The home care nurse

Fear of the unknown is one of the most debilitating symptoms suffered by cancer patients and their relatives. Helping people to understand their illness, how it is likely to affect their lives and how pain and other symptoms can be controlled over the weeks or months ahead, are just some of the tasks undertaken by hospice home care nurses.

There are six hospice-trained nurses working with the Malta Hospice Movement. They liaise with GPs, hospital consultants or other professionals, who have referred their patients to hospice services. These services will enhance their quality of life and bridge any gaps in their continuing care.

With the best will in the world, doctors often simply do not have the time to devote to listening to patients beset with all kinds of worries and anxieties. "What symptoms will I suffer during the course of my illness?" "How will we cope if mother dies at home?" "What if Dad is in pain? What can I do?" "She is taking morphine. Does that mean the end is near?"

Hospice services

The hospice nurse will take the time to listen carefully to these and many other questions. She will try to help answer them and to allay fears and anxieties. She will build up a relationship of trust with patients and their families.

As the illness progresses she will be able to pre-empt certain difficulties and will offer other hospice services, such as day care or hydrotherapy, if they would like this and if it is appropriate. Often patients appreciate having the use of special items of equipment which Hospice makes available to them.

These could be a wheelchair, a special bed or mattress, or many other aids, which can do so much to enhance daily living and help the patient to remain at home.

Often, too, people who have been newly diagnosed have the same need to talk and express their worries. Again, the Hospice nurse can offer this support and can discuss with them what is happening at this difficult time. It maybe all that they need at this time and all that is appropriate.

Adapting to needs

The hospice home care nurse adapts the way she works according to the circumstances and the area she is working in. For instance she may have to cope with patients who live alone and in bad housing conditions. Or she may be able to count on a caring family to step in and help.

Hospice/palliative care focuses on individual needs and so the hospice nurse attaches great importance to identifying these needs in the way the patient experiences them and not so much as others may perceive them.

The needs may be practical ones, or they may be of a psycho/social or spiritual nature. The nurse knows that she can call on her colleagues on the hospice multidisciplinary team to help her address these issues. The multidisciplinary team approach is characteristic of palliative care and it is probably the best means of achieving its goal, of providing 'Total Care'.

Personal experience

Jenny is a nurse on the hospice home care team. She knows from personal experience the fear and helplessness faced by cancer patients and their families. "My own mother was told she had breast cancer the day I took on my job here, and before I knew much about hospice services," she said.

"I realised how important it is for relatives to be able to comfort their husband, wife or parent by explaining what kind of treatment they will be having and how it will make them feel."

Jenny and the other nurses on the home care team get on well together, supporting each other when there are problems, talking over difficulties faced by their patients and suggesting ways to help.

They work closely with the other members of the team, devising 'care plans' together. They work hard to visit between 10 and 20 patients each per week, if possible and appropriate - and in some cases they would visit every day. From January to May this year they carried out some 660 visits.

Support in bereavement

Coping with bereavement is another important part of the home care nurse's work, when that is appropriate. The Malta Hospice Movement offers a bereavement support service on a one to one basis or in group therapy sessions.

Why do Jenny and her colleagues choose this type of nursing? They are all fully qualified and could work in many other fields of medicine. "Because," Jenny says, "as a hospice nurse, you really feel you are giving the best you can. You have more time to spare and more knowledge to share, so you can give much more."