Profiles In Nursing

Cicely Saunders, Founder of Modern Hospice Care

Cicely Saunders created Palliative care

Cicely Saunders bends over to talk to her older, female patient lying in a hospital bed

Although she was a nurse for only a short time, Cicely Saunders devoted her life to serving patients in their final days. Her work transformed our understanding of palliative care, demonstrating that with proper support, terminal patients can find peace, purpose and even happiness.

Called to Nursing

Born to a wealthy English family, Saunders never needed to work for financial reasons, but felt called to nursing during World War II. She enrolled in the Nightingale School of Nursing at St. Thomas’ Hospital in London, from which she graduated in 1944.

As part of her training, Saunders cared for many dying patients, an experience that led her to conclude that there had to be a better way to treat the dying. In that era, in England and elsewhere, terminal patients were rarely told of their prognosis, although many probably guessed. Pain medication regimens were stingy, so hospital back wards were often filled with dying patients’ screams of pain.

After the war, Saunders continued to support terminal patients as a hospice nurse and medical social worker. One of her patients was a terminally ill Polish refugee named David Tasma. As he languished, Tasma and Saunders shared their dreams of a place where patients’ final days could be easier.

When Tasma died in February 1948, he left Saunders £500 (the equivalent of more than $20,000 today) to help establish such a place. “Let me be a window in your home,” he told her.

From Nurse to Doctor

It would take Saunders 19 years to fulfill that dream. Although she met others who believed in her vision, she found that no one at that time would listen seriously to a nurse. She responded by enrolling in medical school, again at St. Thomas’ Hospital. After earning her medical degree in 1957, she became an expert in the emerging field of palliative care while working at St. Joseph’s Hospice in east London.

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Saunders’ approach to pain management was itself revolutionary. The modern concept of total pain stems largely from her carefully documented research. She understood that the pain terminal patients experience is not only due to physical disease, but also psychological or spiritual stress and social pressures like finances and family dynamics. For a dying patient to rest easily, they need relief in all those areas.

She also worked to challenge the medical profession’s reluctance to provide terminal patients with pain medication. Saunders noted that the patients in a home run by impoverished nuns with few resources and only rudimentary medical knowledge were actually more at peace than patients in hospitals because they were offered generous, round-the-clock pain relief.

St. Christopher’s Hospice

Saunders opened her own hospice, St. Christopher’s, in 1967. She based much of the facility’s physical layout and principles of care on her understanding that patients could accept dying if they knew they would not be alone, would not suffer unnecessarily and were valued.

She made St. Christopher’s an open and airy place, emphasizing peace rather than pain. Over the entryway was a window with a plaque dedicated to David Tasma.

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Although it went against her grain as a committed evangelical Anglican, Saunders made St. Christopher’s a basically secular institution that welcomed patients and staff of all faiths and of none. It was also the first research and teaching hospice and became surprisingly successful at combining curative and palliative care.

Like many great innovators, Saunders was determined and not given to compromise. She could be a formidable opponent and people who stood up to her did not frequently win. At the same time, she could appreciate different points of view.

She strongly supported her staff, urging them to rely on their own instincts and practice self-care to cope with their sometimes disheartening role.

Saunders served as St. Christopher’s medical director until 1985 and as chairman until 2000. Her direct involvement with the hospice continued until her death in 2005. Like so many of the patients she had cared for, she died at St. Christopher’s.

Later Life

Throughout her professional life, Saunders received many honors, including the 1981 Templeton Prize. She was knighted in 1965, was named a dame commander of the Order of the British Empire 15 years later and received the Order of Merit in 1989. Her work has become a model for hospice and palliative care in both the U.K. and the U.S.

She was a frequent public speaker and wrote or edited several books on the treatment of terminal disease as well as a collection of her voluminous correspondence. Towards the end of her life, she collected five of her lectures in a volume entitled Watch with Me: Inspiration for a Life in Hospice Care.

Editor David Clark now offers the book for free download here. It offers valuable insights into Saunders’ philosophy of care.

ELIZABETH HANINK, RN, BSN, PHN, is a Working Nurse staff writer with extensive hospital and community-based nursing experience.

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