36 THE QUEENS COURIER • HEALTH • JULY 1, 2021 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
Hospice care and aging
BY SHELDON ORNSTEIN
Ed.D, RN, LNHA
Jane, a 75-year-old woman,
is preoccupied with symptoms
attributed to an advanced terminal
disease. Th e prescribed medication
she was taking was supposed
to alleviate the persistent
wave of excruciating pain she
has been experiencing. However,
the medication apparently was
slowly losing its intended eff ectiveness.
Th e pain was also causing her
to cut back on her usual activities
of daily living. Her primary
care physician and specialist
had recently informed her
with terrifying news that no one
should ever want to hear: “Th ere
is nothing more we can do for
you.” For Jane, the message was
received: Th ere is nothing more
to do but wait! In fact, she ponders,
what could she do?
The family has become
increasingly concerned with her
frequent absence at several family
gatherings. Th erefore, with
Jane’s approval, they decide to
admit her to a local community
hospital which is fully staff ed
and with an active functioning
hospice unit.
Th e hospice movement began
in 1991 and has made hospice a
familiar word to health care professionals
and the lay public. Th e
original model for hospice was
generated more than 35 years
ago. Th e number of hospices in
the United States is estimated at
well over 2,000, with almost 800
that are affi liated with community
hospitals. Others are operated
by public as well as home health
agencies. Hospice is usually free
to the patient and supported by
volunteers, public and private
funds and memorial donations.
In 1986, Congress passed legislation
making hospice a permanent
Medicare benefi t.
Th e hospice ideology is unique
not only in the approach to the
case given, but also in the overall
comprehension of what hospice
care is all about. Hospice is
described as the link between
the needs of the terminally ill
and their families and a staff that
employs the medieval concept of
hospitality in which the community
assists the travelers at dangerous
points along their journey.
And, I might add, it also recognizes
and elevates the profession
of nursing to its historical roots,
i.e.: humane and compassionate
care, an ideal that has been the
basis of nursing for centuries.
Th e dying are travelers along
the continuum of life with a
community of friends, family
and specially prepared people
who care — the hospice team.
Hospice care is available 24
hours, every day of the year
for its clients and provides, as
needed, the services of doctors,
nurses, aides, mental health
specialists, physical therapists,
social workers and chaplains of
all denominations. Th e overall
purpose of hospice is not
to cure, but to care. It enables
the dying individual to live out
moments in tranquility and
comfort to accept the inevitable
rather than fi ght to overcome
it, to have serenity and freedom
from their agony.
Families of people who have
died will oft en comment, “In
the fi nal days she was relaxed,
very peaceful and at ease with
herself.” Elisabeth Kubler-Ross
off ers these words: “Th e fi nal
stage of a person’s dying is oft en
marked by the stage known as
acceptance.” Th e simple notion
of acceptance was clearly and
profoundly expressed with the
words of the “Serenity Prayer”
attributed to the philosopher
Reinhold Niebuhr. “God grant
me the serenity to accept the
things I cannot change, courage
to change the things I can,
and the wisdom to know the difference.”
Th e following scenario is
off ered as a means of reintroducing
the character, Jane. Jane
begins considering what to do
aft er receiving that devastating
medical analysis from her doctor.
Let me repeat her words —
“Th ere was nothing further for
me to do but wait!”
Her family and children begin
grieving and at a point, Jane
decides to give her loved ones
a much-needed closure with a
lasting bequest. She concludes
she must close her life with character
and dignity. She would
thank those who helped her with
the care she has been receiving
and apologize to those she might
have hurt and, perhaps, give her
family some sound advice.
In her fi nal days, Jane gathers
her children and grandchildren
to her hospital bedside for a
family “celebration of life” event.
During this time, Jane speaks
with each child, young and old,
and directs them, “Stay physically
and mentally strong and
above all, remember me with
good memories.” She asks, as a
fi nal request, “Promise me you
will all stay connected and love
each other as families should.”
With many tears and love for
their mother and grandmother,
they promise to honor all of her
requests as each child surrounds
the bedside for one last time to
hug Jane and say goodbye. Jane
passed away shortly aft er, but we
can be sure she realized how fortunate
she was to have had the
benefi t of hospice-trained caregivers
who provided optimum
care for her needs and a family
that was there to support her at
the end of her life.
Rabbi Maurice Lamm, president
of the National Institute
for Jewish Hospice reminds us,
“Hospice also focuses on family
members because they, too,
need help preparing for their
loss. Terminal illness can kill
families as well as individuals.
When there is nothing to hope
for, the process of hope can be a
form of mental comfort that can
alleviate the unrelenting suff ering
it brings.”
FLASHBACK – Prior to
Jane’s demise, she expressed to
her daughter how, just by hoping,
she believed she could still
achieve a respite from her fatal
diagnosis and ultimately be
spared. Elisabeth Kubler-Ross
states, “Even the most accepting
of patients keep hope hidden
in the back of their minds and
that at some point they could
be rescued from the tolling bell
of a miracle with some new kind
of research. Nobody is without
hope. Time is hope.”
I mentioned earlier the group
of signifi cant individuals who
are part of that link that makes
up the hospice community. One
of these individuals is the registered
professional nurse and
the role nurses play on the hospice
team. Nursing practice and
hospice incorporates the practice
of mind-body continuum.
Nurse research oft en refers to the
profession of nursing as the cornerstone
of hospice care and that
they provide much of the direct
care in a variety of roles: fi rst, as
staff nurse giving direct care and
second, as clinical coordinator
for implementing a plan of care
for the interdisciplinary team.
Th e following is a brief enumeration
of those specifi c skills,
knowledge and abilities needed
to practice as the hospice nurse:
Thorough knowledge of
human anatomy and physiology,
and how adverse conditions can
aff ect the body particularly when
in a state of physical decline.
An above-average knowledge
base in pharmacology and the
potential for a drug to cause
either undue side eff ects and/or
benefi t the patient.
Well-grounded skills in performing
physical assessments,
procedures and conveying the
outcome to the team.
Having a broad sensitivity in
human relationships.
Knowledge of specifi c measures
that off er physical as well
as emotional comfort to a dying
patient.
Th e nurse’s knowledge in geriatrics
can be a vital asset to the
hospice team. Th ey bring geriatric
theory and nursing concepts
of chronic as well as acute conditions
that the ill elderly frequently
encounter.
Final thought: Th e following
question is directed to our nursing
colleagues, whether in the
capacity as a nursing student or
as a graduate nurse: How would
you care for dying patients and
their families either while working
in a hospice facility, nursing
home or as a home-based caregiver?
In the “Bill of Rights for the
Dying” there is one particular
right that proclaims it best: “I
have the right to be cared for
by caring, sensitive, knowledgeable
people who will attempt to
understand my needs and will
be able to gain satisfaction in
helping me face my impending
demise.” Th is is one of the guiding
principles of hospice care.
In closing, I wish to recommend
several sources on this
subject of hospice and hope:
Kubler-Ross, Elisabeth. Living
with Death and Dying. New
York, McMillan
Lamm, Maurice. Th e Power of
Hope. New York, Scribner
Dickinson, Emily. Collected
Poems of Emily Dickinson.
Barnes & Noble Books. 1993.
“Hope is the thing with feathers
Th at perches in the soul,
And sings the tune without
the words
And never stops at all.”
— E. Dickinson
Dr. Sheldon
Ornstein is a registered
professional
nurse with
a doctoral degree
in nursing organization.
He has specialized in
the care of older adults and has
published many articles on the
subject. He has done post-graduate
work in gerontology and has
taught at several universities. In
2013, he was inducted into the
Nursing Hall of Fame at Teachers
College, Columbia University.
Photo via Getty Images
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