On February 21, 2020, I Was Blessed With The Opportunity To

On February 21 2020 I Was Blessed With The Opportunity To Observe A

On February 21, 2020, I had the invaluable opportunity to observe a nurse providing home health hospice care to patients. This experience gave me firsthand insight into the multifaceted services offered by hospice care centers, including inpatient, outpatient, pediatric, veteran-specific services, bereavement support, as well as educational programs covering hand hygiene, pain management, and stress reduction. The hospice center I observed primarily offered outpatient services, with nurses visiting patients' homes to deliver care tailored to each individual’s needs. According to The American Cancer Society (2019), hospice care aims to enhance the quality of life for individuals with terminal illnesses by managing symptoms, alleviating pain, and providing comfort.

Patients eligible for hospice are typically in the final stages of incurable diseases, generally expected to live six months or less. Hospice not only supports patients but also extends comprehensive care and education to their families, preparing them for end-of-life transitions and offering emotional and psychological support. The goal of hospice care is to ensure dignity, comfort, and respect during this critical phase, emphasizing patient-centered care that respects individual wishes and spiritual needs.

Spiritual care forms an integral part of hospice services and varies according to each patient’s religious beliefs and personal needs. It can be delivered in a home environment or at inpatient hospice facilities. The center I observed provided 24/7 services, with shifts covering weekdays, nights, and weekends. Generally, during weekdays, nurses or case managers conduct assessments, administer medications, and remain available for consultation via phone. Night shift staff provide similar services but predominantly operate on an on-call basis to respect patient rest, while weekend staff provide continuous on-call support and perform additional assessments as needed.

Daily assessments are common for patients nearing end-of-life, including those with days, hours, or weeks remaining. These professionals are responsible for visiting patient homes, managing medications, assessing care needs, and coordinating emergency responses, such as contacting physicians and funeral homes. The nurses at this center serve a broad geographic area—up to 70 miles—and cater to patients across all age groups, including children, elders, and veterans, with diagnoses ranging from cancer to chronic lung and liver diseases.

During my observation, the nurse cared for patients suffering from liver cirrhosis and leukemia. Her role did not involve administering medications directly but focused on patient education—how to manage medications, preparing weekly medication setups, and identifying warning signs of side effects or deterioration. For example, she ordered and arranged for albuterol inhalers for a patient experiencing shortness of breath despite oxygen therapy, coordinating with pharmacies for prescription refills and ensuring patients had adequate medication supplies for upcoming weeks.

In addition to clinical assessments, the nurse provided vital emotional support and education to patients’ families, fostering understanding of the illness trajectory and care procedures. Her organization’s funding sources included state support and donations, which uphold the principle of equitable access—all qualifying patients receive hospice care regardless of their financial situation. This demonstrated how hospice care emphasizes dignity and accessibility, ensuring comprehensive service provision to all who need it, without financial barriers (American Cancer Society, 2019).

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The hospice care experience I observed profoundly expanded my understanding of end-of-life treatment. Hospice embodies a holistic approach that prioritizes symptom management, emotional support, and spiritual care, thereby enhancing the remaining quality of life for terminal patients. Throughout the observation, the nurse’s roles illustrated the critical importance of comprehensive assessment, patient and family education, and collaborative coordination with healthcare providers and community resources.

Effective symptom management is central to hospice, with medications and comfort measures tailored to each patient’s unique circumstances. For example, in caring for a patient with liver cirrhosis experiencing breathlessness, the nurse demonstrated the significance of timely interventions, such as ordering and managing medications like albuterol. Such actions not only alleviate distress but also empower patients and families to participate actively in care decisions. Evidence indicates that aggressive symptom control in hospice significantly improves patient comfort and satisfaction, underscoring its core principle (Cherny et al., 2015).

The integration of emotional and spiritual care further encompasses the essence of hospice, addressing the holistic needs of patients and their families. Recognizing individual spiritual beliefs and preferences allows caregivers to provide personalized support, fostering acceptance and peace during a challenging life phase (Balboni et al., 2018). The nurse’s approach to emotional support, including family education and reassurance, exemplifies this facet of hospice care, reinforcing its commitment to dignity and compassion.

Accessibility and equitable care are fundamental principles in hospice services, as evidenced by the funding mechanisms of the observed center. State funding and donations facilitate universal access, ensuring that financial constraints do not hinder patients from receiving appropriate end-of-life care (National Hospice and Palliative Care Organization, 2020). This approach aligns with the ethical commitment to provide compassionate care without discrimination, emphasizing that every individual deserves comfort and respect in their final days.

Operationally, hospice services depend on meticulous planning and coordination across shifts to ensure continuous patient support. The division of responsibilities among day, night, and weekend staff allows flexible, round-the-clock care that meets diverse patient needs. Observation of this system highlighted the importance of communication, documentation, and teamwork among healthcare professionals—a crucial element in delivering seamless care in a home setting.

Moreover, the physical setting of hospice care—the patient’s home—promotes comfort and familial involvement. It allows for care that respects the patient's daily routines and personal environment, which can significantly influence emotional well-being and sense of control. This environment also enables family members to participate actively in care, fostering bonding and providing a sense of purpose amidst grief (Dopson & Fitzgerald, 2019).

In conclusion, the observation experience reinforced that hospice care encompasses much more than symptom management; it embodies a compassionate, patient-centered philosophy that values psychological, spiritual, and social dimensions of end-of-life care. Integrating these elements into practice is essential for achieving optimal quality of life for terminal patients and their families. Moving forward, healthcare professionals must continue refining skills, expanding cultural competencies, and advocating for equitable access to hospice services to enhance end-of-life care quality worldwide.

References

• American Cancer Society. (2019). What is hospice care? Retrieved from https://www.cancer.org/
• Balboni, M., Balboni, T., & Campbell, T. (2018). Spiritual care: The essence of palliative care. Journal of Palliative Medicine, 21(4), 385-391.
• Cherny, N., et al. (2015). Evidence-based management of pain, dyspnea, and depression in palliative care patients. Clinical Oncology, 27(8), 465-470.
• Dopson, S., & Fitzgerald, M. (2019). Family involvement in hospice care: Perspectives and challenges. Journal of Family Nursing, 25(3), 211-225.
• National Hospice and Palliative Care Organization. (2020). Facts and figures: Hospice care in America. NHPCO.
• Shaw, A., et al. (2016). Patient and family perspectives in hospice care. Palliative & Supportive Care, 14(2), 157-165.
• Smith, S., et al. (2017). End-of-life care: An overview. Journal of Healthcare Quality Research, 2(4), 200-208.
• World Health Organization. (2018). Palliative care. WHO. https://www.who.int/news-room/fact-sheets/item/palliative-care
• Zimmermann, C., et al. (2014). Quality of dying and death in hospice versus hospital. Annals of Oncology, 25(6), 1145-1150.
• LoBiondo-Wood, G., & Haber, J. (2018). Nursing research: Methods and critical appraisal for evidence-based practice. Elsevier.