Developing Your Role in Hospice and Palliative Care

Even in our increasingly divisive world, we can all agree we have this in common: death and dying. Death and dying is something that will happen at some point to every one of us, from those at the top of the evolutionary heap right on down the food chain of life. The introduction of hospice and palliative care delivered in an organized way has changed the landscape of imminent death quite a bit over the years and continues to revolutionize the options people have when facing impending death.

My first encounter with hospice and palliative care took place in 1987 when I was one of the primary caregivers for my 16-year-old niece, who was diagnosed with an astrocytoma—a brain tumor. At that time, it was difficult for the medical community to have discussions with our family about her prognosis. Only one doctor, of the many she saw, had the courage to say, “Take her home and enjoy her while you can. You’re going to lose her within the year.” Our family was mistrusting of his words because there were no echoes of his sentiment from other medical professionals. But in spite of surgery and radiation, her condition became worse, and it was apparent we were most certainly going to lose her soon. That is when hospice was initiated. We were uncertain about this concept of care, which was in its infancy. The brave nurse assigned to my niece did an amazing job under very painful circumstances and without the tools available today. Her visits were modeled around the home healthcare concept, only these visits were completely focused around end of life and palliative care. Under a physician’s direction, this program of care continues today—nurses, along with other professionals, make home visits, deliver care to their end-of-life patients, and support families.

Hospice and Palliative Care in Veterinary Medicine

Hospice and palliative care are founded in human medicine and date back to the 1960s. Out of this emerged the culture of hospice and palliative care in veterinary medicine.

Eric Clough, VMD, and his wife, Jane, a hospice RN and hospice administrator, presented the topic of hospice care in veterinary medicine at the AVMA Convention in 1998. Jane’s work as a hospice administrator led Dr. Clough to include the hospice approach with his end-of-life patients and clients; as a result, the death experience was remarkably different. The focus was on pain management and comfort in the home setting. The transition his clients had to make in shifting their focus from treatment/cure to imminent death was much deeper and comforting, as they were supported in a dedicated way. The importance could then be placed on quality of life and enriching the days they had left rather than on when and how death would come. Hospice is about how to live the last days rather than focusing on dying. Later, Dr. Alice Villalobos, one of my mentors, would introduce her concept of this care in her oncology practice. She designed Pawspice—palliative care during treatment until end-of-life transition to hospice. Palliative care, in its absolute simplest terms, is a multidisciplinary focus on improving quality of life through physical, emotional, and spiritual support. You can have palliative care without hospice, but not hospice without palliative care.

My Experience With Veterinary Hospice

In 2008, I started a 501(c)3 nonprofit that centered on end of life with pets, Healing Heart Foundation, Inc., which honored the spirit of the human-animal bond and had 3 programs. One of those programs, Healing Heart Pet Hospice, delivered end-of-life care to pets in the home setting. The catalyst for this program was a dilute tortoiseshell feline. It would be easier to list the conditions this cat did not have than list the ones she did have. Her veterinary healthcare team developed care protocols, nurses carried out those protocols, and everyone did their best for this deeply loved feline whose family did not believe in euthanasia. From time to time, the words “hospice” and “palliative care” were mumbled. It would be this little bundle of fur that motivated me to dive into research of the utilization of the hospice and palliative care discipline in veterinary medicine.

I spent 2 years performing independent research, took courses in the human hospice and palliative care world, as well as studies in grief and bereavement, and then found mentors in the veterinary world—all in preparation of delivering end-of-life care to patients in their home. The challenges I experienced as a veterinary nurse delivering this care did not come from the clients. These families were well acquainted with this concept of hospice care and could not believe the gift they’d been given when this option was extended to their pets. Rather, the challenges would come from those in the veterinary field who were having a difficult time understanding the transfer of this type of care to veterinary patients.

The Time Has Come for Veterinary Nurses

Medical and nutritional advances, along with societal changes, have allowed pets, like their humans, to live longer and healthier lives. And this is really something to celebrate! But along with those advances are the challenges and pressures many veterinary professionals feel when faced with the reality of having honest and compassionate discussions with their clients.

Our profession is unique and separate from our human counterparts in many ways, but the most glaring is our acceptance of humane euthanasia. This is often a most pivotal decision on the part of the pet family, and we are entrusted and viewed as “safe” people who are expected to support and help guide them through this decision-making process. And yet, very little is provided to veterinary students or veterinary nursing students to prepare them for these profound moments of their career. When I’ve spoken with veterinary students and veterinary nursing students, I’ve found that a concern of theirs is that they have not been given a solid background in providing end-of-life support. Independent study is their option to gain a deeper understanding of this model of care and to find tools to help them prepare to guide their families in a more poised and confident way.

It is an exciting time for veterinary nurses to have open dialogue and discover the prominent role we can—and should—have in delivering end-of-life care to patients. It is time for veterinary nurses to claim their space in this discipline that is firmly grounded in nursing. In my 40-plus-year career as a veterinary nurse, having experienced a variety of disciplines, I can honestly say delivering care to end-of-life patients and supporting clients through the process has been the most fulfilling. One of the courses I took in human hospice and palliative care had a class led by a member of the clergy. He started his class by saying, “Every time I walk into the room of a dying person I sit at the feet of the teacher.” He took my breath away with that statement. When I began delivering veterinary hospice and palliative care, I discovered the meaning of his words and would not look at my career the same again.