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.
When it comes to hospice care, one common question that arises is whether terminally ill patients should continue seeing their regular doctor or specialists. As an experienced hospice nurse, I have witnessed the benefits and challenges of maintaining these relationships. In this article, we’ll explore the pros and cons of hospice patients still visiting their general practitioners and specialists from the perspective of patients and their families.
As a hospice registered nurse, I have encountered numerous heartwarming and challenging experiences throughout my career. One of the most memorable encounters was with a dementia patient, Miss Norma Jean Smith, who affectionately called me "Jack." This endearing nickname, born out of her unique perception, became a symbol of the special bond we shared. In the following account, I will share the poignant journey of building trust, providing compassionate care, and embracing the unexpected moments of joy and sorrow in the life of Miss Norma. This story is a testament to the profound impact of person-centered care and the invaluable lessons learned from the patients we are privileged to serve.
One crucial aspect for new hospice nurses to grasp is the Hospice Item Set (HIS) requirements. In this article, I’ll explain the HIS requirements for Medicare, providing you with a comprehensive understanding to ensure compliance and quality care delivery.
One of the hardest portions of the job of a hospice nurse is to identify when a patient has two weeks of life left to live; this can be especially difficult at facilities going through staffing shortages leading to inconsistent caregivers with little to verbally report on a patient’s change of condition. Since being aware of the velocity of declines is extremely important, let’s cover an area that we in hospice (nurses, families, and caregivers alike) can keep an eye on in terms of identifying terminal restlessness which is often a key indicator for one week or less of life.
I have seen firsthand the benefits and drawbacks of different medications for managing pain and anxiety in terminally ill patients. Fentanyl patches and Ativan gel are two commonly used medications, but their effectiveness can vary depending on a patient’s build and weight, particularly for very thin or cachexic individuals.
There is a spiritual connection in hospice, dealing with death and dying forty-plus hours per week. We who are in the field see it often, but there are times when we hear it firmly from the patients and families whom we serve. Let me share the most recent event on Memorial Day, 5/29/2023, week.
I understand the challenges that patients and families face when receiving hospice services. One common issue that arises is the need for after-hour calls, which can add stress to an already demanding situation. However, with proactive care and effective communication, dayshift hospice RN case managers can play a crucial role in reducing after-hour calls and providing better support to patients and their families. Here’s how:
One of the most important roles is detecting and managing infections in terminally ill geriatric patients with dementia. These patients are often at higher risk for infections due to their weakened immune systems, underlying health conditions, and limited mobility. Detecting infections in these patients can be challenging due to their limited communication abilities and other cognitive and physical impairments. However, early detection and management of infections can significantly improve the patient’s quality of life and potentially prolong their life.
Hospice nurses play a vital role in providing quality care and comfort to terminally ill patients and their families. They must make accurate and timely assessments of the patient’s condition, needs, and preferences every visit. This article will outline the key aspects that hospice nurses should assess every visit, in addition to the standard physical assessment.
As a hospice RN case manager, I have seen many ethical dilemmas arise in end-of-life situations. Hospice care is unique because it focuses on providing comfort care to patients no longer seeking curative treatment for their illnesses. As a result, the ethical concerns in hospice care differ from those in other healthcare settings. This article will explore some ethical dilemmas that can arise in hospice care and how they can be addressed.
Before I review several case studies gathered from the sources in the resource section below, please allow me to share a current one of mine that is ongoing as this article is being published.
I have cared for many terminally ill patients over the years. One question that comes up frequently is should the dying patient be on oxygen at the end of life?
I see it from both sides, from hospice intake personnel as well as the admitting nurse — all had it drilled into them over the years that low oxygen saturation must be treated — to families who see how hospital and nursing home staff rush to put someone on oxygen because of low oxygen saturation.
Contrary to widespread belief, most dying patients do not need oxygen. Here’s why:
Recognizing the velocity of changes in a patient's condition is crucial for hospice nurses. By understanding the pace of changes in vital signs, symptoms, functionality, and more, nurses can anticipate needs, adjust care plans, and communicate the prognosis effectively with patients and families. The article provides guidelines on interpreting the velocity to estimate the time a patient has left.
This article offers guidance for new visiting hospice nurses struggling with work-life balance. It covers strategies like maintaining a recertification journal, pre-charting before visits, assessing end-of-life status, educating families, and preparing for a "good death." By following these tips, nurses can take less work home while delivering focused, compassionate care.
Dementia is a progressive brain disorder that affects a person’s cognitive abilities, memory, and behavior. In the later stages of the disease, some patients can become combative and aggressive, making it difficult for caregivers to provide the necessary care. As a hospice nurse, it’s important to know how to approach and manage combative dementia patients to ensure their comfort and safety. Here are some best practices to consider:
As an experienced hospice nurse, I understand that working in hospice care can be emotionally and physically challenging. In this presentation, I will share my knowledge and expertise on the topics of death and dying, as well as comfort medications including morphine, to help guide you in providing the best care for your patients.
Understanding drowsiness, lethargy, and obtundation is crucial in hospice care. Drowsiness is a normal sleepiness, lethargy is more profound tiredness, and obtundation indicates severe unresponsiveness. Recognizing these levels helps in providing the right care and comfort for terminally ill patients.
Guide to Recognize and Treat Common End of Life Symptoms provides tips on managing symptoms experienced by those at the end of their lives - Topics such as pain, shortness of breath, respiratory distress, and anxiety, and provides suggestions for medications and complementary therapies to help manage these symptoms.
I have worked with countless terminally ill patients and their families. One of the most important aspects of hospice care is ensuring that the patient and their loved ones are prepared for the end of life.
In this article, I will cover the topics that hospice nurses should discuss with patients and caregivers to ensure a good death.
As an experienced hospice nurse, I understand how difficult it can be to distinguish between delirium and terminal restlessness. Both conditions can cause significant distress for the patient and their loved ones, and nurses must be able to tell the difference between them to provide the best possible care. In this article, I will share my knowledge and experience to help new hospice nurses understand the differences between delirium and terminal restlessness and how to rule out delirium.
Explore the ethical dilemma of physical therapy for terminally ill dementia patients. This article examines the potential harm of aggressive interventions, highlighting the importance of comfort-focused care. Learn why hospice professionals often advocate for gentler approaches in end-of-life dementia care.
Hospice care is focused on symptom management, pain relief, emotional support, and spiritual care. It is a privilege to be a part of a patient’s end-of-life journey, and as a new hospice nurse, you may feel overwhelmed, but you can make a difference in a patient’s life. One of the essential skills you need to learn as a hospice nurse is to recognize when to increase the scheduled visit frequency for a terminally ill patient under hospice care.
I keep the bedside documentation to under 15 minutes (admission visits not included) by creating muscle memory by following consistent templates based on the type of visit (routine, PRN, recertification, death, and admission).
I’ve previously shared my recertification template, so let me share my routine visit template for today. For those new, routine visits are scheduled ahead of time, and while you may arrive to find a crisis before you, the visit itself was scheduled and therefore considered routine. It is regarded as part of the four hospice care levels according to Medicare guidelines.
Our primary focus for our patients is comfort at the end of life as hospice nurses. We work tirelessly to ensure that our patients receive the best possible care during their end-of-life journey. An aspect of that care that is often overlooked, but incredibly important is timely documentation.
Documenting hospice visits at the bedside is crucial for several reasons. Not only does it help ensure that our patients are receiving the best possible care, but it also helps the hospice team as a whole and reduces issues when the caregiver must be involved in triage services. Here are just a few reasons why documenting hospice visits at the bedside is so important:
