A nurse’s perspective: a story on hospice and palliative care
AAN’s Membership Coordinator, Alycia Lobay, visited the Pilgrims Hospital Society in Edmonton in July to speak with nurses and share more about AAN’s role.
Alycia had the chance to sit with the Director of Hospice Care, Patricia Talarico (RN), as well as the Interdisciplinary Practice Lead, Charlotte Baynham, as they shared their experience working in this unique and challenging field of nursing in hospice care.
What is the difference between hospice and palliative care?
Palliative care is an approach to care, a large umbrella which falls within. It can be provided to individuals with a life-limiting illness and provided alongside other types of care, for extended periods of time.
Hospice care is under the umbrella of palliative care and is specifically for end-of-life, when people only have three to four months to live. Hospice care provides a range of supports to provide a holistic, resident-centered approach.
What does a day-in-the-life of a nurse working in hospice care look like?
The day-to-day tasks are similar to other bedside care including medication administration, interventions, team reports, and wound care. We are often managing many symptoms and must be keen on reassessment and use of more medications than may be scheduled regularly.
Other differences in how the day is structured are mornings being a little less rushed like a typical acute care or long-term care unit. Mornings are flexible, and the day starts with wellness checks on residents and waiting for residents to wake up on their own time.
Hospice care keeps to certain staffing ratios (in a perfect world) to allow for the nurse to prioritize communication with their residents and families. Nurses provide a lot of support, counselling, and education, and we try to have time to sit with residents and hear their wishes.
What experience do you look for when hiring?
Prior experience in palliative and hospice care is always an asset. Acute care experience can also be a great asset as you do need to provide a range of nursing tasks to residents and be able to deal with ambiguity, multiple needs, and changing priorities.
Although experience is important, what can’t be taught are some of the most important factors like compassion, comfort in speaking about death and dying, and a passion for holistic care.
What is unique about working in palliative or hospice care?
It is special to be able to walk someone through this experience and help support the resident and their family navigate it together.
As that support person, you can make this journey and death an easier process than it can be. What happens in those final moments stays with the family, and they never forget the day, so little things make all the difference.
Nurses must also learn to balance the professional responsibility of utilizing best practice guidelines, boundaries and self-care, while trying to make those guidelines work with this population, where the resident is dying.
How do hospice nurses stay resilient and positive while working in this environment?
It is a responsibility as an organization to take care of staff by providing and maintaining a positive culture, grief support, and social activities and opportunities to talk and debrief with each other.
This role does come with grief and the nurse has a responsibility to recognize within themselves how to personally deal with grieving and death and be able to manage this and maintain their own well-being to be able to continue the care they give. It is important to set and maintain professional boundaries with the residents and families.
It is also important to take care of yourself and acknowledge when it is affecting you and seek out support when you need it.
What have you personally learned from working in this area?
From a personal perspective, it’s to enjoy life while you can. Don’t waste time putting off the things you want to do, because you never know when things will change.
From a nursing perspective, what I’ve learned most is meeting people where they are at, and the importance of acknowledging their culture and life experiences and applying it to their care. You have to understand where people are coming from, their emotional and psychosocial history, religion, family dynamics, and life experiences that shape them as they are today. These things contribute to how illness, death and dying relates to that, and to meet them there to support them through the experience.
Thank you to Patricia and Charlotte for sharing their perspective on nursing in hospice and palliative care.
