Anticipatory (Hospice Care) and Preparatory Grief

Vitas Hospice - Anticipatory (Hospice Care) and Preparatory Grief.
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This article will focus on the psychological and social challenges facing an individual with a terminal disease and his or her family members.

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Hospice, hospital and hospitality? The word "hospice" derives from the same linguist root as hospital and hospitality. The term goes back to medieval times when it described a place of shelter and rest for weary travelers on long journeys. Hospice was first used to describe specialized care for terminally ill patients in 1967 when the modern hospice movement began in England. Today the term "hospice" refers to a steadily growing concept of humane and compassionate care that is focused on the patient rather than the disease.

The VITAS Innovative Hospice was the pioneer care for adult and pediatric (Comfort Care) patients with a range of life-limiting illness. Today hospice care has moved the focus to providing care primarily in the patient's homes; but also inpatient hospice, nursing homes and assisted living.

Hospice care focuses on relieving physical and psychological suffering, and improving the quality of life when a cure is no longer possible; the patient has six months or less to live if the illness follows its expected course. Pain control and symptom management, as well as emotional, spiritual, and practical support, are components of hospice care, which is directed by the patient's own physician.

The goal of hospice care is to ensure that the patient is able to remain comfortable at his or her home, in control of personal and medical choices, while family members are supported as caregivers. Hospice Care Services include, in-home care provided by the Hospice interdisciplinary team, directed by the patient's physician. Relief from pain and management of other symptoms, medications and equipment related to the illness, emotional support for the entire family, spiritual support and counseling, as requested. Additional services provided are bath and personal hygiene care, education on how to care for the patient and on the nature and course of the illness, volunteer support for caregiver and respite time, alternate levels of care, depending on medical needs, grief and bereavement support, and help with accessing other useful community services.
Numerous health professionals are involved in providing hospice care. The hospice team includes, a Medical Director, which oversees treatment by the hospice team and coordinates patient care with the patient's physician, a Registered Nurses Case Manager responsible for managing physical care and coordinating other services. A Spiritual Care Coordinator assists in identifying spiritual concerns, and offers counseling, a Certified Home Health Aide will assist with personal hygiene needs, and a Bereavement Counselor supports the patient and family, and continues grief support with the family members for approximately 12 months after the patient's demise.

A hospice supportive caregiver will want to create a climate that encourages and supports sharing the patient's feelings. There are six steps a hospice supportive caregiver can implement to be an effective: open honest appropriate and effectively communicating effectively the patient, supporting the patient's spiritual concerns, helping to resolve the patient's unfinished business (family relationships), working with other health professionals, working with family and friends of the patient, and taking care of your own needs and feelings.

Hospice care can be preparation for saying Good-bye; however I have included some aspects of grief that are unique to anticipatory and preparatory grief. First, let me say the word bereavement means to be robbed and bereavement is the grief that comes after a death.
Preparatory grief referees to the grief experienced by the dying person, this is the "grief" that the terminally patient has to under go in order to prepare for their death. This can be loss of loss of health, the simple pleasure of living may be grieved, and/or the loss of their future unfilled plans, hopes, and dreams.

Anticipatory grief or anticipatory mourning refers to grief and mourning before death for both patient and family.

Family members and friends can help the hospice patient, literally say good-bye. Letters, tape recorded messages and video recordings are excellent mediums, give the patient permission to let go of life, keep the patient comfortable, Touch and Talk even if the patient is sleeping much of the time or slips into a coma, touching and talking are extremely important. Touch the patient in a comforting way (hold hand, rub arm, or face/cheek) Talking or playing soft music can help; this can decrease the patient's sense of being alone and can be very comforting. Validate what the patient are feeling, "It's Okay to Cry or feel sad." "It seems to me you are responding normally to a very difficult situation." Welcome family and friends to visit and ask the patient what they want.

Hospice neither hastens nor postpones dying. Just as doctors and midwives lend support and expertise during time of birth, hospice provides its presence and specialized knowledge during the dying process.

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