Healing With a Hospice Heart

When Jenn Weirich, BSN, RN, CHPN, WTA, was starting her healthcare career as a nursing assistant at a skilled nursing facility, she was told by a hospice team member that she had a “hospice heart.”

“She said, you have a hospice heart, our team has an opening, and I think you should apply,” Weirich recalls. “That’s when I fell in love with the hospice nursing specialty.”

To Weirich — who now has 16 years of hospice experience — a hospice heart means “having a lot of compassion and empathy and providing patients the comfort they need in the moment they need it.”As assistant nurse manager at the Cleveland Clinic Justin T. Rogers Hospice Care Center, she says that may be quietly sitting at a patient’s bedside so they aren’t alone or allowing extra time for someone to feed themselves even though they lack the physical strength to do so.

“I ask every patient if there’s something I can do for them or something I should know about them to provide the best care,” Weirich shares.

Once, she and her colleagues had a horse brought to a patient’s window. Another time, she made a special run for a French vanilla latte. “I’ll do whatever it takes to offer peace, comfort and quality of life to someone in the final chapter of their journey,” she admits.

Comfort focused, quality-of-life care

Although hospice care is a specialty within end-of-life medicine, a person doesn’t need to be actively dying to receive it. “A common misconception about hospice nursing is that the care provided is only for patients who have only hours or days to live,” Weirich says. “Any patient with a prognosis of six months or less can benefit from it.”

She adds, “Some patients are going through terminal illness and still drive and work. Others have young children and want to be with them for as long as possible so we do everything we can to keep them home where they want to be and get them to all the special events like dance recitals and ball games.”

Unlike other nursing specialties, which are centered on improving health and curing illness, hospice care is comfort focused. When British nurse and social worker Dame Cicely Saunders established the modern hospice movement, she did so on the notion that the traditional medical model wasn’t the best approach for those facing terminal illness. Instead, she proposed care that prioritized comfort and quality of life.

“Hospice nursing is unique because while we’re switching gears from the saving lives mentality, the intensity of care remains,” Weirich explains. “Balancing quality of life and comfort through the duration of one’s time can be challenging for the patient, family and clinician.”

She adds, “We all come into the world with a labor, but we also leave with a labor — and that process requires just as much support to get through.”

A highly coordinated interdisciplinary team

Achieving the highest level of care takes a full team of professionals. “There’s emotional, spiritual, social, bereavement, dietary and other needs,” Weirich says. “We treat the whole patient, not just the symptom.”

Hospice care today includes four levels:

• Routine care for patients who reside at home or in an extended care, assisted living or hospice facility.
• Continuous care where caregivers increase visits to a patient in response to condition changes that require more intensive symptom management and frequent assessment.
• Respite care that is available when a patient’s at-home caregiver needs a temporary break from their caregiving duties.
• General inpatient care for those who cannot manage their illness in a home or routine care setting, requiring specialized care provided by licensed professionals.

Cleveland Clinic’s 26-bed Hospice Care Center is one of the only facilities in the area to provide routine, respite and general inpatient care. With a census of 300, most Cleveland Clinic patients receive care from field caregivers in home, assisted living or extended care settings.

“Our Center works closely with the field team,” explains Weirich. “We often provide short-term general inpatient care for people who later return home, we help with respite care needs, or we coordinate the transfer of patients to live in our facility when the burden of home care becomes too much.”

Hospice coordinators, who are embedded throughout Cleveland Clinic’s hospitals, identify potential hospice patients, support discharge planning and provide care to those who remain in the hospital to receive general inpatient hospice care. Volunteers, many of whom are former hospice family members, are also vital members of the team, supporting patients and families in countless, meaningful ways.

Meeting people where they are

According to Weirich, exceptional hospice nurses possess compassion, patience and adaptability. “Skills can be taught and experience can be gained, but at your core you need to listen, be intuitive and adapt to do justice to your patients and their families,” she suggests.

Weirich touts these traits for one primary reason — hospice nurses must meet patients where they are in their disease process to properly care for them and guide them and their families through unknown situations.

“For one person, it may be a surprise process and they’ve decided to forgo aggressive treatment, someone else might have fought so hard for so long and they are tired, others have lived long lives, but just can’t sustain any more,” she explains.

The emotional toll can be significant. “Sometimes it’s harder for family members than patients,” Weirich says. “They get this devastating news that they didn’t see coming and they need to process those emotions with you until they eventually come to a point of understanding and acceptance.”

Through the years, Weirich has learned that to continually pour into others, she must fill her own cup. “Tissues are a must,” she admits. “I’ve held a lot of hands, given a lot of hugs and I have my phone-a-friend on speed dial when I need to decompress.”

Cleveland Clinic’s Caring for Caregivers service platform, which offers short-term counseling and other support, has proven advantageous for many caregivers. Nurses also benefit from bereavement, chaplain and massage therapy services, team remembrance ceremonies and more.

“We have a great support system at Cleveland Clinic,” Weirich says. “There are many opportunities to talk about patients we’ve cared for and lost or to release emotion that we build up. It’s very important for hospice nurses to do that.”

Meaningful rewards

While it remains that most professional nursing careers focus on cure and treatment, Weirich stresses the important need for hospice nurses. “Unfortunately, at some point, hospice care is appropriate for everybody,” she notes. “We need to service this very special population of people and it takes very special nurses to do that.”

For a brief period, Weirich stepped away from hospice nursing. “I tried other things to make sure this was where I belonged, and I’ll never regret coming back,” she admits. “It’s an honor to serve this community.”

With resolution, she considers her career decision to be one of the most meaningful of all her life’s choices. “Hospice nursing makes you live differently,” she reflects. “You appreciate things differently, value things differently and see things differently. It’s incredibly humbling to be part of such an intimate and precious time in someone’s life.”