The lecture was given at III. International hospice seminar, which took place on 5 and 6 November 2009 in Bardejov.

Life belongs to death, death to life, with birth we die, just as there is a beginning, so is an end, and I could continue to write like this until we come to three words that characterize the human stay in this world. And they are: Birth, life and death - three phenomena that represent the universal and inevitable experience of humanity and the individual. Death is the individual demise of an organism, it affects not only the biological side, but also the psychological, social, and spiritual side. Despite this, in medical practice it is erroneously considered only as physical death.

If we look a bit into the past, the mortality in all age categories was considerable. Reaching 50 years of life was enviable, death was accepted as normal. It was a matter of course that people were born and died at home, in the circle of their loved ones, in an atmosphere of love and tenderness.

The modern lifestyle, focused on functionality, success, satisfaction of material needs and efforts to prolong life, shows us a new reality of perception of dying and death. Most people die in hospitals and other institutions for the elderly and terminally ill. The achievements of the new era, in addition to positive benefits, also bring us the creation of new problems, especially questions related to the attitude towards dying patients. Already the theorist Elizabeth Kubler-Rossová points to the problem of access to the dying. She showed how to care for the dying and that dying can be a peaceful and meaningful experience. He says: "The seriously ill and especially the dying must be taken seriously and given all our attention. Only in this way will we allow their personalities to mature and only in this way will we mature into a greater fullness of love." Mother Teresa also always stood by the abandoned, the seriously ill and the dying. I say that just as beautiful maternity hospitals are built, facilities should also be built where we can take a breather. Therefore, just as we come into this world with dignity, we should also leave it with dignity. As we are born for this world, we should also be born for heaven.

One of the unmistakable facilities that serves the dying is hospice. It is a specialized medical facility, not a social one. Why? Because it is complex health care, it is a process of professional, holistic, interdisciplinary care. It is a process, because a person leaves under unrepeatable, unique circumstances, the dust of death passes by itself, therefore he must be given highly humanitarian care. And last but not least, it is a medical field that deals with the care of terminally ill patients and that is palliative medicine.

It is very important that doctors, nurses, medical personnel master not only the technique, but also the ethics of caring for dying patients. This places higher demands on their personal equipment, their character traits, character, ability to empathize, responsibility... A multidisciplinary team should be present in the hospice, ensuring comprehensive care for the dying person and satisfying his bio-psycho-soc-spiritual needs. This team should consist of a physician certified in palliative medicine, nurses specializing in palliative care, a nursing team that is continuously trained, a psychologist, a social worker, a spiritual father. And how is it in reality? The multidisciplinary team consists of a doctor, a nurse and a nursing team. Somewhere it is a clergyman who actively helps, is always present and helpful, or a psychologist who is only consultative. The reality is that most of the work is on the shoulders of nurses.

The work of a nurse is very demanding, from a professional point of view it is one of the most difficult jobs of a nurse in terms of managerial, physical, psychological, ethical, as well as social and spiritual aspects. A nurse working in a hospice must be a well-rounded being, at peace with herself, emotionally balanced, empathetic, communicative with a friendly attitude and a smile. On the professional side, she must be independent, able to determine her priorities in the care of a dying patient, educated and willing to continue her education, have managerial skills to lead the entire nursing team. The main task of a nurse in a hospice is to accompany. It is based on the realization that it is the last part of the patient's life, dealing with life and death, reconciliation, thanksgiving, farewell to loved ones. Communication skills are very important, to be able to communicate, to conduct a conversation freely or purposefully so as not to harm the patient, to be able to listen actively, listen to the patient and non-violently guide his steps to the end. He must control not only verbal but also non-verbal communication, many times he will consider how he speaks to him, how he gestures, whether he touches him, etc. He often represents the role of a psychologist, which means that he must also have knowledge in the field of psychology, know some psychotherapeutic techniques. He uses emotional psychotherapy, that is, conversations about the patient's difficulties with a willingness to listen, a conversation according to Rogers where it is about listening, the patient talks, and the nurse encourages him to do so and accepts him as he is, or logotherapy according to Frankl, which is based on the philosophy of life, that is, to guide the patient to the meaning of life, to bring what he believes in to the conscious level of his psyche. He must also know relaxation techniques. Another role that the nurse represents is the role of a social worker, that is, the use of help from the state, which the patient can get to maintain comfort... e.g. adjustable bed, wheelchair, apparatus to facilitate walking... It enables the patient to contact family, friends, neighbors and communities he visited. It allows him contact with the world - newspapers, TV, radio. Contact with patients who have common problems, so that he does not feel alone, isolated from the world.

And what if a clergyman is missing in the hospice? Of course, the nurse does not administer the sacraments, but she is there when it is necessary to sit with the patient and listen to his lifelong confession. She hears his cry for help when he wakes up at night due to restlessness, but she can only listen, possibly bring the family closer together, answer questions from the patient, but for this she needs a lot of life experiences that she herself has lived through to be able to talk openly about spiritual things. She is the one who holds the hand during the escort and leads the dying person to God in the prayers of the rosary, if the dying person is a believer. In my practice, I also met patients who believed, but in the universe, goodness, life...etc. And here you are looking for words of comfort based on the celebration of life, human existence...etc. The nurse takes care of the family, which is many times more difficult than working with the patient. Knowing how to win their trust, involve them in the care of a loved one, guide their steps so that they are the ones who accompany. He gives them information that is comprehensible to them, listens to their ideas, supports them and encourages them. The last service of the nurse is contact with survivors, i.e. he leaves the relationship open so that the survivors have someone to turn to in times of grief, sadness, talking, saying goodbye to his belongings, etc. The volunteer's approach to the hospice patient is very important. It's another problem in our society because we somehow forget that we too will need help one day. Hectic life, rush for material things do not allow us to stop and help those who need it. Many times it is enough to sit, talk, read something, take a hand and be quietly present, that is helping specifically with the patient, but volunteer work also consists of other activities such as environmental modification, bulletin boards....

My recommendations for practice:

  • education in the field of palliative medicine and nursing,
  • educated in the field of psychology - psychotherapy,
  • inclusion of the subjects palliative nursing, communication, dying and death,
  • mandatory practice in hospices or palliative wards,
  • courses for nurses and workers on stress management, use of relaxation techniques,
  • mandatory internships, exchange stays,
  • trainings to solve questions about what the dying person experiences, what feelings accompany the dying person when he feels the proximity of death, what kind of emotional relationships relatives, friends and those who accompany them get into,
  • what the nurses experience, how to manage stress, internal tension during escorting, how to deal with the end...,
  • support the printing of literature, magazines, websites,
  • support conferences, seminars,
  • create hospice management,
  • create nursing standards for hospice and nursing diagnoses,
  • create a network of volunteers, but also interest in them and care.

In conclusion: Hospices are a wonderful work of today's modern times, let's not allow their dignity and their mission to be taken away. It is the best of the medical facilities that provide professional care for the dying, because one day each of us will need it. I want to appeal to employers. Only those who have a heart for this service, not a job, will remain working in the hospice, but still there are workers who live in their families, have desires and dreams, and day after day they face the end. They need support, encouragement and, above all, to feel the interest of their superior, so that they have the strength to go on and at the same time the evaluation of this work, which is not easy when you lead the patient to the end.