Archive for Nurses

I Know More than the Hospice Staff

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When first admitted into hospice care, one of the patients mentioned they looked forward to the chaplain’s visit. In recent years, before and especially during his illness, this person told the admitting nurse about reading (and re-reading) the Bible cover-to-cover.

“There’s nothing the chaplain can say that I don’t already know about the Bible.”

Really?

Did humility, humor, or hubris influence our new patient’s claim? Were the words boastful or spoken to avoid more difficult emotions? What is easily said on the “surface” may hide deeper questions or concerns. Like, Won’t someone please listen to me? or perhaps Let me start with a subject I can control—knowing the Bible—to eventually risk revealing what is out of control . . . my fear of dying.

Many of the people all hospices serve have faith traditions with a unique book. The Hindu reveres the Bhagavad-Gita. Jews claim the Torah. Christians embrace the New Testament. Muslims honor the Koran. Some patients may know little about the sacred text at the center of their religion, while others might possess a scholar’s awareness. A life-threatening disease can cause one person to explore—for the first time, or with renewed energy—the words of her faith, hoping to uncover answers or encouragement. The next person might scorn his religion’s traditions because the illness proves God doesn’t care or never existed.

A hospice chaplain enters into a person’s life, from hours to months. The chaplain has no interest in interpreting, defending, or condemning any scripture. Instead, what is important to the chaplain is what is important to the patient. Even more essential, what are the real hurts and hopes in the shadows behind a patient’s knowledge, ignorance, or doubts about their faith?

What are the deeper questions? Read More →

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A Hospice Chaplain is Quantifiably Wrong

(*Photo by John Rothwell.)

“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. Read More →

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In Hospice, MAC Isn’t About Comfort Food

Mac & Cheese is comfort food, but sometimes . . .

While discussing a new admission, the hospice medical director reminded the patient’s nurse to get a mac.

The nurse immediately nodded. Complete agreement.

A mac? What did the doctor mean? They couldn’t mean a Macintosh computer from Apple, could they? That didn’t make sense. But thoughts of digital apples made me think about real food . . . did they mean Mac & Cheese? Though not a big fan of that packaged pasta and cheese, it is one of my wife’s favorite comfort foods.

My food wondering continued. What about a “Big Mac?” Could the doctor have been recommending a fast food burger? (When younger, I loved McDonald’s flagship burger. The Big Mac debuted, with fanfare and a high calorie count, around the time I started college. If I could scrape together a few extra quarters, I’d always go for the extra all-beef patty and special sauce!)

But we hospice professionals couldn’t have been talking meal deals . . . right?

Ever ignorant, I asked the doctor, “What is a ‘mac?’” Read More →

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