Hospice Nurse

She came through the door and laid her keys on the table. Her feet felt heavy, though not as heavy as her heart. She was drained. The kids were playing in the living room, but their voices were off in the distance to her. Her husband was talking to her, telling her what he had done for dinner. Sure, she could hear his voice, but to focus on what he was saying was more than she could muster. She felt like she had been up for days. Fatigue had settled in like an old hat. She was weak, and lethargic. After the third death visit in 8 hours, she had nothing more to give. She had spent everything she had in caring for the families of her patients. Three of them had passed on in one day. The first patient that died was a one hundred and four year old woman who had cardiac disease. She had lived a good life and had all of her mental faculties' right up until the time of her death. The family was relieved and thankful for hospice services. Next, she was paged and went to the home of Greg. He was a twenty eight year old man who had some cognitive impairment. He had engaged in an adolescence of drugs and alcohol. This resulted in end stage liver disease. He left behind a sister, parents and a girl friend. He had spent the last four years of his life getting clean and trying to build a life. The diagnosis hit him like a baseball in the gut. This was more difficult and the family grieved. The final stop in her day was to Theresa's home. She was a thirty Five year old mother of two with end-stage breast cancer. She had noticed a lump in her breast when nursing her daughter (5 years old). The doctors felt that it was due to nursing and never did follow-up. She became pregnant with her second baby, and began to have pain that breast. The lump had never gone away, but she had nursed her daughter until she was two and then became pregnant shortly after that. It was during her pregnancy that it was diagnosed as breast cancer. She opted to hold treatment until the birth of her son. After a complicated birth, she was diagnosed with metastasis to the liver. She survived just over two years following diagnosis. Theresa's death hit hard. This patient was her age, had children like she did, and was leaving them. Reality hit. We are not infallible. This death made no sense. Should she question God? She wanted to, but knew she would get no answer. Bad things happen to good people. She was at her limit. She questioned herself as she took off her shoes, "Did I give them what they needed?" She sat down to allow her five year old to read her the storybook that he had brought home from school. She remembered him start the first page, but the next thing she remembered was awaking to her husband's gentle nudge telling her that dinner was ready. He loved her job and felt honored to be a part of the lives of the families that she encountered. The aftermath, however, sometimes put her close to the brink. The emotional exhaustion was sometimes too much to bear. She had a wonderful husband, and great family and church support. She felt from the deepest part of her being that she was called into this work, and could see herself doing nothing else. How was she going to manage the mental work of the job and still be able to be functional and give her family what they needed? How was she going to grieve for the patients she lost and still guide the families through their own grief.

Death as a Job Hazard

Hospice is a philosophy of care that offers patients that are suffering with life limiting illness a patient centered and multi disciplinary approach to care. Hospice focus is on the comfort of patients. Hospice treats the physical, psychosocial, and spiritual needs of patients and their families. Hospice emphasizes quality of life and dignity. In this discipline, patients are enrolled not to die, but to live what time they have left with dignity. Dame Cicely Saunders Said: "You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die" Knowing this, it is important that although Hospice is about living with terminal illness, patients do die. Nearly 100% of patient enrolled in hospice will die under that benefit and level of care. That means that the hospice nurses have a near one hundred percent mortality rate. These are not the greatest odds.

Why Do Nurses Choose Hospice?

Why do nurses choose hospice as a career? There are certainly endless opportunities in the nursing field from labor and delivery to general practice to the emergency and operating departments. What makes a nurse choose hospice? In a study done by Dr. H. Lea Barbato Gaydos, this exact topic was explored. In her conclusion she stated that "nursing was not a job or even a career; it was a choice that made sense in light of their whole lives" (Gaydos, 2004). A nurse in this study was quoted when she discussed hospice as a calling. Many hospice nurses share this stance. Hospice is not a job choice, but a calling. In the world of nursing, there are positions with great hours and generous salaries, but few careers come with the personal satisfaction and rewards that hospice offers to its takers. It becomes who you are. It defines you as a nurse.

Do Hospice Nurses Experience Grief with Patients?

"Hospice nursing is an unparalleled form of care giving and involvement in patient's lives and deaths. An experience in hospice nursing that is not encountered in the same ways in other forms of nursing is the phenomenon of multiple losses. Hospice nurses are intimately involved with death and loss on an ongoing basis." (Finch, 2009) Do nurses deal with this loss? Are there repercussions of this ongoing exposure? The study by Finch states that most of the research disproved a higher rate of burnout and stress among hospice nurses. The study stated, "Nurses working in hospice tend to report greater personal accomplishment, higher job satisfaction, lower levels of occupational stress, more coping strategies and less death anxiety than their peers in other areas of nursing." (Finch, 2009) Hospice nurses have, as a rule, good coping mechanisms. They are able to do their job without emotional collapse. There are situations where grieving takes place at a higher level. As mentioned earlier, when a patient's death is perceived as untimely, or traumatic, it leads to more grief. The patient who is elderly, perhaps living in the extended care facility is perceived as having a good life. The death of this patient is likely to affect the nurse less than the death of a young mother. This is imperative in today's society. Patients are younger. The number of cancer victims below the age of fifty is on the

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