Category: Palliative Care
Articles about palliative care including the differences between palliative care and hospice care which is palliative care at end-of-life.
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.
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.
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.
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.
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.
End-of-Life Determinations for Newly Admitted Patients
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.
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.
Educating families on reporting changes in condition
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.
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?
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.
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.
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).
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:
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.
Liquifying Ativan pills for easier delivery
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:
Hospice realistic expectations for on-call
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.”
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.
Food and Liquids During the Dying Process
This article explores the delicate balance of providing food and liquids to the dying and navigating the complexities of end-of-life care. It addresses the emotional and ethical considerations, offering guidance for caregivers during this profound phase.
My Loved One with Dementia
Caring for a loved one with dementia can be challenging. This article provides insights into understanding dementia, its stages, and practical tips for caregivers. Learn about the FAST Scale, validation therapy, and when hospice care might be appropriate to ensure compassionate and effective support.
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.
What are the levels of care in hospice?
This article is meant to help families and new hospice staff understand the four hospice care levels. According to Medicare guidelines, several levels of care govern hospice services in the United States of America, whether the patient uses Medicare or not.
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.
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.
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?”