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 the Continuous Care Benefit in Hospice Care

Hospice Continuous Home Care Benefit

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.

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What is Hospice?

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.

Read MoreWhat is Hospice?

What does critical thinking look like for hospice nurses?

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.

Read MoreWhat does critical thinking look like for hospice nurses?

Terminal Restlessness in the Completely Nonverbal Patient

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.

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Picking a hospice agency to provide hospice services

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.

Read MorePicking a hospice agency to provide hospice services

What’s the process of getting your loved one on hospice service?

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.

Read MoreWhat’s the process of getting your loved one on hospice service?

End-of-Life Determinations for Newly Admitted Patients

how people die trajectory

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.

Read MoreEnd-of-Life Determinations for Newly Admitted Patients

Rally as part of the dying process

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.

Read MoreRally as part of the dying process

Educating families on reporting changes in condition

Illness Trajectories And Palliative Care

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.

Read MoreEducating families on reporting changes in condition

An example recertification template for hospice eligibility

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?

Read MoreAn example recertification template for hospice eligibility

The last hours of life

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.

Read MoreThe last hours of life

The importance of caregiver journaling for the patient and family

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.

Read MoreThe importance of caregiver journaling for the patient and family

Air hunger management at end-of-life

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).

Read MoreAir hunger management at end-of-life

Hospice and the Pennsylvania Orders for Life Sustaining Treatment — POLST

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:

Read MoreHospice and the Pennsylvania Orders for Life Sustaining Treatment — POLST

Understanding Changes in Diet Texture for the Terminally Ill

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.

Read MoreUnderstanding Changes in Diet Texture for the Terminally Ill

Liquifying Ativan pills for easier delivery

pills spread out on a table

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:

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Hospice realistic expectations for on-call

On Call Hospice Nurse

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.”

Read MoreHospice realistic expectations for on-call

Validation Therapy: A Valuable Tool for Families and Healthcare Teams

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.

Read MoreValidation Therapy: A Valuable Tool for Families and Healthcare Teams

Understanding Hospice Benefit Periods

Understanding Hospice Benefit Periods

There are several things that go on behind the scenes when you or your loved one is admitted to a hospice provider. Some of them you may never see because it doesn’t impact the care provided and received. Others like the hospice benefit periods may only come out of the woodwork (so to write) at certain times and can either cause joy or distress depending on one’s point of view.

The goal of this article is to keep it simple and smile (my version of the K.I.S.S. principal) understanding of hospice benefit periods. When a person is first admitted to a hospice provider (having never been on hospice), they start off (behind the scenes) in benefit period number one. This is the first half (90-days/3-months) of the estimated six-months or less to live. Benefit period number two is the second half (3 more months/90-days). And since a terminal illness doesn’t come with guarantees that one will pass in six months or less, Medicare allows for (with fine print through the entire journey) an unlimited number of sixty-day (two months at a time) benefit periods.

Read MoreUnderstanding Hospice Benefit Periods

Interviewing and Observation as part of the assessment

There are observation and interviewing skills you can develop which will help you learn:

What could cause the current change in condition

Determining if a patient is having terminal restlessness

Determining if your patient is within two weeks or less of life to live

Knowing where your patient is in the dying process

While this article is primarily meant for new nurses, what I’m sharing is also valuable for family members and loved ones. Anyone with patience and love toward the person being observed and interviewed can hone and develop these skills.

Read MoreInterviewing and Observation as part of the assessment

The D.O.G.I. at the window case study

As nurses, when we see an acute change of condition, part of what we should be doing in our assessment is determining if there are reversible or treatable elements that are causing the change. In RN school, Dr. Dagen taught the students about using the D.O.G. mnemonic to help us remember that if a patient has an acute change of condition to check whether there were new medications the patient is taking, their O2 saturation level and their glucose level.

I would further add that as a hospice nurse dealing with mainly geriatric patients that if there is an altered level of consciousness (LOC)/personality change, to also consider the patient may have an infection. For any of you dealing with geriatric patients add “I” for infection, hence “D.O.G.I.” While this mnemonic is typically used for acute changes of level of consciousness, the thought process behind it can be used for other acute change of patient condition as well.

Read MoreThe D.O.G.I. at the window case study
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