Precarious Hope: A Hospice Nurse Balances Truth and Kindness

This couple might be your elderly neighbors: he helps his wife into the house as she moves slowly, step by unsteady step, in time with her four-point cane; at the same time, you know that he is recovering from recent chemotherapy treatments. Or they may be your aging parents: your mother’s role as primary caregiver hampered by her right leg weakness from a stroke and advancing heart disease, while your father needs more care from day to day as his renal failure approaches the decision to begin dialysis or not. They support and care for each other.

PrecariousHopeIllustrationThe December Reflections column in AJN, “Precarious Hope,” is by an RN case manager at a hospice. She describes a couple in which one partner has dementia and the other has cancer, their mutual dependency, and the challenge of knowing how best to care for them:

In hospice, I’m often confronted with the difficulty of balancing honesty with kindness. I love a quote often attributed to the Buddha: “When words are both true and kind, they can change our world.” It follows that sometimes what is true is not kind, and that truth must be cloaked in kindness—as in this instance, as I sit at the table listening to George, whose hopeful, unrealistic comments confirm that he simply can’t hear the truth.

It’s a sensitive portrait of love, the fine line between self-delusion and perseverance, and the way that sometimes simply bearing witness is the […]

‘Like an Origami Swan’ – Remembering Tea with Miss Elsie

“Hello,” I said. “I’m the nurse. I’m here to see Miss Elsie.”

“I know,” he answered, grabbing my wrist and pulling me inside.

The heat of the cramped house slammed into my face. The windows were closed and the shades pulled down. Without a word, my little escort guided me down a narrow hallway into a room not much bigger than a closet, then deftly released my wrist and slipped out of sight.

So starts “Tea With Miss Elsie,” by Claire Schuster, MSN, RN, APRN-BC, CWS, associate professor emerita in the nursing program at Berea College, Berea, Kentucky. The Reflections essay in the March issue of AJN is a subtle, quiet portrait of a moment and the gesture at its heart, and it’s well worth a read. (For the most appealing version, click through to the PDF version link in the upper right of the landing page.)—JM, senior editor  

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Home Care Nursing Isn’t for the Faint of Heart


The convalescent-home referral said that Loretta was 71 years old with the usual health problems related to stroke and diabetes. It also said that her husband had a gun and “wasn’t afraid to use it.” Fiercely protective of his wife, he’d had many disputes with the nursing staff about her care. The discharge planner who’d referred her to our home care agency insisted that two nurses make the initial home visit.

Read the rest of “The Dirtiest House in Town,” the Reflections essay in the January issue of AJN, here. And let us know your own experiences in home care nursing.

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