Wednesday, April 18, 2007

Hospice Care and Pain Management

As a hospice volunteer in urban nursing homes, I have seen dying patients in little or no pain. When cure was no longer the focus, the dying process, with its naturally evolving symptoms, was facilitated in a manner that brought beauty to their personal letting go. Death came with perfect closure to life.

But I have also witnessed patients in pain. In a study reported in a 2006 “Journal of Pain Symptom Management,” severe pain was reported at least once by 20.3% of 156,887 hospice patients, although overall pain was mild. A 2006 report in “The Gerontologist” states the obvious regarding pain management in nursing homes: “Care is dependent upon the context in which it is provided.”

I have concluded from my own observations and readings that the certainty of hospice care providing a pain-free, end-of-life experience is increased significantly when several safeguards are in place:

1) Appropriate pain medication and management procedures must be prescribed by a doctor with expertise in this area. Really listening to feedback of patients regarding their pain is crucial. Patients need others to advocate for them when their pain is under treated.

2) Medical personnel must be knowledgeable in how to implement appropriate pain management procedures that the doctor prescribes. This includes informing CNA’s (nurse assistants) of their roles related to the hospice philosophy and pain management. Like any other important procedure, pain management requires ongoing monitoring and adjustment, particularly when staff attendance and schedules are irregular.

3) Attitudes of everyone, including doctors, regarding how pain is being treated must be explored honestly. Staff education on transitioning from a total focus on cure to one of non-curative quality of life must also be addressed. In addition, some families need help in understanding that chronic severe pain is not a necessary part of dying. Ultimately, everyone involved in hospice care must be committed to pain-free death journeys.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

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