Author: Peter Abraham, BSN, RN

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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.

Peter is the author of Empowering Excellence in Hospice: A Nurse's Toolkit for Best Practices, Holistic Nurse: Skills for Excellence, Compassionate Caregiving, and the Dementia Care Essentials series on Amazon. His work aims to provide valuable resources and guidance for hospice care professionals, ensuring that patients and their families receive the best possible support during challenging times.

Beyond his hands-on care, Peter also writes articles to empower caregivers, family members, and fellow nurses in end-of-life care. His passion for helping others is deeply rooted in his love of Christ Jesus. To learn more about Peter, you can listen to an interview by Marie Betcher, RN, on her Hospice Explained Podcast Series, as well as subscribe to his YouTube channel at https://www.youtube.com/@NursePeter

Understanding Discomfort: Distinguishing it from Pain While Caring for Your Terminally Ill Loved One

An Elderly Woman Who Is Uncomfortable

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.

Read MoreUnderstanding Discomfort: Distinguishing it from Pain While Caring for Your Terminally Ill Loved One

Advocating for Your Terminally Ill Loved One in a Facility

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.

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The Hospice Admission Nurse

hospice admission

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.

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Eye-Opening Lessons on Trusting Nursing Facilities: Advocating for Comfort in End-of-Life Care

Empty Hospital Bed At A Nursing Facility

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.

Read MoreEye-Opening Lessons on Trusting Nursing Facilities: Advocating for Comfort in End-of-Life Care

The Unsung Heroes of Hospice Care: Celebrating the Vital Role of Certified Nursing Assistants (CNAs)

unsung heroes of health care

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.

Read MoreThe Unsung Heroes of Hospice Care: Celebrating the Vital Role of Certified Nursing Assistants (CNAs)

The Actively Dying Phase of The Dying Process

Signs Indicating Death Is Imminent

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.

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Breathing Patterns Before End of Life: Critical Clues for the Last Hours!

Breathing Patterns

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.

Read MoreBreathing Patterns Before End of Life: Critical Clues for the Last Hours!

The Transitioning Phase of The Dying Process

Signs of imminent death

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.

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Preventing Friction and Shear Injuries in Elderly Care: A Guide for Non-Health Professionals

friction and shear pictorial

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.

Read MorePreventing Friction and Shear Injuries in Elderly Care: A Guide for Non-Health Professionals

Understanding Hospice Care: Is it Too Early to Start Hospice?

when is the right time to start hospice

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.

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Understanding the Role of IV Fluids at the End of Life

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.

Read MoreUnderstanding the Role of IV Fluids at the End of Life

Empowering Hospice Nurses: Conquering Medicare Audits and Improving Documentation for Better Patient 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.

Read MoreEmpowering Hospice Nurses: Conquering Medicare Audits and Improving Documentation for Better Patient Care

What Does Hospice in a Home Setting Look Like?

wife comforting her terminally ill husband

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.

Read MoreWhat Does Hospice in a Home Setting Look Like?

Educating Facility Staff on What Matters for Terminally Ill Patients

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.

Read MoreEducating Facility Staff on What Matters for Terminally Ill Patients

The Life of Least Regrets

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.

Read MoreThe Life of Least Regrets

Review of the Hospice Documentation Master Bundle

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!

Read MoreReview of the Hospice Documentation Master Bundle

Tube Feeding on Hospice — Increased Risk of Your Loved One Suffering

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. 

Read MoreTube Feeding on Hospice — Increased Risk of Your Loved One Suffering

The Ins and Outs of Hospice Patients Seeing Their Regular Doctor and Specialists

A female doctor with their patient

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.

Read MoreThe Ins and Outs of Hospice Patients Seeing Their Regular Doctor and Specialists

My name is Peter, yet the patient called me “Jack”

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.

Read MoreMy name is Peter, yet the patient called me “Jack”

Understanding HIS Requirements for Medicare in Hospice Care

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.

Read MoreUnderstanding HIS Requirements for Medicare in Hospice Care

Clues for terminal restlessness often missed for facility patients

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.

Read MoreClues for terminal restlessness often missed for facility patients
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