“The nurses do things that can be quantified,” one of our hospice chaplains announced, “which is not like what us chaplains or the social workers do.”
With hospice, a patient is supported by a “team” of doctors, nurses, social workers, chaplains, home health aides, and volunteers.
Was the chaplain, a person and a professional I respect, correct?
What is quantified? It’s a word describing precision, numbers, and comparisons.
A nurse may ask a patient what her or his pain is like on a scale of 1-to-10 or (especially if a patient can no longer talk) to choose from a range of emoji faces depicting happy smiles to grim anguish. Nurses increase or decrease the precise dosages of medications based on experience, information, and established guidelines.
The medical staff in hospice—and this is one of the tough parts of patient care—needs to regularly report how a patient is declining. If a hospice patient demonstrates consistent improvement in their physical health, they certainly still have an illness (and can’t stop the aging process), but they may no longer be eligible for the hospice benefit.
- Is the patient losing weight?
- Does he require stronger doses of pain medication?
- Is she eating less, or only liquids, compared to last week or month?
Yes, nurses quantify, with specifics, to discern a patient’s changes.
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Social workers also do some heavy quantifiable lifting. If you ask your social worker to help with VA benefits, they will provide contact information, appropriate forms, and likely make phone calls to assist with government benefits. Social workers can provide lists of local agencies that patients can hire for caregiving. Furthermore, a trained medical social worker is never above showing a friendly grin, but then sneaking in the 1-to-10 pain question! Many social workers I know have ready access to that handout with smiling to grimacing emojis!
But most social workers, and certainly chaplains, spend considerable time beside a patient talking about that individual’s feelings and failures, God and religion, old dreams or new dreads.
How can you quantify a prayer? A conversation? Answering questions? Sharing silence? Will the social worker chart that the patient worried that no one had taken his dog Buster outside since the morning? And so the social worker, that paid professional, spent time letting Buster do his “business” in the backyard? Will the chaplain, ever the expert on spiritual issues, be able to provide a document containing all of the reasons why God seems distant or angry to the patient?
If a patient frets over a daughter who can’t get off work to be with her in her dying days, the social worker may indeed use the proper (quantifiable) methodology to create a letter to help the daughter take an official family leave from work. However, openly listening to the patient’s anguish about her absent child was part of an open-ended, non-measurable encounter.
When a family is stunned by the reaction of the youngest adult son, who blames a vengeful God on his father’s terminal illness, they may ask the chaplain for help. How they long for the son to pray with the family around the patient’s bed! His father needs his son’s presence, not his hatred. The chaplain may chart in the medical records when she met with the son and how long their conversation was . . . but much of what happened included the non-quantifiable expression of feelings about forever losing a parent.
Yes, I understood why the chaplain claimed a distinction between quantifying the needs for physical well-being versus the incalculable ways that our spiritual and emotional lives are supported.
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However . . .
So much of what a hospice nurse or physician does has nothing to do with quantities or calculations or precise dosages.
(And I suspect the chaplain knows this.)
I remember being with a nurse as she changed a patient’s bandages. Foul-smelling, grim-looking cancerous tumors had burst through the skin’s surface. I held the patient’s hand while the nurse tended to the wound. Everything the nurse did was “precise” and she “followed the book.” But everything the nurse did was also accompanied by gentle actions and reassuring explanations. Later, the medical chart may have shown the pain meds used and described the procedures, but it would not contain anything about the nurse’s tender mercies.
Once I visited a home with a nurse, her hands full of folded dark blue towels. The odds were high that the family could witness a “bleed out,” when the final stages of dying might include a disturbing abundance of blood. The dark-colored towels could be used if that “worst” happened. Their color, rather than the usual white towel, could decrease the visual impact of blood as they tried to help the patient . . . their beloved. Yes, a nurse had ten towels in her hand. Yes, she was prepared to talk precisely about the possible, and troubling, next steps. But the non-quantifiable compassion she showed this family with her explanations was breathtaking to witness.
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Much of what hospice does, when it works best for patients and their families, is quantifiable. From the dosages prescribed to the completed forms, the calculations, analyzing, and yes, even pointing to an emoji face, provide clear information for medical charts.
But there are essential moments that can never be clinically summarized in a chart.
The chaplain was right, except that he was (mostly) wrong.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)
*John Rothwell’s picture of a hospice nurse with a patient is “borrowed” from this lovely article HERE.by