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Running head: HOSPICE CARE

Hospice Care
JoAnne Saba
California State University, Stanislaus

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Hospice Care

Hospice services provide care for clients who have an incurable terminal illness with a
prognosis of six months or less (Tsutsumi, Sekido, & Tanioka, 2014). The intent to provide the
patient with comfort until the end of life. Palliative care, however, aims to reduce the suffering
of a patient regardless of the patient's prognosis (Dobrina, Tenze, & Palese, 2014). Both forms
of care are modeled after the same theories and focus on the patient, the nurse, and the patientnurse relationship while providing care. It is imperative of the nurse in each model to assist the
patient in continuing to have a meaningful life and that the nurse, care environment, and
organization of care are all responsive to the needs of the patient (Sandsdalen, Hov, Hoye,
Rystedt,& Wilde-Larsson, 2015) . As end of life nears, patients tend to have a decline in
physical, psychological, social, and spiritual wellbeing. This paper will examine each in
accordance to Subject A, a specific client visited during the hospice rotation, as well as the the
role of the nurse in hospice care.
Physical Well-Being
As a person progresses toward the end of life, physical capabilities decrease and suffering
informs of pain increase (Tsutsumi, Sekido, & Tanioka, 2014). It is the goal of hospice care to
provide the patient with interventions to minimize the amount of suffering as much as possible.
Subject A was suffering from effects of chronic obstructive pulmonary disease and required
continuous oxygen therapy to reduce the amount of suffering that he or she endured due to
shortness of breath and other breathing difficulties. In addition, he or she required assistance
with mobility and was at high risk for falls due to reduced strength and limited activity tolerance.
He or she also required help with personal care and hygiene. Overall, Subject A has had a
decline in her physical capabilities.

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Psychological Well-Being

Sandsdalen, Hov, Hoye, Rystedt, and Wilde-Larsson (2015) have found that
psychological well-being to patients have encompassed continuing to have a meaningful life
despite his or her prognosis. However, psychological well-being for the patient and family
include a strong therapeutic relationship between them and the nurse to ease the family in to the
idea of death (Dobrina, Tenze, & Palese, 2014) . Subject A had advanced stage of
Alzheimers/Dementia causing memory to be effected. This caused assessment of their
psychological well-being to be impaired. The patient presented to be content and was primarily
concerned with the whereabouts of his or her spouse.
Though not all family members were present during the time of the visit, it was apparent
that the psychological well-being was poor. Each member of the family had their own personal
way to cope with the impending death of Subject A. The spouse and one of the children of the
patient displayed nonchalance and annoyance due to the demanding care the patient required.
The other child showed distress toward the situation, however, was bitter over the attitudes of the
others. While the last child showed a positive regard toward the patient and his or her care.
Social Well-Being
Social contact and support is important for a patient even in end-of-life care (Sandsdalen,
Hov, Hoye, Rystedt,& Wilde-Larsson, 2015). An increased need for social support from a
patient's nurse or health care provider comes from a decreased amount of social support from a
patient's family. Adequate social well-being of a patient does not come solely with the length of
a conversation, but also, the quality of the interaction (Tsutsumi, Sekido, & Tanioka, 2014) .
Subject A had adequate social well-being due to the daughter having constant contact with the

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patient and her consistent visits from the home health aide. These two spend time talking with
the patient while the other family members interacted with the patient out of obligation.
Spiritual Well-Being
There is conflicting data in regards to spiritual well-being. Some patients find comfort
and acceptance in their spirituality, while others, associate spiritual practices with death
(Sandsdalen, Hov, Hoye, Rystedt,& Wilde-Larsson, 2015) . There is no set norm and is
dependent on each patient's set of beliefs. Subject A had no apparent spiritual rituals that were
practiced.
Role of the Nurse
It is suggested that the role of the hospice nurse is to provide higher quality medical care
(Tsutsumi, Sekido, & Tanioka, 2014) that is complimentary to the patient's primary health care
provider (Dobrina, Tenze, & Palese, 2014) . Nurses are required to be present for not only their
patients' needs but also to build a therapeutic relationship for the patient and his or her family. It
is imperative that the nurse provide physical and mental relief so that the maximum amount of
comfort is provided and one can be at ease at the end of life.
End-of-life care is more holistic than previously conceived.

It was assumed that

palliative/hospice care focused only on the person nearing death. However, the patient in the
hospice model focuses on the ailing member and supportive family together. Though easing
physical pain and suffering is an essential aspect of end-of-life care, psychological well-being of
the patient and family are equally as important. Strong therapeutic communication skills are
necessary so that the patient/family have a person to express fears concerning death and feel
comfortable doing so.

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References

Dobrina, R., Tenze, M., & Palese, A. (2014). An overview of hospice and palliative care nursing
models and theories. Inernational Journal of Palliative Nursing, 20(2), 75-81.
Sandsdalen, T., Hov, R., Hoye, S., Rystedt, I., & Wilde-Larsson, B. (2015). Patients preferences
in palliative care: A systematic mixed studies review. Palliative Medicine. doi:
10.1177/0269216314557882
Tsutsumi, K., Sekido, K. and Tanioka, T. (2014) Characteristics of Nursing Care for Terminally
Ill Patients in Hospice/Palliative Care Unit. Health, 6, 2121-2128.