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.

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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?

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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).

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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:

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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.”

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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.

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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.

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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.

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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

Faith stories — yes, faith can be a part of nursing life

Faith and religion in the workplace: Yes, faith has a place in work, and when utilized to direct how one works and interacts with one's patients and families, it can result in a blessing that does not disrespect others.

This article came to be partly a response to one of my favorite YouTube nursing channels, where Nurse Katherine provides educational videos for new and experienced nurses. Her most recent episode at https://www.youtube.com/watch?v=N_lE9O1I3LQ asks the valid question relating to the place of “Religion, Beliefs, and the practice of Medicine | should & can they be combined?”

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The Dying Process at the End of Life

The dying process involves physical and emotional changes as the body shuts down. As the heart weakens, circulation slows, leading to cold hands and feet, pale skin, and drowsiness. Breathing becomes irregular and shallow. The patient may experience delirium or visions. Providing comfort through pain management, emotional support, and spiritual care is crucial.

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