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.
As an experienced hospice nurse, I understand how overwhelming and emotional it can be for terminally ill patients and their loved ones to navigate the hospice process. Hospice care is a compassionate and comprehensive approach to end-of-life care, designed to provide comfort, pain management, and emotional support to patients and their families. However, many people have questions about hospice eligibility and hospice recertification. In this article, I will provide a generalized guide to help you understand these important aspects of hospice care.
As a hospice nurse with years of experience, I have encountered many situations where family members are hesitant to allow their loved ones to receive medications such as morphine and lorazepam. One of the main reasons for this hesitancy is the belief that these medications will hasten death, leading to euthanasia.
In this article, I want to address this concern and help family members and friends understand the use of morphine and lorazepam in hospice care.
I’ve seen firsthand how important it is to understand comfort and discomfort in hospice care. Let’s dive into these terms and how they relate to end-of-life care.
As an experienced hospice nurse, I understand the challenges that terminally ill patients and their families face. One of the biggest challenges is managing symptoms such as pain, anxiety, and nausea. Hospice comfort medications can help provide relief and improve the quality of life for patients in their final days. In this article, we will discuss some of the most used hospice comfort medications and when they might be used for comfort.
Hey there, my friend! As an experienced hospice nurse, I understand that managing symptoms for comfort is crucial for terminally ill patients. One of the ways we do this is through PRN medications. Today, I want to help you understand PRN medications and how they can be used in conjunction with scheduled medications.
Hospice care offers a specialized service known as the Continuous Care Benefit. This unique care type provides crucial 24-hour support to patients who are going through an acute symptom crisis. In this article, we'll delve into what Continuous Care Benefit is, who's eligible for it, how it operates, why it's important, how to access it, and its duration.
Understanding Hospice Care: A Guide for Families
If you or your loved one is facing a serious illness and needs extra care and support, hospice care may be the right choice. Hospice is a special kind of care that helps people who are nearing the end of their lives feel as comfortable and peaceful as possible.
I remember having some nurses tell me that nurses who go into hospice lose their critical thinking skills because they are dealing with people who are dying. Little did they know that hospice nurses often need to think far more critically than other nurses. Let’s outline some key critical thinking areas as a hospice nurse.
Terminal restlessness is a common phenomenon that occurs in the final stages of life. It is characterized by agitation, confusion, and distress. It can be challenging to recognize and manage, especially in patients who cannot communicate verbally. This article aims to share insights and tips from a hospice worker who learned how terminal restlessness can manifest differently in nonverbal patients and how to cope.
When a loved one is diagnosed with a terminal illness, hospice care can provide comfort and dignity in their final days. Hospice care is a type of palliative care that focuses on relieving pain and symptoms rather than curing the disease. It also offers emotional and spiritual support to the patient and their family.
However, choosing a hospice agency is not easy. Many factors must be considered, such as the quality of care, the agency's location, the level of services, and the patient’s rights. This article will discuss these factors and provide tips on choosing the best hospice agency for your loved one.
Hospice care focuses on providing comfort and quality of life for people with terminal illnesses and life expectancies of six months or less. While hospice care can be a difficult decision for families, it can also be a source of support and relief during a challenging time. In this article, we will explain the process of getting your loved one into hospice care and answer some common questions.
Admitting a patient to hospice services is a complex and sensitive process that requires careful assessment and communication. One of the challenges that hospice nurses face is to determine if the patient is close to the transitioning phase of dying, which is the final stage of life when death is imminent. This phase usually lasts for one to two weeks, and it is essential to prepare the family and provide a plan for increased hospice involvement during this time. However, on admission, hospice nurses do not have the luxury of having visited with the patient over the past several weeks to months to observe the changes that often signal that death is approaching. Therefore, they need to rely on other indicators to help them identify whether the patient is transitioning.
Dying is an inevitable facet of life, a natural progression that touches us all. This journey towards the end of life can unfold in diverse ways—peaceful and graceful or turbulent and fraught with stress. Amid this journey, there exists a phase known as the "rally." It occurs just before the final moments of a person's life. This rally phase often shrouds itself in misunderstanding and misconceptions. It's imperative to unravel what it truly signifies.
When someone you love is sick and may not get better, you want to do everything possible to make them comfortable and happy. Sometimes, you may notice that they are acting differently or feeling worse. This is called a change of condition. Some changes in condition are very serious and need to be reported to the hospice provider right away. Other changes in condition are less urgent and can be written down in a journal until the next nursing visit. This article will help you learn how to tell the difference and what to do.
Hospice recertification is a crucial step in which the registered nurse case manager can help make the case for continued hospice eligibility. May I encourage my fellow hospice nurses to start using a template to ensure your recertification visits are consistent and that you are leading early in the documentation portion regarding what declines have occurred since admission and last recertification?
LUnderstanding the physical and emotional changes can be crucial as a loved one nears the end of life. This guide explores common signs of approaching death, offering insights on breathing changes, skin mottling, and decreased consciousness. Learn how to provide comfort and support during this final journey.
Caring for a loved one in hospice is rewarding yet challenging. Keeping a caregiver journal benefits the patient, family, and hospice provider. It enhances care, coping, and creating memories. Get tips on starting and maintaining a meaningful journal to improve your caregiving experience.
I can count the times I’ve run into air hunger at the end of life as a visiting RN Case Manager for going on five years on one hand. Over the years, I’ve managed patients with pulmonary fibrosis, lung cancers (diverse types), breast cancer, COPD, congestive heart failure, B-cell lymphoma, leukemia, and other diseases that can impact one person’s ability to breathe correctly. Air hunger is rare in my firsthand experiences, but it can happen.
Air hunger often sounds like the person is gasping for breath without regard to the actual respiratory rate (how fast they are breathing); it can also sound like stridor (YouTube videos below where you can hear the difference).
A review of the implications of each choice for the terminally ill patient as well as the loved ones of those who are terminally ill. This form comes into practice typically under two conditions… no pulse and is not breathing OR has a pulse and/or is breathing (but while not mentioned is typically in the last two weeks of life if no measures are taken with the understanding that any and all measures do not guarantee a longer time frame). Let’s review the form below:
Navigating the dietary needs at life’s end can be complex. This guide explores the progression of diet textures and liquid consistencies, ensuring comfort and safety for the terminally ill. Learn to adapt meals for loved ones as they approach this delicate phase.
Ativan, generically called Lorazepam, pills can be easily melted into liquid, and given to your loved one in a syringe. This is typically done vs. putting the pill under the tongue if your loved one has a dry mouth, and the Ativan pills are not melting under the tongue.
The process of melting lorazepam into a liquid will require the following resources:
This short article is meant for hospice patients, family members, and friends.
It’s common to read various social media posts where a patient, family member, or friend does the right thing by calling their hospice provider to alert them of a change of condition or otherwise significant issue for on-call to come out for an unscheduled visit. Also, common is follow up posts where the writer asked, “it’s been ______ (minutes, hours) since the call, I hope they show up.”
Naomi Feil is an expert in gerontology and the creator of validation therapy, which is a means of communicating and acknowledging the internal reality of patients with dementia. When properly utilized, validation therapy can enhance the quality of life of patients with dementia as well as reduce stress on the family and caregivers.
While Naomi Feil and her followers (of which the writer of this article may be considered one, at least in form) focus on using this method of communication to maintain health with the potential for a level of restorative health, I want to share how the concepts of this method can be used during times of crisis.
This article explores the delicate balance of providing food and liquids to the dying and navigating the complexities of end-of-life care. It addresses the emotional and ethical considerations, offering guidance for caregivers during this profound phase.
