Wednesday, April 27, 2016

A Deeper Dive into the Interventions: Part 2

A Deeper Dive into the Interventions: Part 2


“Offer reassurance”…sounds simple enough…say a few kind words and all is accomplished…or is it?


Offering reassurance is like a many faceted diamond.  Assuring a patient they are forgiven by God is one example.  Another example is offering reassurance to a patient with dementia who responds to “God loves you”, “You matter”, “You are safe”, or other affirmations of personal worth.  Words filled with encouragement and support are what we mean by offering reassurance.


Let’s face it, our patients are near their last day, last hour, last minute of life.  Some are fearful, anxious, troubled, guilty, shame-filled, in need of kind words.  A hospice patient goes through a lot before they become a hospice patient.  They have been ill for some time, they haven’t felt well, and to top all of this off, like a wrecking ball comes the terminal diagnosis from the physician that they have 6 months to live.  The reaction of the patient to this devastating news is called “the existential slap.”  In the International Journal of Palliative Nursing (November 2004, Vol. 10 Issue 11, p520) Nessa Coyle pens an article that focuses on the psychology of patients when a physician discloses the diagnosis of a life-threatening illness. The usual habit of allowing thoughts of death to remain in the background is now impossible. Death can no longer be denied. This awareness precipitates a crisis for most individuals, who are suddenly faced with addressing and most likely rearranging, their priorities in the time they now anticipate is left. The "existential slap," occurs when the reality and inevitability of one's own personal death sinks in. (Abstract to the article)

Following this diagnosis a recommendation to hospice is made.  In a flurry of activity the patient and family is met by an Admissions Nurse for a 3 hour meeting to enroll the patient in hospice followed by the Case Manager/Nurse, Social Worker, and Chaplain all within a 5 day Medicare mandated window.  Is it any wonder that one of the key personality traits we look for in hospice Chaplains is compassion?  The patient is reeling from the diagnosis of 6 months to live and is thrown into an environment they are totally new to and may never have heard of before or at least not understood. 


Without question, our patients need reassurance. 

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