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Observation at Hospice of the Red River Valley

October 14th, 2019 8:30am – 12:30pm


My observation at Hospice was supposed to be from 8:30am to 3:30pm with a Hospice Nurse,
but do to a scheduling error, my observation ended up being shorter and with a case manger instead of
a nurse. Despite this, I still got to see patients as the case manager, Summer, was still a nurse. She just
had fewer patients. But upon my arrival at the building, the first thing I noticed was how kind everyone
was. When the receptionist realized that the nurse I was scheduled to observe wouldn’t be coming in to
work that day, she immediately went to work to find me someone else to observe even though I hadn’t
asked. The process of finding someone new took a little while, but they were able to find Summer, who
was very enthusiastic about letting me tag along while she worked despite it not being planned. The
receptionist and Summer were amazing when dealing with the unexpected situation.
Even though Summer’s title was not technically a Hospice Nurse, she still saw patients and I was
still able to complete my objectives. My first objective was to describe three techniques used to comfort
the patient’s family. The technique I saw most often was to always let the family know what’s going on.
Summer called her patient’s family before and after she visited the patient and sometimes during the
visit. Making sure the family knows what is happening and how their family member is doing helps a lot
in keeping their emotions controlled. The second techniques were less techniques and more like
personal qualities: being understanding and empathetic. It’s hard for a family to accept that their loved
one’s health is getting worse and that it may be close to the end. Because of this, it’s important for the
nurse to be able to understand the family’s emotions and sympathize with them. This makes the third
technique become reassurance. It is up to the nurse to reassure the family that they are doing the right
thing and that their family member is comfortable.
My second objective was to identify the four most common procedures a nurse performs.
Because hospice nursing is mostly about managing the patient’s pain, hospice nurses perform vital sign
checks most often. That makes the four most common procedures performed temperature, pulse,
respirations, and blood pressure because the nurse is able to assess the comfort level of the patient
through those. But, they also take the SPO2 levels, do assessments for any new medications or changes
to medications needed, give orders to nursing home nurses, and monitor bowel movements.
The third objective I had was to be able to list two ways the nurse cares for the patient
emotionally upon the completion of my observation. Being a hospice nurse isn’t just about caring for the
patient physically. For many patients, the nurse may be the person they see most; thus making it the
nurse’s job to care the patient socially and emotionally too. What I observed was that it is important to
be the patient’s friend and to be understanding and to have patience. When watching Summer check-in
on her patient’s, I noticed how she walked in and greeted them like an old friend. It made the patients
very happy and they seemed excited to see her. But the patient’s have ailments that keep them from
being mobile or able to hear things the first time and many don’t want to be in a nursing home (both of
Summer’s were in a nursing home). So it’s important to understanding of their situation and to be
patient with them.
My fourth objective was to list three other professions that the hospice nurse works with.
Summer talked the most with doctors, the nursing home nurses, and other hospice nurses. As a nurse,
Summer cannot officially make changes to medications without the doctors approval. Hospice nursing
involves a lot of pain medications in order to keep the patients comfortable, so communication with the
doctors is very important. The hospice nurse also does not usually see their patients every day, the
nursing home nurses do. This means the hospice nurse has to communicate often with the nursing
home nurses and be close with them to make sure all directions come across clearly. And, with a job
that can be very emotionally draining, the hospice nurse is close with other hospice nurses because they
are often there to comfort each other after a patient dies.
My final objective was to identify two ways the nurse keeps their own emotions controlled. The
first way is they take deep breaths, but they know it’s okay to cry a little. Obviously they can’t start
sobbing in an emotional situation, but it’s okay to let a few tears slip. The nurses also support each other
because they know what it’s like to lose a patient. Summer said that it is always tough to lose a patient,
but because the hospice nurses monitor the patient’s progress, so they see it coming.
One takeaway that Summer wanted to make sure I had was that patient’s can be with Hospice
for a long period of time. Usually when a patient is put on hospice, the immediate though is that they
don’t have very longer left. But, as long as it can be proved that the patient’s health is declining, a
patient can be with Hospice for years. Summer said she had a patient that had been with hospice for
over a year. I also saw that the nurses don’t have offices. When I first sat down with Summer, we were
in a conference room. It donned on me later that this was because the nurses see all of their patients
either at the patient’s home or at a nursing home, so there really is no need for an office. While we were
in there, I asked Summer about the hours hospice nurses work. She said that because she’s a case
manager, she works a usual 8 hour day. But hospice nurses are usually available 24/7 for their patients.
Which means that being a nurse means a lot of phone calls in order to stay in touch with whoever cares
for the patient while the hospice nurse is not there. The nurse must also call the doctors and families
multiple times a day. With Summer, I also saw of her patients at a nursing home. Through this I learned
that narcotics can be used to treat coughs. They aren’t turned to first, but they are used when oxygen is
not helping and the patient seems to be in pain from the coughing.
As much as I enjoyed this observation, it did not have much of an impact on my future career
choice. Anyone can be with hospice depending on the situation, but it’s mostly geriatrics. For the future,
I am not interested in working with mainly one age group. I’d like to see a wide range of ages. I also
don’t think traveling for the work the way hospice nurses do is for me. I don’t have the best navigation
skills.
For my participation during the observation, I felt I did a good job asking questions. Summer was
on the phone a lot though, so I couldn’t ask questions then. I also cannot ask questions while she is with
patients. Although I did a good job asking questions, Summer was very good at answering them and
many things could be observed, I started to run out of questions towards the end. But by that time, we
had many topics we could discuss.

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