Hospice program helps dying patients

The Hospice program at St Luke’s Hospital Center in New York City helps terminal cancer patients with the problems brought on by illness and impending death. Using a continuing system of social service, nursing, medical, and spiritual supports, the interdisciplinary Hospice team has, since 1975, helped over 150 cancer patients and their families deal with their disease and the crisis of impending death. The team includes a full-time nurse-coordinator and seven parttime members-a medical director, social worker, chaplain, three psychiatrists, and two nurse-clinical specialists as well as volunteers. The Hospice program draws its basic tenets from the British physician Cicely Saunders, MD, who established St Christopher’s Hospice in London to provide skilled and humane care to the terminally ill. St Luke’s director of religious services, Carleton Sweetser, suggested implementing a similar program at the medical center after meeting Dr Saunders and later touring St Christopher’s. Often conflicting with the traditional belief that hospitals are curing institutions, the Hospice program recognizes that “nothing should be done to prolong life after a certain point and that everything should be done to improve the quality of life that remains.” The team therefore concentrates its energies in the area of reducing pain and easing anxieties and stress. Team members agree that use of sophisticated equipment and treatment techniques should be discontinued when there is no

hope of recovery. The use of artificial means to prolong life, attending surgeon Carl Oakman, MD, states, has led to a “gradual erosion of the comprehension of the sick as a person and the dehumanization of care.” Hospice encourages home care for terminally ill patients for as long as it is possible, but when readmission is necessary, team members are ready to provide continuity of care, counseling, and support. Perhaps the most controversial aspect of the Hospice program is its routine use of analgesic drugs to control the patients’ often intense pain. The team believes that the patient’s expectation of pain produces anxiety, which in turn compounds his pain. Therefore, pain-killing drugs-usually morphine or methadoneare administered at regular intervals to keep the patient pain free and alert. Team members use the stages of psychological response to dying-denial, anger, bargaining, depression, and acceptandetailed by Elisabeth Kubler-Ross, MD, to meet their patients’ emotional and psychological needs with compassionate realism. They do not delude their patients of the fact they are dying of cancer. Jane Looney, RN, nurse-clinical specialist, says, “We think that the opportunity to discuss the extent of their illness often helps patients accept their fate more peacefully, and we do not evade such topics. We are also very conscious of the crucial role of family and friends in the care of the terminal patient and enlist their active participation.” Team members receive emotional and

AORN Journal, July 1977, Vol26, No 1

23

personal support from once-a-week “feeling sessions,” impromptu one-teone chats, and regular prayer meetings for those who are religiously inclined. At feeling sessions, team members share personal reactions and work out difficulties they may be encountering. Nevertheless, project coordinator Roberta Paige points out, “you can go to endless workshops but to sit with a patient who is bleeding to death is difficult . . . . it hurts to see the anguish it causes the relatives.”

A spokesman for St Luke’s notes that the hospital’s Hospice program “is the first such program to be developed at an acute care general hospital” in the United States. St Luke’s has received many requests for training programs, lectures, and guidance from other hospitals interested in the program. Representatives of these hospitals have also visited the Hospice at St Luke’s. As a result, similar programs are being established in hospitals throughout the country.

Child abuse services lag behind laws

involved or control of punishment of deviant behavior. Consideration of whether to apply compassion or control starts with the nature of the injury to the child. The report provides guidelines as to whether to help the family or call in authorities. Dr Rosenfeld is with the child psychiatry unit, Naval Regional Medical Center, Portsmouth, Va; Dr Newberger is with Harvard Medical School and Children’s Hospital, Boston.

Services available to abused children have not kept pace with the intent of child abuse legislation, according to a report in the Journal of the American Medical Association. Alvin A Rosenfeld, MD, and Eli H Newberger, MD, note that within the past decade, child abuse laws have changed to indude virtually all childhood physical symptoms of family crisis. Physical, sexual, and emotional abuse and child neglect can now be reported by nearly all professionals who have contact with children. “There has been a dramatic increase in case reports, but the services for which families become eligible do not approach the humane rhetoric and intent of child abuse legislation,” Drs Rosenfeld and Newberger state. In 1967, fewer than 7,000 cases of child abuse came to the attention of the authorities, while in 1974 there were more than 200,000. Social workers in child welfare departments are overworked, underpaid, and poorly supervised and have insufficient access to psychiatric, psychological, and medical consultation and treatment. Staff turnover in these departments is enormous, and the prospects for continued service to a troubled family is small, the researchers note. An increased understanding of child abuse has enabled practitioners to think of parents of abused children as human beings caught in a complex web of social isolation and deprivation. Drs Rosenfeld and Newberger state there are two basic aspects of dealing with child abusecompassion for the family

24

ACOG commission on maternal health The American College of Obstetricians and Gynecologists (ACOG) Health Care Commission has earmarked as its current number one concern ACOG’s participation in development of a national policy related to maternal and child health. The commission has appointed a task force on national maternal health policy to develop “recommendations, in light of previous College statements and the present public dimate, for a national maternal health policy as it might be affected by services, availability, quality of care, costs, patient expectations, and environmental factors influencing the outcome of pregnancy.” Task force recommendations were presented in May. A second task force on national health care legislation will consider legislation in light of these recommendations. Other priority areas marked for task force attention include assessment of clinical competence and evaluation of quality care and regional planning.

AORN Journal, July 1977, Val 26, No 1

Hospice program helps dying patients.

Hospice program helps dying patients The Hospice program at St Luke’s Hospital Center in New York City helps terminal cancer patients with the proble...
150KB Sizes 0 Downloads 0 Views