History of Hospice Nursing
Modern hospice nursing has existed for only about 50 years. In this time; however, the hospice movement has grown to a global entity. Hospice helped to develop new patient-care models, which complemented the traditional hospital-based care model. More importantly, the hospice movement helped to usher in a new understanding of death.
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History
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The term "hospice" originated in the Middle Ages, according to Lewis Aiken in "Dying, Death, and Bereavement." It referred to a place where "pilgrims were fed and sheltered on their way to the Holy Land." However, the modern hospice movement traces its roots to Dame Cicely Saunders. According to Martha Twaddle in "Dignity and Dying," by the 1950s, Saunders realized that there was a "gross divergence" of care given to the curable and to the dying. Saunders conceptualized a type of patient care which emphasized pain management, whole-patient care and quality of life. Implementing this vision, she opened London's St. Christopher's Hospice in 1967. By 1974, hospices opened in New York and Connecticut.
Significance
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The hospice movement represented a new perspective toward death. Traditionally, doctors and nurses are trained in curative therapy and rehabilitation, according to Aiken. Many traditional health care professionals see hospice as an overly romantic notion of death and dying. However, the role of the hospice nurse is to help the patient deal with the dying process. The hospice nurse does not work to prolong life, but to enrich the life that remains, according to Kenneth Cohen in "Hospice: Prescription for Terminal Care."
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Features
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The hospice nurse has always placed a high priority on the symptoms of pain, according to Twaddle. Cicely Saunders spoke of "total pain." Traditional nursing emphasizes on the relief and cure of physical pain. Following Saunders, hospice nurses recognized that along with the physical pain related to the illness, there were psychological, spiritual and social aspects with which they had to contend. To manage this type of multidimensional pain, Saunders constructed the hospice team, which consists of nurses, physicians, social workers, chaplains and volunteers. Today, hospice is recognized, according to Lenora Paradis in "Hospice Handbook," as a "medically directed, nurse coordinated program" providing a continuum of home and inpatient care or the terminally ill patient and his family. It employs an interdisciplinary team acting under the direction of an "autonomous hospice administrator."
Effects
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With its emphasis on pain management, the hospice movement generated the specialized field of "Palliative Care," according to Twaddle. Generally, the terms "hospice" and "palliative" care are somewhat interchangeable around the world. In the United States, palliative care can be applied to non-terminal and terminal patients.
Theories/Speculation
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Many social historians point out that the hospice movement was part of a new school of thought regarding death. Dr. Elisabeth Kubler-Ross, a contemporary of Saunders, produced landmark studies on terminal patients. She developed the theory that death is a process with distinct stages. Her book "On Death and Dying" was published in 1969 and reprinted many times. Due to its popularity, Kubler-Ross' work helped the hospice movement gain acceptance with the public. Moreover, the work helped to create functional frameworks the hospice nurse could draw upon to gain a better understanding of the circumstances of a dying patient.
Considerations
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Twaddle points out that the hospice nurse, from the beginning, has had to face the challenge of combining "a big-picture perspective with an attention to detail." Unlike traditional nursing, where the nurse is an extension of the doctor's voice, the hospice nurse often functions as the "voice" of the patient and the family. The nurse keeps the physician informed as to the patient's condition, makes suggestions for the patient's comfort and tries to ease the stress on the family. Therefore, within a short history, the hospice nurse has developed into a viable and singular entity in the health care field.
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References
Resources
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