Presence, Improvisation, Dark Humor: Crucial Skills of a Hospice Nurse

Illustration by Pat Kinsella for AJN. Illustration by Pat Kinsella for AJN.

Here’s the start of “Molly,” the Reflections essay in the November issue of AJN, written by hospice nurse Thom Schwarz.

Late evening, early spring, the peepers not yet trilling. I am in my car, rain streaking the windshield, reading a New Yorker essay about war writing, an ironic distraction from my visiting hospice nursing work.

This is a piece that doesn’t offer any easy answers for the facts of suffering and death. But it does posit a certain consolation in staying present, undaunted, engaged, and resourceful when faced with the power and mystery of each patient’s encounter with impending death.

All Reflections essays are free, so give it a look.—Jacob Molyneux, senior editor 

2016-11-21T13:03:36-05:00November 3rd, 2014|narratives, Nursing, nursing perspective, patient engagement|3 Comments
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At the Intersection of Hospice and Obstetrics, a True Test of Patient-Centered Care

By Jacob Molyneux, senior editor

Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks. Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks.

We’d like to draw attention to a particularly frank and thought-provoking article in the October issue of AJN. “A Transformational Journey Through Life and Death,” written by a perinatal nurse specialist who is also a bioethicist, describes a hospital’s experience in meeting the needs of a patient with two very different, potentially conflicting, medical conditions.

It was a sunny afternoon in mid-October when I first met Renee Noble. I had already heard about her from staff who had given Renee and Heidi Ricks, her friend and doula, a tour of the neonatal ICU and were taken aback when they asked to see the Hospice Inn as well. The nurses knew that Renee had been diagnosed with ovarian cancer, but no one had said anything about it being terminal. Heidi had insisted that after Renee delivered she would need hospice inpatient care. Alarmed, the staff had called me, the perinatal clinical nurse specialist, after Renee and Heidi left.

In addition, this is a patient with strong preferences about her own care, preferences that may be at odds with the more conventional approaches to treatment held by […]

2016-11-21T13:03:43-05:00October 22nd, 2014|narratives, Nursing, nursing perspective, patient engagement, Patients|4 Comments
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If She Yells ‘Help Me’ – Poster Therapy to Convey the Needs, Identity of an Ailing Parent

Joan Melton, MSN, lives in Indiana.

Photo by Ann Gordon, via Flickr Photo by Ann Gordon, via Flickr

I am a geriatric nurse practitioner and have also been the daughter to an ill, aging parent. I felt well trained for my professional role but struggled with the latter.

I joked that, despite my logical understanding of what was going on with my mother, it could be hard to accept her physical and functional changes, which sometimes seemed to fly in the face of logic. There were days Mom’s hospice nurses spent more time with me than with my mother. They’d sit and allow me to vent my frustration at watching my mother slowly leave me, at feeling overwhelmed and “losing my cool” with her, at not being able to practice the advice I’d so readily handed out to so many other families over the years, not being able to “fix it” and successfully comfort all of Mom’s fears and ailments 24 hours a day, seven days a week.

Yes, I know how unrealistic that last statement sounds. Thank goodness for hospice nurses, who reminded me that I was “the daughter” and did not need to be “the nurse practitioner.” They reminded me that as the daughter I had amazing insight no one […]

2016-11-21T13:04:15-05:00July 23rd, 2014|Nursing, Patients|7 Comments
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Intensive Care of a Different Ilk

MayReflectionsIllustrationThis month’s Reflections essay (“Intensive Care”) is by John Fiddler, an NP who describes his work as an inpatient hospice nurse in New York City as being “as close to the ideal of nursing as I have ever been.”

This is a big claim—but if you read Fiddler’s brief, artful summary of the evolution of his nursing career, which started in an actual ICU, and then his description of what he found when he went to work in a hospice, you might find that he makes a pretty good case.

Here’s a small excerpt:

Inpatient hospice to me was the room at the end of the palliative care corridor that I had never bothered to visit. I had pictured it as a quiet haven for the dying, where birds chirp outside and music is heard playing through open windows as patients calmly drift off and up into dusty shafts of sunlight.

Not quite.

Instead, picture a unit where patients arrive on stretchers in extreme pain and distress, afraid, breathless—usually with families trailing behind, holding on to as much emotional and personal baggage as they can carry. Often these patients bear the physical and psychic bruises of a prolonged ICU stay.

And this is what happens here…

Maybe the author will someday find another ideal of nursing care, or maybe he won’t, but it’s worth reading his account of the current one. Reflections essays are open access. (Click through to the PDF […]

2016-11-21T13:04:48-05:00May 9th, 2014|career, nursing perspective|1 Comment
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Nursing Blog Links, Late Winter Edition: Emotions in Primary Colors

By Jacob Molyneux, senior editor/blog editor

by doortoriver, via Flickr by doortoriver, via Flickr

Nurses seem to have hope on their minds as the daylight grows longer and stronger and the winter ever so slowly winds down. There’s a good post at According to Kateri about hope and letting go of the past.

Which reminds me: sort of along these lines, we recently had a good post here at Off the Charts about hope and patient prognosis.

Theresa Brown’s latest at Opinionator, a New York Times blog, is about the communication gap between clinician and patients and the need to find ways to bridge this, for everyone’s sake.

There’s a post at Not Nurse Ratched about another of the more basic emotions: anger. Or, more specifically, anger related to workplace issues that are slowly driving you nuts. Not that any nurses can relate to that . . .

If you’re up for it, here’s a pretty profound post from Hospice Diary about someone who is very articulate about the meaning of his own dying process.

And here’s a kind of funny one at Nursing Notes of Discord about the questions a new nurse asks in the course of a day.

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2016-11-21T13:05:22-05:00February 18th, 2014|career, healthcare social media, nursing perspective|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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