Hospice of Cincinnati

Christopher Swaim, Summer 2013

My time at Hospice of Cincinnati (HOC) provided me with a wonderfully enlightening experience. I wanted to work at this site because I felt unprepared to handle death and dying in both my professional and personal life. I am fortunate to have not yet experienced the loss of any family or friends, but for the same reason, it is more difficult for me to empathize with those in such situations. The internship helped me to understand end of life care by placing me with several health care professionals and attending staff training sessions. What I learned is that there is an immense value in ensuring a comfortable, dignified death for those patients beyond the limits of curative treatment. This is the core of the philosophy of hospice and palliative care. It does not downplay the struggles that people face in this situation, but it does everything possible to make it better. With this in mind, hospice care is much less depressing as popular belief might have it. Instead, the staff at HOC demonstrated that a “good death” exists and this philosophy provides that to their patients.

My daily activities varied significantly depending on what was occurring at the office. In addition to rounding at an inpatient unit and shadowing nurses, I participated in meetings that discussed patients, diversity, quality care improvement, training, management, policy updates, and more. I gained a sense of some of the challenges that HOC and other hospice organizations face. While many of these were short term goals for improvement, I realized that there was a long term goal that I can support in my career. That is to encourage more patients and physicians to discuss values and wishes for end of life care. It is often a sensitive topic, but it is a discussion that needs to happen for medical care to fit the needs and values of patients. There is a large disparity between the environment and manner in which people would prefer to die, and what actually occurs largely because of a lack of end of life planning. Similarly, when patients are no longer able to communicate or make decisions about their care, many factors come together that can lead to futile treatment with poor quality of life, high costs, and greater emotional burdens on family. Medical Orders for Life Sustaining Treatment is a new form that can prevent such things from happening. However, this also requires advanced planning. At this point in my medical education, I don't believe so much emphasis could be placed on end of life planning. But it holds so much value that I would encourage my colleagues to understand its importance throughout my career.

The project I helped with during the summer focused on hand hygiene for the hospice workers. Following the tenet that hospice care does not hasten death, the hospice staff is trained to use proper hand hygiene to prevent iatrogenic infections. The Education Department created and administered a simulation training session that incorporated hand hygiene with two other skills. I helped analyze data that HOC can use to make further improvements in the quality of care in the future. While this is an ongoing struggle for all other health care providers, I do hope that my contribution has a beneficial impact on HOC. They have certainly given me a unique experience that will impact my career like no other. I am humbled to appreciate the more meaningful aspects of life, and will encourage others to do the same.