Paper
Thursday, July 22, 2004
A Model Hospice
Jeanie Kayser-Jones, RN, PhD, FAAN, Alison Kris, RN, PhD, and Diane L. Norcio, RN, MS, MPH, GNP. School of Nursing, University of California San Francisco, San Francisco, CA, USA
Objective: To identify, describe, and analyze factors that influence the care of terminally-ill nursing home residents. Design: An ethnographic, anthropological study. Population: Terminally-ill (primarily indigent) residents on a 30-bed hospice unit, in a city and county long-term care facility. Data were collected over a two-year period. Concepts Studied: Communication and quality of care. Methods: Participant observation and event analysis. Findings: The philosophy of the interdisciplinary team (nurses, hospice physician, social worker, activities director, spiritual coordinator, grief counselor, and volunteer coordinator) was “To meet the physical, psychological emotional, social and spiritual needs of the terminally-ill residents and their families.” The hospice unit was seen as a therapeutic community; residents and their families were an integral part of the community. Every symptom (e.g., pain, dyspnea, fear, sleep, anxiety) was assessed, treated, and monitored on a daily basis. A major goal of the hospice team was to help residents live their lives fully and meaningfully. Brief case studies illustrate how staff achieved this goal. Memorial services were held every three months to show respect for those who died and to help families deal with their grief. Residents and families reported a high level of satisfaction with care, and families returned, sometimes months and years after the death of a loved one, to visit the staff and participate in the activities on the unit. Conclusions: When a hospice care team has and implements the philosophy that every member of the team is of equal value and essential to meeting the physical, psychological, emotional, social, and spiritual needs of terminally-ill people, excellent care is provided. Implications: Lessons learned from our observations of the care provided on this model hospice unit could have a great impact on improving the care of terminally-ill patients regardless of where they die, in their homes or in an institutional setting.
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Sigma Theta Tau International
July 22-24, 2004