National Nurses United

6 S E P T E M B E R 2 0 0 5 C A L I F O R N I A N U R S E News Briefs T he Madison-Deane Initiative, a pro- gram of the Visiting Nurse Associ- ation of Chittenden and Grand Isle Counties in Vermont, has made a 49- minute video tribute to the founders of the modern hospice movement. Pio- neers of Hospice: Changing the Face of Dying focuses on four hospice profes- sionals who worked in Europe, Canada, and the U.S. to create our modern con- cept of hospice care. This is an oppor- tunity to give credit where credit is due to the hospice activists of their time in the years following WWII. Homage is paid primarily to Dame Cicely Saunders—nurse, social worker, and medical doctor—who challenged the status quo at the heart of the West- ern concept of death. Three other pio- neers added their determination to the hospice fight, and together they crafted a new paradigm for healthcare of the dying. Nursing principles were at the core of this conceptual change. Ironically, unlike the revolution Florence Nightin- gale spearheaded from her reclusive life in 19th century England, these people had to change a medical model from within the system. The video explores the journey from the perspective of these central figures and their peers. In 1948, Saun- ders was a novice social worker for a London hospital, and she soon learned that dying people were not getting spe- cialty care under the existing medical model, which denied them the dignity of holistic treatment for the dying process. They weren't getting truth in diagnosis, their spiritual and emotional journeys were being ignored, and their pain needs were sorely under treated. Nothing was being done, there was no research on anything to do with dying, and no one was listening to what the dying had been saying for a long time. She quickly added nursing the dying to her duties while there. Saunders was determined to change care for the dying, and returned to medical school because she knew that a non-medical perspective for change would not carry the weight it does today. In 1967, she founded St. Christopher's Hospice in South East London. By 1964, some of the theoretical base for hospice care was emerging. Another colleague of Saunders, Dr. Elis- abeth Kubler-Ross, was working on her studies with the observable phases of dying and sharing those thoughts with medical students in Europe and here, as well as Canada. Florence Wald, an RN from the Yale School of Nursing, brought the revolutionary ideas about patient-focused care back from St. Christopher's to nursing students here. Dr. Balfour Mount carried the hospice movement to Canada where palliative care gained a name. It still wouldn't be until 1982, how- ever, that the first article written about suffering would appear when one of Saunders' American associates, Dr. Eric Cassel, a bereavement psychiatrist, wrote about that core need of dying pa- tients and their families. In England and here, the MD role in dying was being challenged, RNs were finding a new voice as advocates for their patients, and nurses were pick- ing up the pieces of the hospice care model. Social and ministerial serv- ices were bolstering the alienation and loneliness terminal patients were expressing. The interdiscipli- nary team approach in hospice care was evolving, and the entire needs of patients and their families were being addressed. MDs were en- couraged to get close to their pa- tients to discover their real needs. This model exploded the status quo in healthcare. This video is of value to begin- ning nursing students and to more experienced nursing professionals because it delineates how far healthcare has come in the last half of the 20th century by giving death its due. The best principles of a healthcare model remain their purest with hospice. It is the place where a multidisciplinary team shares the most comprehensive care for the whole person. Hospice incor- porates the time and patience to do the work well. The public has these hos- pice pioneers to thank for the best healthcare model available. The video was informative for its compact length. It was largely historical, with no discussion of current contro- versies within the hospice movement, so turned out a bit bland. And the film would have been more complete if it had included some patient or family comment. Saunders herself passed away in mid-July at St. Christopher's. Except for an obituary in the Los Angeles Times, I did not see many stories or any television news coverage here of this important woman. Perhaps she had finally been able to make death so natural that the Western world didn't bother to make a fuss. To learn more about the Madison- Deane Initiative and this documentary, see the website at www.pioneersofhos- pice.com, or call (800) 860-4419, or write the Visiting Nurse Association of Chittenden and Grand Isle Counties, 1110 Prim Road, Colchester VT 05446. —Jan Howe, RN Hospice History A new video traces the origins of hospice care by profiling four pioneers

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