TRANQUILITYLIVINGCARE

Hospice:TranquilityLivingCare
CaitlinA.Martinez
CaliforniaStateUniversity,Stanislaus

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Hospice:TranquilityLivingCare
Intheworldtoday,hospiceseemstobemisunderstoodandlookedatinanegative
light.Manypeoplebelievethatwhensomeonegetsputunderhospicecarethattheyare
immediatelygoingtodieorthathospicewillmakethemdiesoonerthantheywouldif
notusinghospicecare.However,hospiceisaprogramthatprovidespeoplewhoare
dyingwithsupportivecareincludingphysical,psychological,spiritual,andsocialcare.
Hospiceprogramsareusedforpeoplewhocannotbetakencareofthroughcurative
means.Itisintendedtohelppeoplewhoaredyinglivecomfortablyandmaintainahigh
qualityoflifeupuntiltheypassaway.Inaddition,mosthospitalscannotprovideproper
palliativecareforpeopleintheirlastyearoflifeandmanypatientsprefertobecaredfor
athomeorinahospicefacility(Robinson,Gott,&Ingleton,2013).
Thehospicemodelofcareisverydifferentfromthecarethatisgiveninhospitals
andthesettingsdiffergreatly.Intheliteraturereview,Patientandfamilyexperiencesof
palliativecareinhospital:Whatdoweknow?Anintegrativereview,Robinson,Gott,
andIngleton(2013)explainedsomeofthemaindifferencesbetweenhospicesettingsand
hospitalsettings.Theseincludedsymptomcontrol,decisionmakingrelatedtopatient
careandmanagement,communicationwithhealthprofessionals,andtheenvironment.In
thehospitalsettingonly39%ofpatientsreportedhavingtheirpaincontrolledallofthe
time,whereasinhospice81%ofpatientsreportedhavingtheirpainmanaged(Robinson
et.al,2013).Painandthephysiologicalsymptomsassociatedwithdyingareoneofthe
mostimportantaspectsofhospicecareandarecriticaltomanageinordertoprovide

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patientswiththehighestqualityoflifeintheirlastyear.Inaddition,manyfamiliesinthe
hospitalsettingreportedhavingsymptomsofdistressthatwasuncontrolledandnot
addressedbythestaff(Robinsonet.al,2013).Manyhospicesprovidecounselingfor
familieswhoareexperiencinggriefandlossofalovedonewhiletheyareunderhospice
careandformanymonthsaftertheypassaway.Also,inthehospitalsettingmany
familiesfeltlikehealthcareprofessionalslackedcommunicationskillsbecausethey
explainedthingstothefamilyintermsthatwerehardtounderstandanddidntkeepthem
uptodateonthepatientscondition(Robinsonet.al,2013).Thisresultedinafalsesense
thatdeathjusthappenssuddenlyandthedoctorsdidntexplainthedeterioratinghealth
conditionsthepatientwouldexperience(Robinsonet.al,2013).Thisleftfamiliesfeeling
uneducatedandunpreparedforthedeathoftheirlovedone.Lastly,thehospital
environmentisnotperceivedasanappropriateplacetodiebecauseitistypicallynoisy,
busy,andlacksprivacy(Robinsonet.al,2013).Alloftheseaspectsareextremely
importantinmaintainingapatientswellbeingasawholeandtheyneedtobetakeninto
considerationwhendealingwithpatientswhoarenearingtheirlastyearoflife.
OnFebruary24th,2014,theauthorvisitedTranquilityLivingCare,anassisted
livingfacility,inOakdaleandshadowedanursefromCommunityHospice.Oneofher
patientsthatdaywas,B.M.,an86yearoldfemalewhoseterminaldiagnoseswereheart
diseaseandchronicpulmonaryobstructivedisease(COPD).B.M.alsohadahistoryof
osteoporosis,hypertension,neoplasmofthebladder,malignantneoplasmofthecolon,
andseniledementia.AccordingtoLiaoandAckermann(2008),approximately36%of
terminaldiagnosesarecardiacproblemsandabouthalfofterminallyillpatientshave

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cognitiveimpairments.Canceristhemostcommonterminaldiagnosis;however,in
B.M.scase,cancerisasecondarydiagnosistoheartdiseaseandCOPD.B.M.hadafall
lastweekandfracturedherrightwristandherrightproximalhumerus.Herwristwasina
softcastandherarmwasinasling.Herskinaroundthecastwasintactwithnoredness
andshewasabletowiggleherfingers.Inaddition,B.M.hadanonproductivecoughand
dyspnea.Shehadtostopoftenwhentalkinginordertocatchherbreath.HerO2
saturationwas86%;however,shedidnotwanttouseheroxygenandstatedthather
breathingwasnaturalandshestatedsheonlyusesheroxygenwhenIwanttogoout
somewhere.B.M.hadcoarserightlungsounds,ronchi,andherleftlungsoundswere
clear.Hervitalsignswere126/50forherbloodpressure,100forherpulse,and24forher
respirations.Shehadfaintpedalpulses,butherradialpulseswere+2bilaterally.In
addition,shehadsomegeneralizededemaandtraceedematoherlowerextremities.Her
lastbowelmovementwasonFebruary22andshewaseatingverywell,finishingalmost
100%ofhermeals.
B.M.seemstohaveseniledementia;however,sheisverypleasant,happy,and
content.TheauthorandhernursetalkedwithB.M.abouthowshewasfeelingandshe
statedthatshefeltwellandcouldcroakanydaynowasshelaughedandsmiled.She
saideveryonediesandthatitsanaturalpartoflifeandsheseemedveryintouchwith
realityandpreparedtopassaway.Shedoesntwantanymedicationsandwantstolether
bodydienaturally.Shestatedthatshedidntwantanyantibioticsandthatshebelieved
thatteawithhoneywouldhelpher.Herfamilybringsherhoneyoften,sothatshecanuse
itinhertea.B.M.wasalsopreoccupiedwithtellingusstoriesabouthowherhusband

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cheatedonherandtookherkidsandlefthim.Shetalkedabouthowheworkedhard
duringthedayandthenwenttobars,drankandscrewedthewomen.Accordingto
Neimeyer,Currier,Coleman,Tomer,andSamuel(2011),patientscansometimesbe
consumedbymisgivingsandshortcomingsintheirlives.AlthoughB.M.spokeofthese
shortcomings,shedidsowithasmileandlaughedaboutthemasifshewasreminiscing.
B.M.talkedofGodalotduringourconversationtoo,showingthatherspiritualitywas
intact.
Spiritualitycanplayanimportantroleinoneslifewhenoneisnearingdeath.
Patientswhoaremorereligiousreport"lessemotionalsufferingandgreateracceptance
ofdeath"(Neimeyer,Currier,Coleman,Tomer,&Samuel,2011).B.M.talkedabouthow
herlifeisinthehandsofGod.Hehasalwaysleadherdownthepathshewassupposedto
go.Hewastheonewho"toldher"totakeherkidsandleavehercheatinghusband.Her
husbanddiedafewweeksafterthatandshebelievedthatitwasinGod'splan.B.M.
seemedreadytopassawayandwascontentwithwhateverGodhadplannedforher.
TheauthorsnursetoldtheauthorthatB.M.usedtobeeverysocialbeforeshe
fracturedherwristandherarmthepreviousweek.Sheusedtogototheactivitiesand
talkwiththeotherresidents.Shewasambulatorywiththehelpofawalker;however,
nowshecannotuseherleftarmorhand,soshecannotuseherwalkerandshedoesnt
likeusingherwheelchairverymuch.Thishasconfinedhertoherroom,butsheisvery
talkativewiththehealthaidesandthenurses.Inaddition,herdaughterandher
granddaughterlivelocallyandcometovisitheroften.Shehasagoodsupportsystem,

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whichiswonderfulbecauseloveandsupportfromfamilyplaysakeyroleindealingwith
sufferingandlimitationsinthelastweeksandmonthsoflife(Neimeyeret.al,2011).
Thenursethattheauthorshadowedonthisdaywasabsolutelywonderful.She
haddevelopedarapportwithherpatientsbecauseshehasbeencaringformanyofthem
foralongtime.Shetookhertimewitheachpatientandreallylistenedtothem,talkedto
them,andassessedtheirneeds.Shemadeeachpatientfeelspecialandshedideverything
shecouldtomeettheirneeds.Herrolewastoassesseachpatientphysically,
psychologically,andspirituallyinordertodeterminehisorherneeds.Sheworks
togetherwithsocialworkers,doctors,healthaides,chaplains,occupationaltherapists,etc.
inordertoprovidethepatientswiththeservicesthattheyneed.Oneofhermainfocuses
ispainmanagementandshedevelopstheplanofcareforthepatient.Shealsocallsallof
thefamilieseverydaytocheckinwiththemandupdatethemontheconditionoftheir
lovedone.
Overall,theexperiencewithCommunityHospicewaswonderful.Theauthor
learnedalotabouthospiceandwhathospicenursesdoandhowtheyworkwithothersto
providethebestqualityoflifeforterminallyillpatients.Themostimportantthingthe
authorlearnedwasthatnoteveryoneunderhospicecareismiserableandscaredor
anxious.Manypatientshaveaccepteddeathandareverycontentwiththeirlife.Theyare
happylivinginthemomentandarereadytopassawaywhenitistheirtime.Itisnt
alwaysdepressingandittakesaspecialnurse,liketheonetheauthorwasshadowing,to
makethingslighthearted,enjoyable,andrewarding.

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References
Liao,S.&Ackermann,R.(2008).Interdisciplinaryendoflifecareinnursinghomes.
ClinicalGerontologist,31(4),8396.doi:10.1080/07317110801947201
Neimeyer,R.A.,Currier,J.M.,Coleman,R.,Tomer,A.,&Samuel,E.(2011).
Confrontingsufferinganddeathattheendoflife:Theimpactofreligiosity,
psychosocialfactors,andliferegretamonghospicepatients.DeathStudies,35,
777800.doi:10.1080/07481187.2011.583200
Robinson,J.,Gott,M.,&Ingleton,C.(2013).Patientandfamilyexperiencesofpalliative
careinhospital:Whatdoweknow?Anintegrativereview.PalliativeMedicine,
28(1),1833.doi:10.1177/0269216313487568

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