Finding Peace in Hospice and Palliative Care 

I will keep them in perfect peace whose minds are stayed on thee (emphasis supplied).  Isaiah 26:3 

When we think of Hospice and Palliative care our minds immediately revert to fear, worry, anxiety and hopelessness.  This is true, however, there are some unique individuals and unique situations that transcend circumstances such as the one described in the following story:  

I once encountered a man who had brain cancer.  He was placed on hospice care, but refused to lie down in bed and wait for death.  He instead was up preaching and telling everyone whom he encountered about the “Peace” that he was experiencing as he had placed his trust in God.  His famous words were: “I am at peace with God and Man.  Therefore, I am teaching people how to die without fear, but with hope, joy and peace.”  I thought, what a man, what a story to share with the world during this difficult time? 

Faith Community Nurses (FCNs) share this same hope.  We are in a unique position to prioritize patient dignity and well-being when we incorporate the PEACE model into the daily lives of individuals experiencing hospice and palliative care.  PEACE stands for Presence, Empathy, Advocacy, Comfort, and Education.  These principals allow FCNs to deliver compassionate, faith-centered and wholistic care to individuals and families in this setting. 

It would be beneficial and productive for us to familiarize ourselves with the timeline and processes of end of life that patients may experience:  

One to three months prior to the end of life.  

Patients may become more withdrawn, less active, less communicative, and possibly even more introspective during this time. They may also experience the following: 

• Decreased appetite, showing a lack of interest in eating 
• Increased sleepiness, showing a growing desire for sleep 
• Increased sense of ambivalence to people or the environment around them  
• Increased pain and nausea 
• Increased risk of infections 
• Noticeable loss in weight  

One to two weeks prior to the end of life.  

It is not uncommon for patients at this stage of the hospice end-of-life timeline to have trouble in taking oral medications or hydration. Patients may also lack the will or energy to get out of bed. They may also experience the following: 

• An even greater desire to sleep 
• Perhaps stopping all eating  
• Increased restlessness 
• Increased congestion 
• Increased levels of confusion 
• Increased hallucinations or visions, often involving loved ones who have passed 
• Changes in vitals such as temperature, respiration, pulse, and blood pressure 

Days or hours before the end of life.  

During this time it, you may notice a Death Rattle or that their skin, particularly on their hands and feet, has become increasingly mottled and blotchy.  

• May experience a sudden and brief surge of energy 
• Blood pressure may continue to decline 
• Breathing may become erratic  
• Hands and feet may become cold, purple, and/or blotchy 
• Pulse will weaken 
• Eyes may become glassy or teary, or only be half open 
• Urine output may decrease  

Minutes until the end of life.  

It is impossible to predict the time of death, it may take hours or even days. The final stages of the end-of-life timeline can be difficult. Patients should be made as comfortable as possible, and the environment should be peaceful and well lit. Individuals can range anywhere from unresponsive to lucid and clearheaded to confused and may be prone to hallucinations. These are all normal end-of-life responses.  

• Expect eyes and mouth to remain open 
• Expect gasping breathing 
• You may be unable to wake your loved one 

FCNs are trained to offer presence, a listening ear, a helping hand to attend to the physical, emotional and spiritual needs of this population which are paramount and impactful to their well-being. Showing empathy allows patients and families to express fears, regrets, hopes and spiritual beliefs with trust and openness without judgment. Providing comfort lends to the feelings of peace. Education also allows for pertinent information to be disseminated, giving peace.   

 

Great blessings belong to those who work to bring peace. God will call them his sons and daughters.  Matthew 5:9, ERV 

 

We are peacemakers through Christ.