Empowering caregivers, families, and nurses in end-of-life care
Author: Peter Abraham, BSN, RN
Peter Abraham is a seasoned nurse committed to supporting nurses, caregivers, families, and patients in their learning, growth, and well-being journey. His extensive nursing career includes practical experience as a cardiac telemetry nurse in a dynamic cardiology unit at a Magnet-awarded teaching hospital. Additionally, Peter has served as a second-shift RN supervisor, managing an entire building in a Skilled Nursing Facility/Long-Term Care (SNF/LTC) setting with 151 residents. Notably, during the initial wave of COVID-19, the facility achieved an impressive near-100% recovery rate before the completion of Operation Warp Speed.
Peter's nursing career also extends to rural home hospice care. As a visiting hospice registered nurse case manager, he provides compassionate care to patients in various settings, including private homes, personal care homes, assisted living facilities, skilled nursing facilities, and hospitals. His dedication to compassionate care led to the establishment of the Peter Abraham Wound Care Scholarship, which offers education in wound care. This scholarship, associated with the theme of "Wound Care: Enhancing Healthcare for the Aging Population," underscores Peter's commitment to improving care for those in need.
In this article, we will explore the vital role of a hospice chaplain, as explained by Katherine Seiler, an experienced and compassionate hospice chaplain. Hospice chaplains play a significant role in providing emotional, social, and spiritual support to terminally ill patients and their families during their end-of-life journey.
Facing a loved one's diagnosis of frontal lobe dementia can be overwhelming and challenging. This article aims to provide families with essential information about frontal lobe dementia, its progression, changes they might observe in their loved one, and best practices for caregiving from onset until the end of life.
Hospice care is a vital form of healthcare dedicated to providing comfort and support to patients in their final stages of life. While it's a relatively recent concept in the United States, with its inception in 1974, it has gained significant popularity, with over half of Medicare beneficiaries in 2020 receiving hospice services. Nevertheless, as we delve into 2023, hospice care confronts several formidable challenges. These include labor shortages, concerns about the quality of care, and the notable presence of for-profit entities in the industry. In this article, we will navigate through the history of hospice care in the United States, its present state in 2023, and the challenges that affect not only hospice patients but also the dedicated staff and providers.
It’s essential to familiarize yourself with the key local coverage determination (LCD) facts for different terminal illnesses to avoid admitting patients who are not eligible for services only to be required to refund the money back to Medicare; otherwise, only have the patient on for one benefit period then discharged for failure to decline. These determinations provide guidelines on the coverage of hospice services for specific conditions. If you are the admitting nurse, please do not just admit because you were told to admit by someone, regardless of the position or standing of the person or party that told you to admit. Use your critical thinking and clinical judgment skills to evaluate the patient for admission. Most doctors will write "evaluate and treat" or something to that effect; never lose sight of the "evaluate" portion of the doctor's order.
Based on the provided PDF files, as noted in the resources section below, let’s explore some essential information for each terminal illness.
If your loved one is facing a discharge from hospice due to failure to decline, it's crucial to comprehend the situation clearly. This discharge indicates that the healthcare team believes your loved one's condition has stabilized and no longer requires hospice care. While this might be a positive sign, it's important to weigh the pros and cons before making decisions. Let's delve into both the positive and negative aspects of this situation to help you navigate it effectively.
Caring for a terminally ill loved one is a profound and challenging journey that requires compassion, understanding, and a willingness to alleviate any discomfort they may experience. In this guide, we will explore the concept of discomfort, its distinction from pain, and the importance of recognizing and addressing discomfort in addition to pain. You'll be better equipped to provide holistic care that enhances your loved one's quality of life during this sensitive time.
Throughout your loved one's illness, you might find yourself thinking that they don't require "pain medication" because they don't seem to be in pain. They might even respond with a direct "no" when asked about their pain. However, are you aware that most types of pain medication can alleviate discomfort? Did you also know that your loved one could be feeling uncomfortable without necessarily being in severe pain? Nonetheless, it's important to recognize that their discomfort requires the same treatment as if they were in pain.
As a family member of a terminally ill loved one receiving care in a facility, you play a vital role in ensuring they receive the best possible care and support during their journey towards a good death. Advocating for your loved one involves understanding their needs, communicating effectively with the facility staff, and staying informed about their care plan. This article aims to guide you on being an effective advocate, asking the right questions, and ensuring your loved one's comfort and well-being.
This article delves into hospice care with Andrew Viozzi, an adept hospice admission registered nurse. Andrew brings valuable insights into the hospice admission process and the broader spectrum of hospice care. Although Andrew's current position revolves around admissions, his extensive experience encompasses case management, preceptorship, mentorship, and the guidance of new hospice nurses. In this article, we dispel misconceptions, highlight the advantages of hospice care, outline the admission procedure, and emphasize the pivotal role of hospice in end-of-life care.
As an experienced hospice visiting registered nurse, today offered me profound insights from two interconnected perspectives. The first highlights the blind trust we often place in facility nurses and doctors when caring for our loved ones. The second involves the challenges I encountered while advocating for proper end-of-life care for a patient with Alzheimer's.
In the realm of hospice care, compassion and comfort take precedence. A team of skilled professionals comes together to offer comprehensive support to patients, their families, and caregivers. Among these essential contributors, Certified Nursing Assistants (CNAs) stand out as unsung heroes, bringing immeasurable value to the field of hospice care. This article delves into the distinctive role CNAs play in hospice, their frequent and meaningful interactions, and their leadership within the hospice team.
For a non-healthcare professional who has never witnessed death before, it can be unsettling to be present with someone who is nearing the end of their life. However, there are certain signs and observations that you can make using your senses that may indicate that the person you are with may pass away within seconds, minutes, or hours. Understanding these signs can help you provide support and comfort to the individual and their loved ones during this grim time.
Understanding the final breath: This article explores the critical breathing patterns observed in the last hours of life, offering insights for caregivers and family members to prepare for the end-of-life journey.
Losing a loved one is an incredibly challenging and emotional experience. If you find yourself in the presence of someone in the transitioning phase of the dying process, knowing what signs to look for can be helpful. Although every individual's experience may vary, some common observations may indicate someone is in the transitioning phase. Here's a guide to help you recognize these signs and provide support during this grim time.
Taking care of an elderly fragile person at home can be both rewarding and challenging. One crucial aspect of caregiving is preventing friction and shear injuries, which can be painful and detrimental to the person's well-being. In this article, we'll explore what friction and shear injuries are, how they can be avoided, and some practical tips to ensure your loved one's safety and comfort.
It's common in nursing to be told by others that you shouldn't be a nurse, and some may even call you a "fake nurse" if you don't meet their standards of what they think is required to be a nurse. The first time I was told I could not be a nurse was by an elderly woman who believed only women could be nurses.
Is it Too Early to Start Hospice?
It's crucial to remember that hospice care is about improving the quality of life for the patient and their family, regardless of the time left. Hospice care can be initiated when the patient's condition is declining and they require comfort-focused care rather than life-prolonging treatments. Starting hospice care early can provide ample time for the patient and their family to benefit from the support and services offered.
If you're unsure when to consider hospice care, consult the patient's primary physician or a hospice care provider. They can guide you through the process and help you make an informed decision based on the patient's needs and circumstances.
Explore the delicate balance of IV fluid use at life’s end. This article discusses the hospice approach, potential risks, and prioritizing comfort over invasive measures. A must-read for families facing tough decisions in palliative care.
This article provides valuable insights for hospice nurses on improving documentation to conquer Medicare audits and ensure claims are not denied due to insufficient evidence of terminal prognosis. The author shares real-life examples of visit narratives before and after implementing documentation best practices learned from an expert. The tips focus on capturing negative condition changes, disorientation levels, and functional decline to paint a clear picture of the patient's terminal state, ultimately leading to better patient care.
Caring for a terminally ill loved one can be challenging. Still, with the proper support and understanding, you can help ensure they experience a comfortable and dignified end of life. Hospice care offers specialized medical and emotional support during this time. This guide aims to empower families new to hospice services by providing essential information on what to expect from a hospice provider and how to manage the journey towards a good death.
Educating nursing home staff on hospice care priorities like shifting focus from vital signs to comfort, managing symptoms like pain/breathlessness, providing psychosocial support, end-of-life planning, and bereavement care is crucial. Hospice emphasizes quality of life over curative treatments. Effective symptom management through medications and non-pharmacological approaches enhances patient comfort. Open communication, empathy, and respecting patient autonomy are essential. Hospice prepares families for the dying process and grief counseling.
The longer I work in hospice, the more I'm reminded about two critical pieces of wisdom: 1) Hospice is about living, and 2) we should all do our best to live a life of least regrets.
While this article is geared towards family members with a terminally ill loved one, as well as my fellow workers in the fields of palliative and hospice care, I believe the thoughts that I will share apply to everyone alive near and far.
Whether you are a new hospice nurse or an experienced one like me, I would hope that it is your desire to prove and support continued hospice eligibility for your patients and families. In my years as a hospice nurse, I've always felt the training on what words and phrases to use to support hospice eligibility was weak compared to the training received in other areas of nursing. Now, you have a means of getting the education you need in a very portable setup that you can take with you, use as you see fit, and bloom!
Considering tube feeding for a loved one in hospice? This intervention may not improve quality of life and can lead to discomfort, reduced mobility, and complications. Learn about the risks and make informed decisions for their end-of-life care.
