Living with a respiratory condition can be a longtime, difficult journey. For those approaching the end of life, respiratory therapy helps them breathe easier with greater comfort.
Registered respiratory therapist Tricia “Trish” Livingstone, RRT has worked in this specialized field with several providers across many care settings. Working for Suncoast Hospice, a member of Empath Health, for the past 13 years has been especially rewarding. In this Q&A, she discusses the education and collaboration she has done with our teams and families, the methods she uses to bring relief to patients and the peaceful passings she has experienced with our patients and families.
1. What’s your background?
I’ve been a respiratory therapist for more than 25 years. I started at Bayfront Medical Center (now called Bayfront Health St. Petersburg) when I was a student. Then I worked in nursing homes, home care and other hospitals for several years. At Morton Plant Hospital, I served as manager of extended respiratory services overseeing patients in the community, including schools (children with cystic fibrosis), managed care programs (people with asthma or COPD) and the DME program (durable medical equipment).
After taking a break and having my second child, I wanted to return to my career. I applied to Suncoast Hospice and received a letter back from our DME department asking me to call them because I hadn’t included my phone number on the application. I interviewed and got the job. I felt it was faith and I was meant to be here. I love it.
2. What positions have you held at Suncoast Hospice?
I started in DME supporting the drivers, collaborating with nurses on respiratory evaluations for patients and doing whatever the nurses needed us to do. Our respiratory therapists, including myself in north county, one in south county and two on-call, are all part of the supplemental staff team. We attend care team meetings, help with plans of care and support our nurses. Respiratory care is 24-7.
3. What are the primary conditions of your patients?
Many of our patients live with COPD (chronic obstructive pulmonary disease), ALS (amyotrophic lateral sclerosis) and respiratory failure. Almost all of our patients are adults but we do support some children in our pediatric program. About 35% of our hospice patients need oxygen therapy.
4. How do you care for and treat your patients?
We’re seeing more patients with respiratory failure who go into hospitals and don’t wish to be placed on ventilators. They’re usually discharged from the ICUs into our hospice care and we can do BiPAP (bilevel positive airway pressure) therapy to treat their symptoms and keep them comfortable. Other treatment may be concentration in their rooms, tanks or aerosol nebulizers. Sometimes our nurses will refer patients to our Suncoast Hospice Integrative Medicine Clinic for massage, Reiki or other therapies that bring additional comfort.
I’ve learned a lot from our patients. They’ve lived a long time with their conditions and I need to meet them in the middle and listen. They tell me what their biggest symptoms are and I work with our nurses to help make them more comfortable. Many of our patients are only in our care for just a few days but we help them and their families prepare and give everyone that TLC we love to give.
5. What education do you provide to your teams, families and caregivers?
We do a lot of education with our nursing staff and volunteers, who aren’t responsible for care but may be of assistance. We teach families and caregivers how to take care of patients who’ve had a tracheotomy performed. For those caring for loved ones living with COPD, the main thing is to help them stay calm if they have panic attacks. They should try to help them relax and do proper positioning. Puffer devices, anxiety medications or BiPAP therapy may also be needed.
6. How do you and your teams support patients and families as the end of life nears?
When patients decide they no longer wish to be on ventilators, our teams can assist with that and provide support. Our doctors, social workers, spiritual care coordinators and nurses will meet with patients and families and make sure everyone is in agreement.
These can be emotional situations. One of the things I do is pray that I will know the appropriate things to say and right time to give a hand or hug. It’s important to have a calm tone of voice, pay attention and listen in these times. Sometimes talking is stressful for patients with their conditions so I just sit with them without asking a lot of questions.
We work to keep our patients and families comfortable and can provide music, pictures or whatever else they want in their rooms to have loving experiences. They may tell stories, read poetry and say goodbyes. It lets everybody have closure. I always think, what a beautiful death. It would give me comfort.
7. What does your job mean to you?
The teaching and support is so important. It’s all about my patients. I could do patient care all day. I love my patients, hearing their stories and being there for them.
Is it time for hospice?
Talk with us any time about our Suncoast Hospice care at 727-467-7423 or visit our website to request services.