Dear Fellow Hospice RNs,
It’s now, more than ever, that your hospice patients really need your kindness, your compassion, your caring nature, and your gentle demeanor. They need you to visit, to provide a listening ear, and to provide them with some social interaction.
At a time we are being told to avoid others and limit our time with our patients, is a time that hospice nurses should really be increasing their frequency of weekly visits. Most of your hospice patients, if not all of your patients in facilities, are alone and separated from family members. No-Visitor policies are in effect throughout the United States to prevent the spread of COVID19. Facilities are limiting the amount of visitors, including hospice team members. Hospice Social Workers, Hospice Chaplains and even Hospice Aides are now being asked to work from home, calling in and checking on patients via phone, while many hospices are even laying off team members. However, I believe, this is the time that hospice patients need all the support and visits they can get. Having No-Visitor Policies at facilities means that hospice patients are being physically separated from loved ones and are not allowed to have personal, touching, friendly, and uplifting visits.
The basic hospice belief and philosophy is to provide end of life cares encompassing the Mind, the Body, and the Spirit. Hospice is providing QUALITY over quantity of days. Hospice is a TEAM approach and patients (and families) ELECT this benefit, which includes the entire team of nurse, social worker, chaplain, volunteers, and home health aides. By not allowing the whole team to visit our hospice patients is truly breaking my heart, as it is breaking our hospice patients hearts too. And, because facilities are not allowing Hospice Social Workers, nor Hospice Chaplains, nor Hospice Aides in facilities, we as Hospice RNCMs, are finding ourselves now doing the role of social worker, chaplain, nurse, and hospice home health aide. We are working harder than ever (and are suddenly finding out how much we appreciate the roles of these other hospice team members)!
As a Hospice Case Manager, I am seeing the toll this separation is having on my hospice patients in facilities. Not only are they not allowed to have visitors, but all scheduled activities have been canceled, and many of the residents are eating all of their meals in their rooms alone because the dining hall is closed. This separation is causing patients to sleep more, spend more time in bed, spend more time just sitting in their chairs, alone, quiet, very little human interaction, and with very little mind stimulation. I’m now seeing an increase in sores developing, a decrease in appetite, and increase in hours sleeping during the day, and an increase in sadness in their eyes.
Human contact is an essential human need. While facilities are doing a good job providing physiological needs (food, water, warmth, rest) and safety needs during this pandemic, the residents needs for love and affection from loved ones are not being met. According to Maslow’s Hierarchy of Needs, humans need intimate relationships, friends, belongingness, and love. These are basic psychological needs and without these, there are effects on the person’s overall wellbeing.
As a hospice nurse, during this pandemic, you are needed now more than ever at to help your patients who are physically separated from their loved ones due to the No-Visitor policies at many facilities. Increase your weekly frequency visits, provide a positive visit to each of your patients, take the time to listen to a story from your patient (ask them to share a story about a favorite family vacation), take the time to allow a personal connection, and/or help them write a letter. If allowed, bring items (from your home) to your patient that provides them with activities to pass the time: items for a simple craft, magazine, book, newspaper, puzzles, games, joke book, CDs, notebook and colored pencils, writing paper, fresh flowers from your garden, and/or envelopes with stamps. Then, it is so very important to update the family via phone about your visit and go into details. Ask the family to send letters or cards to their loved one or arrange for a phone call/Facetime to/with family members.
Remember, as the Hospice RNCM, you are needed at this time. You are important at this time. So, it is important to stay healthy yourself, follow all the guidelines for protection (to protect you AND your patients), and stay positive. In order for you to continue to provide the same, high passionate, gentle, end of life cares for your hospice patients, you now also need to protect yourself more than you did before. Your patients need you, your families need you. Care for yourself, love yourself too.
Keep you Immune System Up! Eat healthy, get good sleep/rest, stay positive, get daily exercise (even if it is a 10 minute walk down your street and back), inhale that fresh outdoor air deep into your lungs and soul. And, connect with a fellow Hospice RNCM and debrief each day, and allow him/her to debrief with you also.
Follow the CDC guidelines for protecting yourself in a facility: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html . Aren’t sure if you should wear that mask? Just wear it! Aren’t sure if it is the right time to wash your hands? Wash them! Better to go overboard with safety at this time, and your patients and families will appreciate it.
We, hospice nurses, know that PPE, including masks and glasses/goggles, can limit the personal contact we have with our patients, but remember that PPE is absolutely necessary to protect your patient and all of your other hospice patients. AND, touch is still important, even if it is with a gloved hand.
Many of my patients are hard of hearing and then with a mask over my mouth, communication can be very difficult and even frustrating. One thing I have done to help while I’m wearing a mask to my visits, is that I have created a laminated sheet of paper that I show each of my patients when I arrive for their visit. I show it to them while reading it, (and I wipe it down easily after my visit):
“Hi again! It’s me, Teri, your Hospice Nurse here to check in on you to see how you are doing today. I’m wearing this mask because of a virus that is going around. I’m feeling very well, but am wearing it to protect you and to protect myself.”
Remember, as a Hospice RNCM, your hospice patients at facilities need you now more than ever. Stay positive. Visit frequently. Stay Safe by following all of the CDC guidelines and facility guidelines for PPE. Keep yourself healthy. Communicate with your team and keep them updated on your visits. And, debrief with a fellow team member. These times are not easy, but your calling is clear. You have made such a difference to your patients, and will continue to make a difference now more than ever.
Visit http://www.hospice-101.com for more information about hospice, and/or to access other hospice blogs and articles.