I have been a patient-contact volunteer for over twenty-four years. During so many of my visits, when the spouse is preparing to leave, she will give her husband (who is on our hospice) the shortlist of hospice staff who may be stopping by. Experience has shown me the most important person expected to visit is no surprise. It is the man or woman who is the nursing assistant.
Being in the forefront as a somewhat passive observer to hospice, I have learned much about everyday hospice care. A good percentage of what I have learned is not so much what is in the books and brochures about amazing care by amazing staff; rather it is about what is most important to the person receiving the care. Not only is the person receiving a great deal of attention, but so is the family. To see so much attention focused on a loved one gives the family assurance that they are not alone.
Each hospice generally assigns a registered nurse (RN); possibly a licensed practical nurse (LPN), also known as a licensed vocational nurse (LVN); a nursing assistant (aide, CNA, STNA); a social worker; and the offer of a chaplain and a volunteer to be of assistance. The one who makes the most favorable impression, by my unscientific study, is the nursing assistant. Theirs is a title that varies by region: nurse aide, certified nurse aide (CNA), nursing assistant, certified nurse assistant (CNA), patient care assistant (PCA), and state-tested nursing assistant (STNA). I’m sure that I have left a few titles out, but at the core they are the angels of hospice care. Probably the easiest way to describe what they do is to use the short version of the Prayer of St. Francis. It follows:
Lord, make me an instrument of Your Peace: where there is hatred, let me sow love. Where there is doubt, faith, where there is despair, hope. Where there is darkness, light. Where there is sadness, joy.
O Divine Master, grant that I may not so much seek to be consoled as to console; to be understood as to understand; to be loved, as to love; for it is in giving that we receive, it is in pardoning that we are pardoned, and it is in dying that we are born to eternal life.
Let’s take a look at that prayer line by line, from the perspective of a nursing assistant:
Where there is hatred, let me sow love. Since the late 1990s, I am aware of only two people with AIDS who have been under the care of my hospice’s service. Both of the people, by their own admission, had become infected with AIDS as a result of their lifestyle. And they felt they were now paying the price.
However, their parents were also paying the price, although they had done nothing to deserve it. The parents heard derogatory comments about AIDS patients wherever they went. They hurt because their sons were suffering and because no one seemed to care about them.
No one cared until the families called my hospice and our staff entered their lives. I remember when one of our STNAs gently, tenderly put salve on one of the men’s sores. I felt as if I was watching Mother Teresa doing it. The STNA told me she only sees the need, not the cause.
Where there is injury, pardon. Our home-side nursing assistants visit the people on hospice wherever they live. In one particular setting, a newly hired nurse assistant had a difficult person she was caring for. After a few months, when the dying process started, the man reached for her arm and, in a barely audible voice, said, “Thank you. I love you.” The nursing assistant had taken the brunt of his anger over her previous visits with him. She endured much but understood where it came from. Those five words confirmed that this was where she belonged.
Where there is doubt, faith. People always think of the future, perhaps thinking of an upcoming vacation, a special outing with friends, or simply a day to enjoy one of life’s pleasures. When someone becomes terminal, everything changes because the person runs out of future. Doubt begins to settle in rather than looking forward to what lies ahead. Our nurse assistants remove a person’s doubt and fear by looking at the individuals with the eyes of faith. By their presence, nurse assistants bring emotional and spiritual comfort to those at the end of their life.
Where there is despair, hope. Often, terminally ill people have been lying in bed for an extended period. Often they may experience depression. The anticipation of the nurse assistant’s arrival gives them something to look forward to as a ray of hope.
Where there is darkness, light. I was talking to one of our nurse assistants, Stephanie, and she said that whenever she tells someone she works in hospice, she gets admonished in some fashion. “That’s so depressing.” “How can you work there? Can’t you find something better?” Truth is, Stephanie has been with us for quite a few years, and she told me she wouldn’t want to be anywhere else. She lights up the lives of the people on service with her unconditional and empathetic love.
Where there is sadness, joy. A woman was brought to the Pickering House for symptom management. She seemed depressed. Talking to her, one of the nurse assistants discerned that she had been engaged for quite a while, and now it looked like she and her fiancé would never get married. Hearing this, our STNA initiated plans that were quickly carried out by the staff of the Pickering House, the in-patient facility of my hospice. And the couple was married that evening. While the ceremony was taking place in the Sun Room, the staff eagerly made the new bride’s room into a “honeymoon suite.” Through tears of joy, the woman said, “Now I am complete.”
Grant that I may not so much seek to be consoled as to console. Patsy, one of our nurse assistants, walked into a person’s room to give her a massage. The lady was curled up in a ball, not from pain, but from fear. Over the next hour, as Patsy gave her a slow, gentle massage, she sang and prayed for her. The lady relaxed to the point that Patsy said she would lift the woman’s arm a tiny bit, and it would “plop” down on the bed. The woman went to sleep as Patsy was shampooing her hair. When Patsy told me about this, she said it had been a rough day up to that point, but the ill person came first, and Patty came second.
To be understood, as to understand. Near the end of her shift, Carla, a Pickering House nurse assistant, was pushing a man on service in a wheelchair. He had been restless, and she was hopeful this would relax him. The man noticed a woman carrying her purse, a floral arrangement, and a shopping bag. He asked if he could take them to the door for her. “Sure, I could use the help. I hope my purse isn’t too big,” she said with a laugh. He placed the three items on his lap, and Carla pushed him to the front door, where the woman thanked him. Earlier the man felt that he was “wastin’ away,” as he put it. Intuitively, Carla understood his need to be needed.
To be loved, as to love. I was talking to a woman whose mother had been on hospice. She mentioned that she had never forgotten how tenderly Kelly, the nurse assistant, would touch her mother. She also mentioned that when her mother wanted to talk, Kelly would pull up a chair and sit next to the bed so that she would be at eye level. “Where do you find people with so much love?” she asked.
It is in giving that we receive. Every nurse assistant I have talked to has told me they receive much more than they give. A family member told me that she was “almost startled” by the cheerfulness of our aides.
It is in pardoning that we are pardoned. Our nurse assistants sometimes may deal with difficult people. It is a part of the job. They understand the emotion of a person losing control of his or her life. They easily pardon any negative emotion because it is not aimed at them.
And it is in dying that we are born to eternal life. Angela, a longtime nurse assistant, told me about a woman she was tending to at an assisted living community. When Angela visited one afternoon, she noticed that the dying process had started.
The woman always had a two-bulb lamp lit next to her bed, but as Angela approached the woman’s bed, one of the lights went out. She didn’t think too much about it at the time. Sensing that the woman’s final hour was approaching, Angela sat at the woman’s bedside. At almost the same instant that the woman took her last breath, the second bulb went out. The room was now dim, and Angela was enveloped by the spirituality of the moment. She was there at the most important moment in the woman’s life, as she entered eternal life.
What does a nurse assistant do? I think the quickest way to find out is to listen to the words of St. Francis.
