As we have been learning Community Health Nurses (CHN) can practice in a variety of settings. One of these setting includes Hospice Home Care. Hospice nurses help to improve the quality of life of terminally ill patients. Patients can be admitted into hospice care when they have 6 months or less to live. Hospice care focused on comfort rather than curing a patient’s illness. Patients can receive hospice care in the hospital, at home or at a hospice facility. As a CHN it is important to perform a thorough assessment to address the patient and family needs. “Caring for the terminally ill person at home demands that the nurse view the family system as a unit” (Nies, 2019, p. 683). It is also important for the hospice nurse to assess the ability and state of the primary caregiver as caregiver burden is a real concern as they can be at risk of getting ill as well or having a mental breakdown from the stress of caring for their loved one.
The initial assessment by the hospice nurse includes evaluating the patient’s functional abilities, conducting a health history and physical, determining which medications will benefit the patient, finding out what the goals are for the patient and the family (including the primary caregiver), helping the patient utilize coping strategies and determining what their emotional state is in regards to their prognosis and imminent death.
Levels of prevention include primary, secondary and tertiary. Primary involves preventing diseases or illnesses, secondary prevention includes detection and intervention and tertiary helps correct and prevent deterioration of illness or disease. Pain control for the hospice patient would be considered a secondary level of prevention. Assessing and managing pain experienced by the hospice patient is an important role of the hospice nurse. The nurse needs to perform a thorough individualized pain assessment and administer pain medications to keep the hospice patient comfortable until their death. “Individual patient pain management goals are crucial in pain assessment and management practices because it ensures that patients and those in their support system are engaged as partners in their care” (Miner, Stephens, Swanson-Biearman, Leone, & Whitman, 2018). Every person experiences pain differently and this is something that the nurse needs to remember and be able to work with the patient and the family to provide adequate pain relief.
Miner, M., Stephens, K., Swanson-Biearman, B., Leone, V., Whiteman, K. (2018). Enhancing cancer pain assessment and management in hospice. Journal of Hospice and Palliative Nursing, 20(5), 452-458. DOI: 10.1097/NJH.0000000000000467
Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier