney disease, end stages of Alzheimer patients and other unreversible conditions. “Most of the patients who enroll in hospice are people with cancer.

Cancer refers to a group of diseases characterized by uncontrollable growth and spread of abnormal cells, which, if not checked may end in death. ” [Beresford 1993:13] Hospice is open. What I mean is that it will treat any patient with a terminal illness just as it will treat a person of any age. “According to the National Hospice Organization Census, two thirds of hospice patients are over 65 years of age and but one percent are over eighteen. ” [Beresford 1993:13] The reason that the elderly are more apt to require the services of hospice is because a hospice is not trying to find a cure.Instead hospice is trying to bring the patient palliative care in preparation for death. Many people under the age of 65 are not quite emotionall! y ready to give up There are six requirements that you must meet in order to be eligible for enrollment in hospice. “1.

The patient has been given a medical diagnosis of a terminal illness, usually measured by a prognosis of six months or less to live. ” [Beresford 1993:13] This means that hospice should not be the first choice. The patient should try for a cure but if the diagnosis does not allow for a cure then hospice is an option.

“2. The patient is seeking comfort-oriented care, rather than treatment aimed at care. ”[Beresford 1993:17] The reason for this requirement is so patients know that hospice is for the terminally ill that cannot be cured. “3. The patient and family are informed about hospice and other options, and consent in writing to hospice care; the patient’s physician also consents to hospice. ” [Bersford 1993:18] Again this requirement is put in place because this is a huge decision.

It is literally a matter of life and death.This is why hospice patients must get consent! from their doctors. The decision cannot be taken lightly and everyone in the family should have input in the decision. “4. Hospice must be provided in a safe setting for care. ” [Beresford 1993:20] This is an obvious requirement. The idea behind hospice is comfort care. Therefor there must be a comfortable area for care.

If this situation does not exist in the home then hospice also has a nursing home type of facilities that allow for this safe setting for care. “5. A “Don not resuscitate” order must be in effect.” [Beresford 1993:22] This is in place to assure a peaceful death. If the patient is actively dying, you must let them go. All that is accomplished by resuscitating the patient is prolonging the pain. “6.

Other admission requirements. ” [Beresford 1993:23] These requirements are different for different areas. But basically these require patients to be within certain proximity of available nurses. All of these requirements are put in place to ease the proces! s of applying for hospice. But also they inform the family of everything that goes with hospice.For instance, you should not put a loved one in hospice care and expect a miraculous cure.

The list of requirements makes this known to the family before it is too late. There are two costs for the care of hospice. The first is an emotional cost. “When a loved one dies, for example, there will be those left behind who increase their use of medications and/or alcohol to escape the pain of their loss. ”[Buckingham 1996’83] However for the family who has lost a loved one through hospice, the emotional loss is prepared for and hospice helps the family to cope which is priceless in the long run.Basically, hospice enables the families to achieve closure and deal with the pain of their loss in a more gradual and positive way. There is also a monetary cost of hospice. To a person not familiar with hospice, they may look at the program and the quality of care and expect it to be very costly.

However, this is not the case. ““He results of a study of the effect of the hospice program an Medicare Part A expenditures during the first three years of the program reported that Medicare saved $1. 26 for every dollar spent on hospice care.That is for ev! ery $2.

26 spent by Medicare on traditional methods of care, only $1.00 was spent to provide hospice care. ” [Buckingham 1998:87] After the birth of hospice in London in the 1960’s, the hospice movement spread to the United States. ““He first hospice in the United States was established in New Haven, Connecticut in 1974. ” [HTML 1 DocumentEndcodingutf-8] That hospice still exists and has helped spread the hospice movement throughout the US. “Today more than 3,100 hospice programs in the United States including Puerto Rico, and Guam. Hospice cared for nearly 540,000 people in the United States in 1998. ”[HTML 1 DocumentEncondingutf-8] .

This proves that more and more families are opting to make death more comfortable. Hospice is a program that for certain people is the right choice. It is emotionally and economically a good system of health care. The hospice choice is not something that can be pushed on people.

It is a good system, staffed by good people, but the choice for hospice is the choice for death. Hospice can only get better. More education and more experience are going to lead us to a better hospice. By having a better hospice, we can continue to assure a peaceful and dignified death to all that choose it.