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Hospice nurses face new challenges with end-of-life care for patients during COVID-19 pandemic

"It's heartbreaking because you want to do so much, but sometimes it's just the small things that can help," said hospice nurse Nicole Green.

SAN DIEGO — In honor of National Nurses Week, News 8 is sharing a series of stories to honor San Diego nurses and highlight some of their dedication and sacrifice. 

The pandemic is bringing new set of challenges for all nurses caring for patients, and in this article, we highlight the additional role hospice nurses are playing as the coronavirus continues to affect people's daily lives.

Patients in hospice care have a life expectancy of six months or less, so hospice nurses are used to the end-of-life process and keeping patients comfortable. 

They also play a big part in supporting the patient's family. 

Personally, I still remember how helpful the hospice nurse who cared for my father five years ago as he was dying of cancer. She gave me her cell phone number and told me to text or call whenever my mom or I had questions or concerns, and we had many.

During this pandemic, however, support for a patient's family member comes with more challenges.

"I find that is the most difficult part, right now," said Nicole Green, a hospice nurse with Uni Care Hospice. "When I have a patient pass, I'm not able to physically comfort that family member who may need that type of support."

As a hospice nurse, Nicole often becomes quite close to the families of her patients.

"You're in such a personal, intimate part of their life when it comes to end of life," she said. 

Restrictions on visitors and many families unable to travel, Nicole is now connecting families with their loved ones through an iPad or phone.. 

"Even if the patient is not responsive, I'll still put the family member on speakerphone or we'll do a FaceTime chat so that the family member can see the patient," said Nicole.

Over the past few weeks, she has sat with patients as they've died, comforting them during those final hours, through their final breath. 

"Whether it's with touch, reading to them, humming a song, playing music that they like, just being present with the patient and knowing that you're providing them that comfort or peace that they may need before they pass," she explained.

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Nicole works for Uni Care Hospice and has patients in hospitals, skilled nursing facilities, assisted living facilities and private homes. She said some patients prefer to do virtual calls with her when possible to limit exposure, and she is tailoring her care to each patient's needs. 

Recently, an elderly man who is caring for his dying wife at their home, asked if she could bring them some groceries, as he was afraid to go out and possibly be exposed.

"It's heartbreaking because you want to do so much," she said. "But sometimes it's just the small things that can help."

During the coronavirus pandemic, Nicole said some family members have become concerned their loved one might have contracted COVID-19. She said of the symptoms of COVID-19 are similar to normal end-of-life changes when a person is transitioning or actively dying. 

"We're providing a lot of education on the normal physiological changes that happen to a person when their bodies are changing," she said, to help people discern whether or not the changes are natural or if there's cause for concern. 

"I don't think anybody, just anybody could be a hospice nurse. I think it's a special calling. I think it's more than a job," said Beverly Clark, whose mom is in hospice care with late stage Alzheimer's Disease. 

Every time the phone rings and she sees it's her mom's hospice nurse, Beverly says she gets very excited. She has been unable to visit her mom for the past several weeks due to visitor restrictions, and said her mom's nurse has been a cherished lifeline. 

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"I'm so appreciative because I can't go and see her in person, so to get that phone call saying, 'I saw your mom today and you know, she's doing well,' means a lot."

Nicole said it's humbling to be able to have such a profound impact on a patient and family's life. 

The job does not come without personal sacrifice, however, during the coronavirus crisis. 

The mom of three did the Zoom interview with me from a hotel room, where she was staying to protect her husband and children from possible exposure. 

With one family with asthma, Nicole decided to check-in to a hotel while her husband made repairs to a guest bedroom and bathroom where she can isolate herself from her family.

"As a mom and a wife and a nurse, I want to protect them as best I can," she said. 

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She misses the family time. "I'm not there to tuck them in, say good night and make them dinner," but she knows it's only a temporary solution.

Nicole said she appreciates her family's support of the important work she does, as she never wants to let her patients down. "I feel helpful because I can be there and I can provide that link to the family and the patient."