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Selfless service: Honoring the hospice patient’s wishes

By Lauri Weiss, CRNP

Seva, or selfless service, is a traditional yogic concept. The Sanskrit word seva comes from the root siv or sev, meaning to serve or to honor. One of the reasons I work as a Hospice/Palliative Care Nurse Practitioner is because I believe hospice offers an opportunity to serve and honor patients. I know many of the people I work with feel the same way.

A recent patient experience made me take a closer look at what it really means to honor and serve selflessly. I am often asked to visit patients for symptom management consults. A few weeks ago, I was asked to visit a patient, Charlie, who was having severe pain. After speaking with Charlie, getting a history of the illness and doing a physical assessment, I made several recommendations for pain management interventions.

I later found that Charlie refused all of my recommendations. Read more

Hospice without borders: Global Partners in Care

By Maggie Vescovich, SLP

In the United States, we take access to hospice care for granted.  In fact, our biggest hurdles are usually convincing family members to use hospice services, not finding an agency to provide the care.

Would it surprise you to learn that there are many areas in the world where hospice programs do not exist?

Global Partners in Care has its roots back in 1999, after U.S. hospice leaders had a powerful experience while touring hospices in Zimbabwe and South Africa. Read more

You might be ready for hospice if…

By Ron King, D.Min., LMFT, Hospice Chaplain

You might be ready for hospice if your doctor reports there are no further treatment options available to you.

  • If no treatment options exist for a serious condition or if available treatment is considered too risky for you, it may be time to consider taking advantage of your hospice benefit.  Encourage your physician to be honest with you about options and be sure you understand the potential risks and benefits to each choice.

You might be ready for hospice if your doctor has offered extreme life saving measures that have an uncertain outcome, limited benefit or percentage of success and your main goal at the end of your life is to be comfortable. Read more

How do we grieve? Let me count the ways….

by Pat McGettigan, M.S.

A recent article in the NY Times which talks about the process of grieving gave me pause to begin to think about the men and women who have come through my office at the Counseling Center seeking help as they navigate their own grief after the loss of a loved one.  The article cited research on the grieving process, mentioned Elizabeth Kubler Ross’ five stages of grief and a new way of grieving developed by a young widow.

As I pictured the faces of and recalled the words of many of those who sought help during their grieving process one thing was clear to me.   Almost all of them wondered if how they were grieving was “normal”.   As a society many of us tend to want a “recipe” for unfamiliar or painful transitions. When we can look up what to expect it can comfort us and remove the anxiety of facing “the unknown”.  But what happens when our grief process doesn’t follow “the recipe”? Read more

Finding inner strength during hospice caregiving

By Valerie Hartman

Today I was driving in my car between hospice visits.  I turned on WHYY, our local public radio station, I and heard the end of a segment on creativity, a conversation facilitated by psychologist Dan Gottlieb with guest psychologist Tara Brach. Brach says that when we afraid and overwhelmed, it’s easy to turn away from ourselves for comfort. Instead, Brach urges us to explore pathways to “carry us to an inner sanctuary…[that] is always there for us–and within which we begin to find strength and peace.” Poet Ellen Bass also shared her way of expressing her inner thoughts through poetry.

Perhaps with the recent death of poet Maya Angelou—or perhaps being the anniversary of my mother’s birth date (she, a Poet Laureate herself)—Ellen Bass grabbed my attention.  She is an award-winning poet and she writes beautifully about emotional difficulty – including death, dying, grief, and loss.

In honor of the great Maya Angelou, and the poetic expression that can help heal emotional depths of pain, I share with Caring With Confidence readers a few thoughts on writing poetry and one of Dan Gottlieb’s favorite Ellen Bass poems.

Read more

Hospice caregivers: learning to let go at the end of life

By Barbara L’Amoreaux

“It is a pivotal point for a caregiver: the transition from doing to “being” as a loved one’s life is ending.”

Thus begins an article in last Sunday’s Philadelphia Inquirer. The concept is simple, but often difficult for caregivers to accomplish: there is a time near the end of life when the best thing a caregiver can do is be with their loved one. Stop tidying up. Stop checking meds and messages from others. Stop moving. Just be. Read more

Hospice and the child caregiver

By Ron King, D.Min, Chaplain

Doris, the daughter of a dying patient, was consumed with the burden of caregiving and feeling particularly alone. When questioned about her spiritual resources, Doris responded that she felt abandoned by God.  Recent losses and lack of support made it seem that God was not hearing her prayers or noticing her distress.

Through the tears of isolation, the voice of Doris’ five-year-old granddaughter, Jasmine, broke through declaring, “I know God”.  Jasmine went on to explain that God had visited the house on Tuesday and was planning to come back in the afternoon. While Doris continued in her despair about having no one to help, Jasmine “called” God on the cell phone and asked him to stop by, announcing that he would be welcome at any time.

Children sometimes bring the voice and care of God to our hearts and homes before a chaplain, priest, or pastor even arrives. Read more

Military memories at end of life

by Barbara L’Amoreaux

Decades after serving, many veterans are still resolving the things they did and saw while in the military.

At the end of life, when we often seek closure on issues, veterans may have different concerns than non-vets. According to the National Hospice and Palliative Care Organization (NHPCO), it’s important to ask about a veteran’s time in the Service. “Since many Veterans’ stories were never heard, it is important to create a trusting environment and encourage conversations about their combat and/or other related experiences. By taking the time to ask about their time in the service, feelings of guilt, anger and other emotions can also be acknowledged.”

This week the Philadelphia Inquirer published an interview with a Holy Redeemer Hospice Chaplain, Debbie Ganci, who specializes in working with veterans in hospice. Read more

Treating the hospice patient + caregiver as ‘one’

By Valerie Hartman, CRNT

As a hospice nurse I am part of a team, and I have access to a lot of support as a professional caregiver.

And, it’s my job (at least part of my job) to create a care plan that includes support for the family member as caregiver, since the hospice philosophy of care sees the patient and family as ‘one’.  They are the central unit that drive decision making and will carry the legacy of their own personal hospice experience.

When I teach new hospice team orientees about the philosophy of hospice care, I always emphasize the reason why the patient and family member are treated emotionally as one: because the patient and his or her loved one(s) experience end of life with shared pain in the grieving process—which is why hospice care includes 13 months of bereavement counseling after a loss.  Read more

Give your family the gift of making your own decision

By Ron King, D.Min., LMFT

When you receive a diagnosis of a terminal illness, difficult choices must be made.

Signing hospice admission forms indicate a choice has been made for comfort over cure.  Many appreciate the freedom to make this decision, especially when treatment for comfort and cure cannot be carried out simultaneously.  This choice can be made by a patient or by family members if the patient is unable to consider or communicate their preference. Read more