Hospice
Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person's goals.
In France however, the word hospice refers more generally to an institution where sick and destitute people are cared for, and does not necessarily have a palliative connotation.
Compared to general healthcare providers, hospice professionals take a different approach to talking to people and their families.
[5] They are more likely to make predictions or express uncertainty around future events (e.g., "He might die this week" or "I think she might live longer") than to issue orders or prescribe actions (e.g., "She needs a nurse" or "He can't go home").
[5] The word hospice derives from Latin hospitum, meaning hospitality or place of rest and protection for the ill and weary.
[1] Historians believe the first hospices originated in Malta around 1065, dedicated to caring for the ill and dying en route to and from the Holy Land.
[11] Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, which by 1892 offered 35 beds to patients dying of tuberculosis.
[11] Four more hospices were established in London by 1905,[11] including the Hostel of God on Clapham Common founded in 1891 by Clara Maria Hole, Mother Superior of Sisterhood of St James' (Anglican) and taken over in 1896 by the Society of Saint Margaret of East Grinstead.
Saunders was a British registered nurse whose chronic health problems forced her to pursue a career in medical social work.
[16] Saunders emphasized focusing on the patient rather than the disease and introduced the notion of 'total pain',[17] which included psychological and spiritual as well as physical discomfort.
[22] At about the same time that Saunders was disseminating her theories and developing her hospice, in 1965, Swiss psychiatrist Elisabeth Kübler-Ross began to consider social responses to terminal illness, which she found inadequate at the Chicago hospital where her American physician husband was employed.
[23] Her 1969 best-seller, On Death and Dying, influenced the medical profession's response to the terminally ill.[23] Dr. Balfour Mount introduced the concept of palliative care to Canada in the early 1970s and established the first hospice program at the Royal Victoria Hospital in Montreal, laying the foundation for modern palliative care practices.
[26] IAHPC founding member Derek Doyle told the British Medical Journal in 2003 that Magno had seen "more than 8000 hospice and palliative services established in more than 100 countries.
[28] As of 2009, an estimated 10,000 programs internationally provided palliative care, although the term hospice is not always employed to describe such services.
Hospice was the subject of the Netflix 2018 Academy Award–nominated[31] short documentary End Game,[32] about terminally ill patients in a San Francisco hospital and Zen Hospice Project, featuring the work of palliative care physician BJ Miller and other palliative care clinicians.
[41] Hospice Africa Uganda (HAU), founded by Anne Merriman, began offering services in 1993 in a two-bedroom house loaned for the purpose by Nsambya Hospital.
[43] The government of Uganda published a strategic plan for palliative care that permits nurses and clinical officers from HAU to prescribe morphine.
[44][45] After meeting Kübler-Ross, Mount studied the experiences of the terminally ill at Royal Victoria Hospital, Montreal; the "abysmal inadequacy", as he termed it, that he found prompted him to spend a week with Cicely Saunders at St.
Given differences in medical funding, he determined that a hospital-based approach would be more affordable, creating a specialized ward at Royal Victoria in January 1975.
[45][46] Canada's official languages include English and French, leading Mount to propose the term "palliative care ward", as the word hospice was already used in France to refer to nursing homes.
Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four-hour/seven-day-a-week access to care, and support for loved ones following a death.
Florence Wald, Dean of the Yale School of Nursing, founded one of the first hospices in the United States in New Haven, Connecticut, in 1974.
[4] The first hospital-based palliative care consultation service developed in the US was the Wayne State University School of Medicine in 1985 at Detroit Receiving Hospital.
In 1993, President Clinton installed hospice as a guaranteed benefit and an accepted component of health care provisions.
[52] As of 2017[update], 1.49 million Medicare beneficiaries were enrolled in hospice care for one day or more, which is a 4.5% increase from the previous year.
Nevertheless, hospice and palliative care provision in Egypt is limited and sparsely available relative to the size of the population.
[60] Key efforts made in the past 10 years have been initiated by individuals allowing for the emergence of the first non-governmental organisation providing primarily home-based hospice services in 2010,[61] the opening of one palliative medicine unit at Cairo University in 2008 and an inpatient palliative care unit in Alexandria.
[63] More than two decades later, a 2016 study found that 46% of the general Israeli public had never heard of it, despite the 70% of physicians who reported that they had the skill to treat patients according to palliative principles.
Most nurses will work with a team that includes a physician, social worker and possibly a spiritual care counselor.
The nurse will need to explain to the patient and family that a pain-free death is possible, and scheduled opioid pain medications are appropriate in this case.
