A Holistic Approach: Hospice Nursing Assessment vs. Hospital/Nursing Home Assessment

Published on November 17, 2023

Updated on November 25, 2023

As an experienced , I understand the importance of providing compassionate care that focuses on maximizing patient comfort and removing avoidable distress. The hospice differs from assessments conducted in hospitals or nursing homes, where the focus is often on normal versus abnormal and lab values. In this article, I will compare the hospice to assessments done in other healthcare settings, providing examples that highlight the unique approach of hospice nursing.

Example 1: Pain Assessment

Hospital/Nursing Home Assessment: In a hospital or nursing home setting, the primary focus of pain assessment is often on quantifying pain using numeric scales and evaluating the effectiveness of interventions through and lab values.

Hospice Assessment: The 's approach to pain assessment is centered on the patient's subjective experience and overall well-being. The assessment includes:

  • Actively listening to the patient's verbal and non-verbal cues to identify pain and .
  • Using observational skills to assess changes in facial expressions, body language, and behavior that may indicate pain.
  • Engaging in therapeutic communication to encourage the patient to express their pain and describe its qualities.
  • Assessing the impact of pain on the patient's ability to engage in desired activities and maintain comfort.

By adopting this comprehensive approach, the hospice nurse can develop an individualized plan that prioritizes patient comfort and addresses their unique needs.

Example 2: Nutritional Assessment

Hospital/Nursing Home Assessment: In acute care settings, nutritional assessment often involves evaluating dietary intake, monitoring weight changes, and analyzing lab values to determine nutritional status and interventions.

Hospice Assessment: The hospice nurse's approach to nutritional assessment recognizes that maintaining nutrition is important for comfort and quality of life, but it prioritizes the patient's autonomy and personal preferences. The assessment includes:

  • Engaging in open conversations with the patient and their family to understand their food preferences, cultural or religious dietary restrictions, and aversions related to their illness.
  • Observing changes in appetite, , and ability to swallow, and adapting the diet accordingly.
  • Collaborating with the interdisciplinary team to provide nutritional support that aligns with the patient's goals and wishes.

Hospice nurses understand that the focus shifts from aggressive nutritional interventions to providing comfort and honoring the patient's choices.

Example 3: Psychosocial Assessment

Hospital/Nursing Home Assessment: In acute care or nursing home settings, psychosocial assessment may be brief and focused on identifying major mental health concerns using standardized screening tools.

Hospice Assessment: The hospice nurse's psychosocial assessment aims to address the emotional, social, and spiritual needs of the patient and their family. The assessment includes:

  • Building trusting relationships with the patient and family to create a safe space for them to express their fears, concerns, and emotions.
  • Assessing coping mechanisms, support systems, and cultural or religious beliefs that may influence the patient's end-of-life experience.
  • Collaborating with the interdisciplinary team, including social workers, counselors, and chaplains, to provide holistic support.

Hospice nurses recognize the importance of addressing the psychosocial aspects of end-of-life care to help patients and families navigate the complex emotions associated with terminal illness.

Example 4: Symptom Management

Hospital/Nursing Home Assessment: In hospital or nursing home assessments, the focus is often on identifying and treating specific symptoms based on objective data from vitals and lab values.

Hospice Assessment: The hospice nurse's approach to symptom management involves a holistic evaluation of the patient's comfort. The assessment includes:

  • Actively listening to the patient's reported symptoms and their impact on daily life.
  • Observing changes in physical appearance, behavior, and vital signs that may indicate symptoms of distress.
  • Collaborating with the interdisciplinary team to develop an individualized symptom management plan that addresses the patient's unique needs.

Hospice nurses prioritize patient comfort by addressing symptoms promptly and tailoring interventions to enhance quality of life.

Example 5: Spiritual and Emotional Well-being Assessment

Hospital/Nursing Home Assessment: In hospital or nursing home assessments, spiritual and emotional well-being may receive limited attention or be addressed through referrals to chaplains or mental health professionals.

Hospice Assessment: The hospice nurse recognizes the importance of spiritual and emotional well-being in end-of-life care. The assessment includes:

  • Engaging in open and empathetic conversations to explore the patient's beliefs, values, and sources of comfort and strength.
  • Assessing the patient's emotional state, fears, and concerns related to their illness and end-of-life journey.
  • Collaborating with the interdisciplinary team and chaplains to provide spiritual support and counseling.

Hospice nurses understand the significant impact of addressing spiritual and emotional needs on overall well-being during the end-of-life journey.

Key Areas Assessed in Each Hospice Nursing Visit

During each nursing visit, hospice nurses prioritize a comprehensive assessment that focuses on maximizing patient comfort and addressing avoidable distress. Key areas assessed include:

  1. Pain and symptom management: Assessing the patient's pain levels, symptom distress, and response to interventions.
  2. Emotional and psychosocial well-being: Exploring the patient's emotional state, fears, concerns, and coping mechanisms.
  3. Communication and understanding: Ensuring effective communication between the patient, family, and healthcare team regarding goals of care and treatment preferences.
  4. Spiritual support: Assessing the patient's spiritual beliefs, values, and sources of comfort and providing appropriate support.
  5. Family support and education: Assessing the needs of the patient's family, providing education, and offering emotional support throughout the caregiving process.

By focusing on these key areas, hospice nurses provide holistic care that addresses the physical, emotional, and spiritual needs of patients and their families.

Conclusion

In every hospice nursing visit, the focus remains on key areas that define holistic care: pain and symptom management, emotional and psychosocial well-being, effective communication, spiritual support, and family education. These areas collectively contribute to a comprehensive approach that addresses the multifaceted needs of both patients and their families.

The essence of hospice nursing assessments lies in embracing a holistic perspective, prioritizing individual experiences, and providing personalized care that extends beyond medical parameters. This approach ensures that patients and their families receive support that not only attends to physical needs but also recognizes the intricate emotional and spiritual dimensions of the end-of-life journey.

Resources:

What Hospice Nurses Should Assess Every Visit

Dietary Changes through the Dying Process

Journal Article: Spiritual care in nursing: an overview of the measures used to assess spiritual care provision and related factors amongst nurses

Article: 4 End-of-Life Care (Hospice Care) Nursing Care Plans

Journal Article: Nursing and the Future of Palliative Care

Journal Article: The Role of Hospice Care in the Nursing Home Setting

Journal Article: Hospice care in US nursing homes: benefits and barriers

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

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