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  Vol. 21, No. 17  Previous Table of Contents Home  Next September 15, 1999 

Hospice Care
`It's About Changing Direction'


by ROGER WIDMEYER
Texas Medical Center News

Hospice, a word which comes for the Greek word for hospitality, is not so much a place as it is a philosophy of patient care. Hospices as places do date back to medieval Europe when they served as rest sites for tired or lost travelers, the sick, women about to give birth - and the dying.

"Today, it's both a concept and a place," says Brandy R. Hicok, R.N., vice president of patient services at The Hospice at the Texas Medical Center.

The Hospice opened in 1983 and is one of about 40 hospices in the Houston metropolitan area. The Hospice at the Texas Medical Center cares for 160-170 patients per day, over 12,000 annually.

"The hospice concept can be a difficult one for some care givers in acute care settings," says Hicok, who also possesses a bachelor's degree in nursing. "I came to hospice care from an acute care background," she says. "And an important reason I left that setting was my dissatisfaction with the way death was approached. There was a reluctance in many of my co-workers to discuss the fact that the patient was not going to make it, was not going to be cured."

Hicok and her colleagues in hospice care frequently use the word `transition' to describe the mission of their work with patients and families. Hospice care marks a transition from the health care team's efforts at curing a disease to a new period of providing pain relief and emphasis on quality of life for the patient and family. The hospice patient care team includes physician, nurse, social worker, chaplain and volunteer.

"It certainly is not about `giving up.' It's about changing direction," says Hicok. "And in most cases, there is a sense of relief, for both the patient and the family. Our emphases are different than the acute care setting."

Pain relief is the immediate priority. Each member of the hospice team is committed to pain relief because it is difficult to imagine any meaningful quality of life without relief from pain. "We have patients come to us in acute pain, and sometimes with multiple sources of pain," says Hicok. There is the source of pain from the disease itself, and there can be severe headaches, muscle ache, stiffness, constipation, bedsores.

"We listen very carefully to what our patient says the needs are, and we medicate accordingly. There remains, unfortunately, quite a bit of stigma about pain medication," says Hicok. "In hospice care, we discuss the need for pain relief with the family and we can teach them to administer medications."

The family is a critical part of the hospice team: over 90 percent of hospice care is provided in the patient's home or family member's home.

"As a nurse, hospice care calls for all my skills in assessment," says Hicok. "Importantly for me - and, I think, for anyone involved in hospice care - is also the role of patient advocate. Frequently, patients can feel as if they have no voice, that decisions are being made without their input."

Typically, Hickok says, someone in the family will begin to take a leadership role, because the family will also have urgent needs. The hospice team will offer support, and they will listen. Frequently, the family dynamics become central in the overall patient care. The patient and one or more members of the family may have unresolved conflicts; there is a real need to resolve these.

"When the patient's pain is being managed, there will be several escalating needs to address. A spiritual need, for example. At these phases, we want to have the right person from the team in place.

"During the process of letting go, the patient's world can become smaller, more focused."

When Brandy Hicok was just 3 years old, her father was in a terrible automobile accident. He remained in a coma for six years, dying when Brandy was 9. "Oh, I'm sure that had an enormous effect on me, and I'm in the health care field because I'm most comfortable caring for people - as we did for him.

"But each hospice patient is very unique, and it is a very special and unique setting - whether it's home or here at the Hospice at TMC. And in every case I think the team members experience self-discovery. I know I do. And I become more committed to being an advocate for patient and family, for their safe passage from this life."

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