Hemoptysis, or coughing up blood, can be a distressing symptom for patients at the end of their life journey. As a hospice nurse, your expertise in managing this symptom is crucial in ensuring a peaceful and comfortable experience for your patients and their families.
Hospice care is a specialized form of medical care for individuals with a life expectancy of six months or less, focusing on comfort, quality of life, and symptom management. It affirms life and recognizes dying as a natural process, neither hastening nor postponing death. The aim of hospice is to help patients live as fully and comfortably as possible, providing comprehensive support for both the patient and their family. This unique approach to care is exemplified by the stories of patients with terminal cancer who, with the help of hospice, were able to fulfill their final wishes, such as feeling the sun on their face or visiting the beach one last time. These experiences highlight that hospice is not just about dying, but about making the most of the time that remains, finding joy, and creating meaningful moments.
I don’t know about you, but every time I see a patient and their family for the first time and take their vitals as part of the nursing assessment, either after each vital or at the end of the vital checks, I’m asked something to the effect of “is that good?”
As you, my friendly readers, bloom as hospice nurses, you will learn that the vital sign portion of the assessment is just a smidge of the entire assessment as to whether someone is approaching the end of life, going through reversible or terminal restlessness, or just having a difficult day. Let me share how I educate families that get hyper-focused on vitals.
Pain is a subjective sensation that can affect a person’s physical, emotional, and spiritual well-being. While pain can be measured objectively by using vital signs such as temperature, pulse, blood pressure, and respiration count, these indicators may not reflect the true intensity of pain that a person is experiencing. This is especially true for non-verbal patients, who cannot communicate their pain verbally. Non-verbal patients may include those with advanced dementia, terminal illness, or other conditions that impair their speech. In this article, I will discuss the importance of assessing pain in non-verbal patients, the tools and methods that can be used to do so, and the benefits of providing adequate pain relief for these patients.
Personal stories from the frontlines of Covid-19 in a nursing home, highlighting the bravery of heroes and the harsh realities faced by residents and staff.
When I first started working in the field of hospice, my clinical manager told me (I’m paraphrasing), one day you will be able to walk into the room, and without getting a single vital sign, just by visual observation, be able to tell that the person is dying or will be shortly dying. That was about three years ago. Today, it’s almost chilling for me (as it is both a blessing and tremendous responsibility) to be able to share she told the truth, and that over time — if you give yourself patience and grace and take the time to listen, observe, and remember — you too will learn how to tell when someone is close to or otherwise is dying.
Please allow me to share some of my insight as to how I know a person has less than a month left to live, and often far less. First off, let’s go into the important discussion you should have with the family, friends, and the patient themselves that provides an overall background to the prognosis. That discussion should be centered around what types of decline (downward, negative) changes have been taking place in the patient’s life over the last six months making note as to whether the decline is minor, medium, or major and the frequency (once a month, once a week, etc.) of those changes.
You are in with a patient with whom you believe will benefit from a treatment/medication. You call the provider who either goes with the recommendation you made as part of the SBAR (situation, background, assessment, nursing recommendation) or otherwise adjusted it to better fit the situation.
Most EMR (electronic medical record systems) now requires you to enter a doctor (provider) order. For visiting staff, most EMR systems will send an electronic communication to the doctor to “sign” the verbal order over the next 24 hours (some systems, the next business day).
Can you imagine how many orders the provider must sign in a day? How do you protect your patient and your nursing license in the written documentation of the doctor’s order you enter into whatever system you are using?
Your dying patient has lost their gag reflex as part of the dying process. One of the questions I implore you to ask yourself is what’s the safest route to administer liquid medications? Well, before even going to answer this question, unless contraindicated, make sure the patient’s head of the bed is at least at a 30 to 45-degree angle (I prefer the latter).
The buccal route is the safest route to administer liquid medications at the end of life in my experience. In practice, I strongly encourage you as well as the families we mutually teach to give any liquid medications on the side of the mouth least likely to have spillage — this depends on the position of the patient — and slowly over time giving the medication in 0.25 ml increments allowing for the absorption of the medication switching cheeks as applicable.
Navigating the final days of a loved one's life can be a challenging and emotional journey. One of the signs that can be observed during this time is known as terminal restlessness. As someone deeply rooted in hospice care, I have witnessed various manifestations of this restlessness. Understanding its types, causes, and management strategies is crucial for providing compassionate end-of-life care. This article aims to illuminate the different kinds of terminal restlessness, identify reversible causes, and discuss effective management techniques. By equipping caregivers, families, and healthcare professionals with this knowledge, we can ensure that terminally ill individuals experience comfort and dignity in their final days.
People often say to me, "It must be challenging to work in hospice." Unfortunately, due to HIPAA regulations, I cannot share photos of the events that occur. However, let me share a poignant moment from today—a dying individual's final wish was to feel the warmth of the sun on their face one last time. And we made that wish come true. This seemingly simple gesture held immense significance for both the patient and their family.
One of the main challenges of new nurses is time management. In a hospital or nursing home setting, you often have coworkers to rescue you in a pinch in case you are overwhelmed; on top of having nearby coworkers, most orientation programs, as well as nursing schools, focus on time management skills in a facility setting. Yet what about time management as a visiting nurse — in home health or home hospice or both?
Let me share with you my wisdom and experience in time management in the field of a visiting nurses to hopefully help you have more time for life compared to work — a better work-life balance.
If you are a new nurse to hospice, one of the tasks you probably dread is doing an admission especially if you have scheduled visits the same day as the admission.
I would like to share with you some tips that when applied may help lower your stress level, and help you remain on time even in cases where you have three to four visits including recertification to do the same day.
Here are some ideas that may be beneficial to those of you who are relatively new visiting hospice nurses:
These are my experiences as a registered nurse caring for geriatric patients in a long-term & rehab care setting where I was the house supervisor responsible for up to 151 residents along with managing the second shift healthcare staff.
By now, you’ve probably had your temperature checked ad nauseam as you visit different locations. Yet, is checking the temperature of your elderly loved ones a good way to know if they may have COVID-19? Are you aware that according to Vital Signs in Older Patients: Age-Related Changes, “older patients are less able to mount a fever response.” Most of my geriatric patients did not have a fever when they contracted COVID-19, and most remained afebrile (without fever) through their stay in the COVID unit.
What’s a more reliable sign of potential COVID-19 infection in the elderly?
Navigating conversations about Do Not Resuscitate (DNR) orders with terminally ill patients and their families can be challenging yet crucial for ensuring that the patient's wishes and comfort are prioritized. The decision between opting for DNR or full code often involves delicate emotions, medical considerations, and ethical concerns. In this article, we will delve into a methodology that has proven effective in facilitating these discussions, particularly in the context of hospice care. Drawing from years of experience and successful outcomes, we'll explore approaches that prioritize compassion, clarity, and patient-centered care. Additionally, we'll reference valuable resources to enhance understanding and guide these critical conversations.
As an INFJ, I’m almost constantly introspective. Today, I was helping with an emergency where one of our wonderful on-call nurses was in a car accident. During my visit with a patient I admitted yesterday who is transitioning towards actively dying, I was in bewilderment in my mind about how comfortable and peacefully patient I am when I’m around the terminally ill and their family.
Morphine is a crucial medication in end-of-life care, but it's often misunderstood. This article debunks common myths about morphine use in hospice, addressing concerns about addiction, hastening death, and sedation. Learn the truth about morphine's role in providing comfort and dignity for terminally ill patients.
Autonomy, the right to receive or refuse medical treatment is a crucial element of health care ethics (American Nurses Association (ANA), 2011; Plakovic, 2016). Nurses are involved in helping patients and families be aware of when end-of-life is occurring, and in educating the patient and family about end-of-life legislation that helps guide everyone committed to continue the right of patient autonomy when the patient is no longer able to express their wishes. Before the Patient Self Determination Act, we had the famous cases of Karen Ann Quinlan and Nancy Cruzan who were, from a point-of-view, forced to suffer for ten or more years of futile treatment (Miller, 2017). Now, we have advanced directives that allow patients to express their wishes while they are able, yet we still have ethical dilemmas when either those needs are expressed vaguely or not at all. It is in the best interest of the patient and the patient's loved ones for advanced directives to be utilized and kept up to date.
