Author: Peter Abraham, BSN, RN

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Peter Abraham, BSN, RN, is a compassionate hospice nurse, certified end-of-life doula, and Health and Life Navigation Specialist. He warmly supports nurses, caregivers, families, and patients during challenging moments. His rich background spans cardiology, medical-surgical, and long-term care. Additionally, he has led teams in rehab, rural hospice, and palliative care as a dedicated case manager and admissions nurse.

Through Compassion Crossing, Peter offers practical support, including advance care planning, guidance on hospice and palliative care, legacy projects involving photography and videography, medication reviews, and vigil planning. He conducts on-site visits in Madison County, Kentucky, and provides virtual support nationwide. His goal is to turn fear into peace through education and compassionate presence. Guided by his faith in Christ Jesus, Peter brings hope during challenging transitions.

How Peter Helps Through Compassion Crossing

Peter founded Compassion Crossing to provide personalized support that transforms fear into peace. His services include:

Peter's Mission

Peter's goal is simple: create a supportive environment where no one faces life's most challenging moments alone. He writes helpful articles, books, and guides to help caregivers, families, and healthcare professionals feel prepared and confident.

He also shares his knowledge through his YouTube channel, Nurse Peter, where he discusses death, dying, and compassionate care with hospice nurses, holistic nurses, caregivers, and end-of-life professionals.

Life Beyond Work

When Peter isn't working or writing, he enjoys spending time with his wife, Laura, and their two rescue dogs in the beautiful countryside of central Kentucky.

Ready to Talk?

Schedule a free conversation with Peter to see how we can support you, someone you care about, or your organization.

You don't have to face life's difficult transitions alone. We're here to help.

What Hospice Nurses should assess every visit

assessment sheet top

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.

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Ethical Dilemmas in Hospice

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.

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Should dying patients be on oxygen?

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:

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Frequency of Changes in Condition as an Indicator of Approaching Death

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.

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The Hospice Nursing Visit from a Nursing Perspective — Home Patients

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.

Read MoreThe Hospice Nursing Visit from a Nursing Perspective — Home Patients

Best Practices for Approaching Combative Dementia Patients

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:

Read MoreBest Practices for Approaching Combative Dementia Patients

Presentation: Death, Dying, and Comfort Medications in Hospice Care

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.

Read MorePresentation: Death, Dying, and Comfort Medications in Hospice Care

Drowsiness vs. Lethargy vs. Obtunded

Altered Level Of Consciousness

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.

Read MoreDrowsiness vs. Lethargy vs. Obtunded

Recognizing and Treating Common End of Life Symptoms

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.

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Preparing for a Good Death: Topics to Cover with Hospice Patients and Their Families

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.

Read MorePreparing for a Good Death: Topics to Cover with Hospice Patients and Their Families

Delirium vs Terminal Restlessness

delerium vs terminal restlessness

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.

Read MoreDelirium vs Terminal Restlessness

The Dark Side of Physical Therapy for Geriatric Patients with Dementia

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.

Read MoreThe Dark Side of Physical Therapy for Geriatric Patients with Dementia

Considerations for Increasing Hospice Visit Frequencies

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.

Read MoreConsiderations for Increasing Hospice Visit Frequencies

Hospice Routine Visit Template

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.

Read MoreHospice Routine Visit Template

The Importance of Documenting Hospice Visits at the Bedside

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:

Read MoreThe Importance of Documenting Hospice Visits at the Bedside

Hospice Eligibility and Hospice Recertification — information for families and new hospice nurses

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.

Read MoreHospice Eligibility and Hospice Recertification — information for families and new hospice nurses

Morphine and Lorazepam are not euthanizing agents

Morphine and Lorazepam do not hasten death

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.

Read MoreMorphine and Lorazepam are not euthanizing agents

Understanding PRN Medications for Comfort Care

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.

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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.

Read MoreTerminal Restlessness in the Completely Nonverbal Patient