Crash Course in Hospice Nursing for ER and ICU Staff.

With the sudden and continuing increase in COVID-19 patients in our world, there are many nurses that are finding themselves face to face with death, more than ever before.  ICU Nurses and ER nurses are trained to help and care for patients with urgent and emergent needs, with the goal to have them walk out their hospital doors.  However, with the death rate continuing to increase, the likelihood of this goal is still poor.

Hospice Nurses would love to come into the hospitals and advocate for the dying patients.  Yes, we really would.  Hospice Nurses, true Hospice Nurses, are passionate about helping patients die comfortably, with dignity, and with compassion from loved ones and caregivers. And, we’d love to be there so that they don’t have to die alone.  So, yes, it really upsets us Hospice Nurses to see the amount of death happening and we are not able to help and be with those patients.  Plus, unfortunately, many of us devoted hospice nurses work for outside hospice agencies not affiliated with the major hospitals that are receiving and caring for the COVID19 patients which limits our ability to work our hospice and palliative skills within the walls of these hospitals.

Since we, the Hospice Nurses, can’t be there at the hospital with the dying patients, we’d like to do the next best thing and offer advice and some quick tips for ICU and ER nurses to help them with their grave and seriously ill patients during this national crisis:

  1. LISTEN. Listen to the patient, hear their words, hear their wishes, hear their wants. Hopefully, you are given the chance to listen to them before they are no longer able to talk on their own. Unfortunately, many nurses and hospital team members listen to the numbers from lab reports and numbers from the vitals, instead of listening to the wishes of the patient. Maybe they have a message that they want you to tell to a loved one, maybe they don’t want certain testing, maybe they are scared and just don’t want to be left alone. Listen to their words and listen to their eyes (as eyes can speak louder than words).
  2. THEY ARE LOVED BY SOMEONE. This patient in front of you is someone’s grandma, someone’s mom, someone’s sister, someone’s best friend, or someone’s brother, someone’s dad. This patient in front of you means the world to someone else. This could be YOUR grandma, your mom, your sister. Treat them like they are the most important person to someone else. Treat them like you would want your loved one treated.
  3. BE KIND. Being in a hospital is your normal, as you are no longer fazed by the lights, the sounds, the machines, the masks, the equipment, the sterile fields. However, most people are not. Most people are scared of the unknown, scared of what could happen to them, scared of being alone. Be Kind, touch the back of their hand (even if you are wearing a glove), show compassion, show good eye contact, and although you can’t always reassure them with false hope, please show kindness with a simple gesture – tucking them in with a blanket, holding their hand, smiling with your eyes. I know you are busy, I know you are overwhelmed, but simple kind acts can turn a scary moment into something not-as-scary (still scary, but knowing that someone cares can mean the world). This is especially true if they are dying. Be Kind, as you may be the last person that touches them before they die.
  4. ADVOCATE. Advocate for comfort for the patient. Advocate for anything and everything palliative to keep that patient comfortable if they are dying. Morphine is great at controlling feelings of breathlessness. Use medications to help dry up secretions, use medications to help control anxiety. In the world of hospice, we have many tricks for controlling symptoms that are non pharmacological based, but in a hospital setting for COVID 19 patients, there might not be time to see if these work, so medications might be necessary to help control symptoms of the dying: pain, shortness of breath, anxiety, restlessness, terminal secretions. Speak up for comfort medications for your patient.
  5. DEBRIEF. Debriefing with fellow coworkers at the end of your shift is essential for maintaining your mental health, especially when you have had patients die during your shift. Hospice nurses help prepare family members and hospice patients for death. Sometimes we have months to prepare them, sometime we only have hours. Education and communication is key to helping loved ones with death – please know that preparing them doesn’t make things easier, but it does make it easier to accept, and makes it not-so-scary for the family members (and hopefully the patient). Debriefing with coworkers can help release any thoughts or feelings from within you. Keeping these unwell concerns within you will only cause them to manifest into other symptoms (anxiety, distress, sadness, illness). If coworkers are not able to help you debrief/destress from these death experiences, then find a friend you can open up with (be careful about HIPAA violations).
  6. DO THE RIGHT THING. We hospice nurses truly believe that things happen for a reason. There was a reason you were brought into that patient’s life, even if it is just for a shift, or just for a moment. Make that time count. Make that time matter. Be the good, be the kind, be the difference to help them have a peaceful, comfortable death (or at least work as hard as you can to provide them that peace).

Thank you, ICU and ER nurses and hospital staff for all that you are doing during this COVID-19 Pandemic.  We, hospice nurses, have also been busy with an increase in admissions during this time (mostly with the sudden increase in “pneumonia” in community patients who do not want to go to the hospital).  Together, we can all make a difference.  Bless you all.


Visit http://www.hospice-101.com for more information about hospice, and/or to access other hospice blogs and articles.

Published by TeriHospiceRN

The author is a dedicated RN with 8-years experience as a Hospice Nurse. She is a Certified Hospice & Palliative Nurse (CHPN) who is passionate about education, and providing compassionate end-of-life cares.

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