Category: Terminal Illness
Articles about terminal illnesses that one typically sees and cares for on hospice.
Understanding Discomfort: Distinguishing it from Pain While Caring for Your Terminally Ill Loved One
Caring for a terminally ill loved one is a profound and challenging journey that requires compassion, understanding, and a willingness to alleviate any discomfort they may experience. In this guide, we will explore the concept of discomfort, its distinction from pain, and the importance of recognizing and addressing discomfort in addition to pain. You'll be better equipped to provide holistic care that enhances your loved one's quality of life during this sensitive time.
Throughout your loved one's illness, you might find yourself thinking that they don't require "pain medication" because they don't seem to be in pain. They might even respond with a direct "no" when asked about their pain. However, are you aware that most types of pain medication can alleviate discomfort? Did you also know that your loved one could be feeling uncomfortable without necessarily being in severe pain? Nonetheless, it's important to recognize that their discomfort requires the same treatment as if they were in pain.
Read MoreUnderstanding Discomfort: Distinguishing it from Pain While Caring for Your Terminally Ill Loved OneEye-Opening Lessons on Trusting Nursing Facilities: Advocating for Comfort in End-of-Life Care
As an experienced hospice visiting registered nurse, today offered me profound insights from two interconnected perspectives. The first highlights the blind trust we often place in facility nurses and doctors when caring for our loved ones. The second involves the challenges I encountered while advocating for proper end-of-life care for a patient with Alzheimer's.
Read MoreEye-Opening Lessons on Trusting Nursing Facilities: Advocating for Comfort in End-of-Life CareThe Actively Dying Phase of The Dying Process
For a non-healthcare professional who has never witnessed death before, it can be unsettling to be present with someone who is nearing the end of their life. However, there are certain signs and observations that you can make using your senses that may indicate that the person you are with may pass away within seconds, minutes, or hours. Understanding these signs can help you provide support and comfort to the individual and their loved ones during this grim time.
Read MoreThe Actively Dying Phase of The Dying ProcessBreathing Patterns Before End of Life: Critical Clues for the Last Hours!
Understanding the final breath: This article explores the critical breathing patterns observed in the last hours of life, offering insights for caregivers and family members to prepare for the end-of-life journey.
Read MoreBreathing Patterns Before End of Life: Critical Clues for the Last Hours!The Transitioning Phase of The Dying Process
Losing a loved one is an incredibly challenging and emotional experience. If you find yourself in the presence of someone in the transitioning phase of the dying process, knowing what signs to look for can be helpful. Although every individual's experience may vary, some common observations may indicate someone is in the transitioning phase. Here's a guide to help you recognize these signs and provide support during this grim time.
Read MoreThe Transitioning Phase of The Dying ProcessUnderstanding the Role of IV Fluids at the End of Life
Explore the delicate balance of IV fluid use at life’s end. This article discusses the hospice approach, potential risks, and prioritizing comfort over invasive measures. A must-read for families facing tough decisions in palliative care.
Read MoreUnderstanding the Role of IV Fluids at the End of LifeThe Life of Least Regrets
The longer I work in hospice, the more I'm reminded about two critical pieces of wisdom: 1) Hospice is about living, and 2) we should all do our best to live a life of least regrets.
While this article is geared towards family members with a terminally ill loved one, as well as my fellow workers in the fields of palliative and hospice care, I believe the thoughts that I will share apply to everyone alive near and far.
Read MoreThe Life of Least RegretsTube Feeding on Hospice — Increased Risk of Your Loved One Suffering
Considering tube feeding for a loved one in hospice? This intervention may not improve quality of life and can lead to discomfort, reduced mobility, and complications. Learn about the risks and make informed decisions for their end-of-life care.
Read MoreTube Feeding on Hospice — Increased Risk of Your Loved One SufferingMy name is Peter, yet the patient called me “Jack”
As a hospice registered nurse, I have encountered numerous heartwarming and challenging experiences throughout my career. One of the most memorable encounters was with a dementia patient, Miss Norma Jean Smith, who affectionately called me "Jack." This endearing nickname, born out of her unique perception, became a symbol of the special bond we shared. In the following account, I will share the poignant journey of building trust, providing compassionate care, and embracing the unexpected moments of joy and sorrow in the life of Miss Norma. This story is a testament to the profound impact of person-centered care and the invaluable lessons learned from the patients we are privileged to serve.
Read MoreMy name is Peter, yet the patient called me “Jack”Clues for terminal restlessness often missed for facility patients
One of the hardest portions of the job of a hospice nurse is to identify when a patient has two weeks of life left to live; this can be especially difficult at facilities going through staffing shortages leading to inconsistent caregivers with little to verbally report on a patient’s change of condition. Since being aware of the velocity of declines is extremely important, let’s cover an area that we in hospice (nurses, families, and caregivers alike) can keep an eye on in terms of identifying terminal restlessness which is often a key indicator for one week or less of life.
Read MoreClues for terminal restlessness often missed for facility patientsTwo days…. until…
There is a spiritual connection in hospice, dealing with death and dying forty-plus hours per week. We who are in the field see it often, but there are times when we hear it firmly from the patients and families whom we serve. Let me share the most recent event on Memorial Day, 5/29/2023, week.
Read MoreTwo days…. until…Detecting Infections in Terminally Ill Geriatric Patients with Dementia
One of the most important roles is detecting and managing infections in terminally ill geriatric patients with dementia. These patients are often at higher risk for infections due to their weakened immune systems, underlying health conditions, and limited mobility. Detecting infections in these patients can be challenging due to their limited communication abilities and other cognitive and physical impairments. However, early detection and management of infections can significantly improve the patient’s quality of life and potentially prolong their life.
Read MoreDetecting Infections in Terminally Ill Geriatric Patients with DementiaShould 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:
Read MoreShould dying patients be on oxygen?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.
Read MoreFrequency of Changes in Condition as an Indicator of Approaching DeathBest 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 PatientsRecognizing 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.
Read MoreRecognizing and Treating Common End of Life SymptomsThe 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 DementiaTerminal 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 PatientEnd-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.
Read MoreEnd-of-Life Determinations for Newly Admitted PatientsEducating 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.
Read MoreEducating families on reporting changes in conditionAir 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-lifeUnderstanding 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 IllValidation 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 TeamsFood 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.
Read MoreFood and Liquids During the Dying Process