My first experience dealing with death and hospice care was when I was 15 years old. My great grandmother suffered from Alzheimer disease and was no longer able to care for herself. Her ability to swallow was diminished and she had a hard time breathing on her own. Knowing we wouldn't have her much longer and wanting her to have a peaceful death, we arranged for her to be admitted to hospice care. Although I don't remember the details of the care she received, I know that my great grandmother was treated with dignity and respect in her final days. This was my first experience with death, dying, and hospice, but not my last. I was fortunate to become more familiar with the hospice process during my first nursing school clinical rotation, but it wasn't until my medical mission trip to Ghana that I saw just how important hospice care is.

In the United States, care for hospice patients involves more than just giving medications and following doctor's orders. The care is holistic, addressing mind, body, and soul. Most hospice patients are cared for in their own homes or, if in the hospital, are given their own room, often in a quiet area away from all the commotion. The care includes bed baths, skin care, emptying of the catheter bag, providing oral care, preventing bed sores, easing the patients' pain, and most importantly comforting them during this time. With hospice we care for not only the patient but for the families of the patient, providing support throughout the process. If the patient doesn't have family, it is the nurse's job to be there for that patient, lend an ear, and offer a helping hand.

Last summer while on a medical mission in Ghana, I saw patients with a wide array of ailments. Patients receive very little direct nursing care in hospitals in Ghana. They are left to fend for themselves, expected to empty their own buckets of vomit and urine, and get their own food when they are hungry. When their linen is dirty, they are expected to change the sheets themselves. When patients need to be bathed or are soiled, they are responsible for their own personal hygiene. This expectation is no different for hospice patients, and when the patients can no longer care for themselves, it is the family's responsibility to care for them.

Patients who were dying were laid in beds in the general ward, just feet from other patients, and given no quiet, or privacy. They were often left with pressure sores, not turned at all, just left to lay in one position. Hardly any care was given to the pressure sores because it was the expectation that they will die soon anyway, and resources are not plentiful in Ghana. I once saw a patient with clothes and bed covered in vomit, and when her condition was pointed out to one of the staff nurses, the nurse responded "the daughter will clean it up when she comes later." Patients who were on oxygen would have mold in the tubing and humidification systems. They weren't given replacements; they were expected to pay for a new one or clean the one they were given. Patients were left unclean, unfed, and alone, their basic needs not being attended to. It seemed like the more likely the patient was to die, the less care they received.

After seeing patients neglected and expected to care for themselves in Ghana, I am grateful for hospice as it is practiced in the United States. As a nurse, I want to care for all patients the way I would want my family members cared for. I am thankful that we have the resources to do this in the United States.