As an adult daughter with older parents and children of my own, I fall into the "sandwich generation" with family responsibilities at either end of the life spectrum. I have been blessed with healthy children and relatively healthy parents (given their ages) but life was thrown into disarray this past spring when my father was hospitalized for 17 days to recover from complications after a ruptured appendix on Easter Sunday. Because I am the only health care professional in the family, I became the liaison between the hospital staff and the rest of the family. Regular phone calls to the nurses on the unit helped me to monitor my father's condition long distance; I relayed information back to my mother so she could be prepared for her daily visits. I consulted with colleagues about his status and searched the Internet for information on his treatment and care. I rationalized my activities as important and necessary to help my mother cope. I realize in retrospect that I was coping in the only way I knew: by being a nurse.
A colleague gently pointed this out to me in an e-mail when she wrote, "Leslie, I went through this with my mother and husband. I suggest that you be a daughter first, and a nurse second." It took a few days for her advice to sink in, but eventually I was able to trade my "nurse's cap" for my "daughter hat"-and it made a difference, both emotionally and practically. As a daughter, I could provide better emotional support for my parents; I still used my nurse resources for information gathering and sharing, but it was no longer my primary focus of activity.
People cope in ways that are familiar and effective. We manage new and difficult situations by finding a frame of reference and then selecting those coping skills that have worked in the past. For me, the way to cope with the stress of my father's hospitalization (a new experience) was to revert to the role of nurse, since my frame of reference for the hospital came from this context. A colleague, who had obviously experienced the same thing, helped me to broaden my perspective and include the role of daughter as part of the context. Being a daughter gave me an expanded and, in many ways, more effective repertoire of coping skills to bring to the experience.
As hospice and palliative care nurses, you may encounter family members and others who are having similar difficulties. For many of the people you care for, the experiences of terminal illness and hospice may be new and unique. In trying to find a frame of reference, people may turn to known and familiar coping skills. While they may be effective, they may not be the most appropriate for the situation at hand. Communication is an apt example. Many people are uncomfortable talking about death and dying, and when confronted with the imminent death of a loved one, communication may be more difficult than usual. On the other hand, it is an important component of the dying process to finish up old business, to have important conversations, and to say good-bye. Families need to be helped to find new ways to communicate and cope in the face of the new experience.
What you bring to the situation is a familiarity with the experience and an understanding of the rewards of the experience of a good death. Keep this in mind as you help the loved ones of the people you care for trade their familiar "hats" for different, perhaps new hats. I know it was a caring colleague who helped me realize the difference and find my proper role during my father's illness. You can do the same, on a daily basis, with all you see in your clinical practice.