Heavy Burdens Weigh Down Front Line of Hospice Workers — Professional Intervention Provides a Strong Pillar for Palliative Caregivers

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Being on the front line of hospice wards, the nurses bear an unimaginable burden as they face patients who need attentive care, whether due to the intensity or tension of their work. In addition, they are under great pressure due to insufficient manpower in clinical on-site care, low psychological support, and the high expectations and sustenance from patients and their families.

Having been in the internal medical ward for seven years, Ms. Xiu-Mei has seen too many heartbreaking scenes. After numerous patients try their best persevering through various treatment methods, they finally take their last breath in a state that can be too unbearable to look directly at.

Recalls Xiu-Mei, "There was once an old man whose skin was bruised from injections, but before it could recover, a new needle was inserted due to the start of a new treatment." Even though he was a patient she had taken care of more than ten years ago, she still remembers vividly that the blood vessels in the old man’s skin was almost indistinguishable. She winces, "After the new treatment started and a catheter was inserted into his neck, he passed away the next morning."

"If we were unable to save the patient, could we at least make the last leg of his life journey more comfortable?" she wonders. Soon after, the idea of being in the hospice ward came to fruition as Xiu-Mei was transferred to serve in the hospice ward.

"But it was actually very painful after I entered hospice care," Xiu-mei sadly mentions as bitter memories quickly flood her mind. She had once thought that the hospice ward would be the much needed new beginning for her nursing career, but she never expected that everything would be completely beyond her imagination.

Manpower Shortage Brings Unbearable Stress

The first difficulty Xiu-Mei faced was the serious shortage of manpower.

There are many reasons for the shortage of manpower in hospice care. One is that the health insurance payment is not sufficient, which has a negative impact on the operations of the hospital. Therefore, in the allocation of manpower, unless the hospital provides strong support for hospice care, most of it is supported by the most basic staff. Besides, in domestic medical training, rescue and prolonging life are still the main focus, and hospice education has not been paid much attention to. Lastly, the necessity to bear the weight of life heading to nowhere but death is often one of the main reasons for hospice care being ranked last in the career priority list.

In Xiu-Mei's impression, during her three years in the hospice ward, practically every night shift had only one nurse on duty, but this nurse had to take care of nearly 18 patients. She says, "I tried to send more people, but they typically stayed only very briefly. Whenever the hospital is short of manpower, they were usually transferred away.”

Once, among the 18 people she took care of, there were three patients who were prone to hemorrhage. Almost all night, she immersed herself in wiping the pools of blood on the patient's body and on the floor. It was difficult for her to persist until finally the dawn arrived, and she was finally able to finish her shift. Only then did she realize that her uniform was already stained with blood.

In addition to being busy, the lack of manpower in the night shift brings unbearable pressure to the nurses on duty.

"One day when the shift was over, I knew that probably four or five patients might be leaving in my shift." That night, her nerves Image by Freepik were tense. Unsurprisingly, one patient was dying. At the same time, from a nonhospice ward came the request that one of their patients was in shock and needed urgent CPR. Xiu-Mei immediately woke up the patient's caregiver and asked him to notify the family to come to the hospital, and then hurriedly went to the non-hospice ward to help.

"As a result, when I came back, the patient had already died, but because the caregiver was so tired from already taking care of him for many days, he forgot what I had just told him to do." Fortunately for Xiu-Mei, in the handover document, the family members clearly stated that it wouldn’t matter if they were notified to come to the hospital after the patient died, which provided some small comfort.

When the family members arrived, their emotions were stable, and they also carried out the parting care of the deceased with the assistance of Xiu-Mei. However, due to the disease, they were unable to close the patient's eyes and mouth, and finally had no choice but to let the funeral parlor handle the follow-up cosmetics of the deceased.

"That's how it went,” recalls Xiu-Mei. “As a result, when the family members came for the discharge procedures the next day, they started crying hysterically and berating us for letting their family member not die in peace." Even though it is a memory from many years ago, the phrase "not die in peace" is still like a heavy rock which weighs on her today so that she could hardly breathe sometimes. Such a serious accusation would break her heart to tears in the years to come.

"It was illness that kept the face of the deceased not intact. If a person dies badly, the nurse is to blame, but should I have to sacrifice my life to prevent this matter? Because he was already dead, there was nothing I could do about it," Xiu-Mei reminds herself in an attempt to provide herself lasting comfort.

The Influence of Guidance Boosts Frontline Confidence

The lack of manpower, the emotional state of family members, and unending pressures are placed on the shoulders of the nursing staff in the hospice ward. As a result, day after day, the enthusiasm for hospice care in the hearts of many clinical nurses is eroded little by little.

While some are better prepared than others, in order to avoid lasting emotional injuries, these nurses choose to let their once enthusiastic hearts become indifferent and calloused. However, the formation of this high wall of indifference not only distances them from their patients and their families, but also causes a gap among their colleagues due to differing goals.

Ms. Xiao-Chiao, who devoted herself to hospice care as soon as she graduated, said that she is happy "Because the senior nurses in our unit are very enthusiastic!If they hadn't been encouraging us and guiding us, I think in the face of the huge pressure of the hospice ward, I would have wanted to quit soon!"

On the site, she saw that many patients were repeatedly admitted to the hospital. Able to speak at first, they gradually became weaker and weaker until even medication could not completely relieve their symptoms. For a long time, whenever a patient passed away, Xiao-Chiao would always reflect, asking herself, "Have I not done enough? If I could do it over again, how would I do it better?"

Facing the patients’ departures during her work hours, the young Xiao-Chiao was not without stress and fear, but fortunately, an experienced senior nurse chose the right time to give her a life-long consolation. Xiao-Chiao shares, "The senior nurse told me that since the patients are willing to leave life during my shift, let me help them clean, change clothes, and walk the last mile of their life, it means that they trust me very much.”

Once, she was struggling with whether she should uphold the professional image that a nurse should have after the death of a patient and hide the sadness in her heart. However, the senior nurse assured her that when nurses were sending off the patients, the sadness and weeping are, in fact, very normal, advising, "After all, you have feelings for them when you take care of them. It's natural that we cry."

Limited Experience Is a Challenge to Overcome with Time

Being able to work in a team that goes all out for hospice care, Xiao-Chiao always regards it as a blessing; however, she has also experienced many setbacks along the way.

Due to the shortage of manpower at the hospice site, most hospitals can only dispatch new nurses to the hospice ward. Lo Hui-Chun, a psychologist who provides counseling at MacKay Memorial Hospital’s Counseling Center, sympathizes with these nurses who devote themselves to hospice care as soon as they graduate. Based on his research, he further analyzes that, in the face of high-intensity work such as hospice care which confronts life and death issues, the average length of years needed to build sufficient psychological strength as caregivers is at least 10 years of relevant clinical experience.

Xiao-Chiao says frankly that when she was 22 years old, the age when she first entered the hospice field, she was like a baby chick that mistakenly wandered into the jungle. She reminisces, “I had thought the patients in the hospice ward would be well prepared to face their death; but in fact, they are still afraid. There are many knots in life that are hard to untangle, and death is one such knot."

She knew at that moment what she had to do was guide and comfort the patients; yet at the same time, she was struggling with these difficult life issues, which were completely unfamiliar to her. She recalls, "Whether it is life or work experience, I had just taken my first steps into society, and didn’t have enough strength to guide my patients. Furthermore, school education did not prepare me much in this respect.”

Faced with such a predicament, she had to be grateful once again for having found strong support, saying, "Fortunately, the senior nurses are very helpful, but we also realized that we had to catch up with them soon."

In the challenges of hospice care, most situations are not without solutions. XiaoChiao's support comes from the help of the environment. However, in the hospice site, there are many nurses who are not as lucky as her, and they can easily become deeply psychologically burdened, and unable to bear the consequences.

Xiu-Mei, who has transferred to serve in another unit, suggests that if the hospital can provide professional psychological support and pay attention to the lack of manpower in the hospice, perhaps the predicament of hospice care can be broken. She concludes, “Even as professional caregivers, nurses themselves desperately need the care of professional intervention. Please don’t place us, who are on the front line of clinical practice, as a last priority of many improvement projects.”