End of Life Wound Care
Published on June 21, 2024
Updated on June 30, 2024
Published on June 21, 2024
Updated on June 30, 2024
Table of Contents
As a family member, caregiver, or hospice nurse, understanding end-of-life wound care is crucial for providing the best possible comfort and quality of life for terminally ill patients. In the final stages of life, various types of wounds, such as pressure ulcers, ischemic wounds, and skin changes at life’s end (SCALE), can impact the patient’s well-being. Knowledge about preventing and managing these wounds is essential to ensure the patient’s comfort and dignity. This article aims to provide comprehensive education on the types of wounds, prevention strategies, and the value of comfort-focused care in the last weeks of life, addressing the needs of family members, caregivers, and hospice nurses.
Different types of wounds may occur at the end of life, depending on the underlying cause and the stage of the dying process. Some of the most common ones are:
Pressure Ulcers are wounds caused by prolonged pressure on the skin, usually over bony areas. They can range from mild redness to deep tissue damage. Pressure ulcers are often preventable with proper positioning, mobility, skincare, and nutrition. However, some pressure ulcers may be unavoidable at the end of life, as the skin becomes more fragile and blood circulation decreases. In this case, wound care aims to prevent infection, control odor, and manage pain and drainage.
Ischemic Wounds: These are wounds caused by reduced blood flow to the skin, usually due to vascular diseases or heart failure. They can appear as dry, black, or gangrenous areas on the extremities, such as the feet or toes. Ischemic wounds are often painful and difficult to heal. Wound care aims to improve blood circulation, if possible, and prevent infection and further tissue damage.
Skin Changes at Life’s End (SCALE): These changes occur due to the dying process, such as skin discoloration, mottling, or breakdown. They are not caused by pressure or ischemia but by the failure of multiple organ systems. They can appear as purple or maroon areas on the sacrum or other body parts and develop rapidly within hours or days before death. SCALE is not preventable or treatable, and wound care aims to provide comfort and dignity to the patient and family.
As a family member supporting a loved one in hospice care, it’s essential to be mindful of wound prevention to ensure their comfort and quality of life during this time. Wounds can cause unnecessary pain and discomfort, and preventing them is an essential aspect of hospice care. Here are some tips to help prevent wounds at the end of life:
Since the skin is the largest organ of the body and a terminally ill patient often does not and is not able to maintain proper nutrition and hydration, the terminally ill are at elevated risk for wounds. The risk is so high that, at times, even providing the absolute best care will still result in your loved one having too many wounds, including wounds that get worse over time, especially as your loved one approaches death.
The National Pressure Ulcer Advisory Panel reports that more than 50% of patients experience skin failure 2 to 6 weeks before death.
In the last two weeks of life, the focus shifts to providing comfort and maintaining the highest possible quality of life. While wound care is essential in certain situations, it’s essential to consider the comfort level and benefits for the patient during this time. Here’s why comfort may take precedence over wound care:
Remember, the hospice team supports you and your loved one throughout this journey. If you have any questions or concerns about wound care, comfort measures, or anything related to hospice care, don’t hesitate to contact the team.
As nurses, we play a vital role in educating families about the common occurrence of wounds at the end of life. The combination of poor nutrition, declining health, and limited mobility in terminally ill patients puts them at higher risk for developing wounds. Some specific points to discuss with families include:
Kennedy ulcers, or terminal ulcers, are a specific type of wound that can occur in patients nearing the end of life. These wounds are often deep, painful, and challenging to treat. Education about Kennedy ulcers includes:
In my experience as a hospice nurse, the onset of a Kennedy ulcer is often a clue the patient has two weeks or less to live.
As nurses, we must approach wound care with compassion and sensitivity, always considering the patient’s comfort and dignity. Here are some best practices to follow when performing wound care for someone at the end of life:
As experienced hospice nurses, we understand the complexities of end-of-life wound care. Our primary focus is always on ensuring our patients’ highest comfort level and quality of life during their final journey.
End-of-life wound care requires a compassionate and holistic approach to prioritize the patient’s comfort and dignity. Family members and caregivers are vital in preventing and identifying wounds, ensuring the patient’s skin integrity and overall well-being. For hospice nurses, understanding the common occurrence of wounds, including specific types such as Kennedy ulcers, and following best practices for wound care is essential to provide quality care. By emphasizing the value of comfort over aggressive wound treatment in the last weeks of life, we can ensure that patients receive the support and care they need to maintain the highest possible quality of life. Together, we can work towards enhancing the end-of-life journey for terminally ill patients, focusing on empathy, compassion, and personalized care.
Wound Care: Enhancing Healthcare for the Aging Population
The Peter Abraham Wound Care Scholarship
Pressure Injury – Formerly Known As Pressure Ulcer
Wound Bed Preparation – TIME Mnemonic
SCALE wounds: Unavoidable pressure injury (PDF)
Bates Jenson Wound Assessment Tool (PDF)
FRAIL Palliative Wound Care: Palliative Wound Care And Healing Probability Assessment Tool (PDF)
Payne‐Martin Classification System for Skin Tears (PDF)
Pressure Injury Prevention Points (PDF)
CaringInfo – Caregiver support and much more!
Surviving Caregiving with Dignity, Love, and Kindness
Caregivers.com | Simplifying the Search for In-Home Care
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Compassionate Caregiving series
Take Back Your Life: A Caregiver’s Guide to Finding Freedom in the Midst of Overwhelm
The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself
Everything Happens for a Reason: And Other Lies I’ve Loved
Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying
Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)
Preparing the patient, family, and caregivers for a “Good Death.”
Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)
The Dying Process and the End of Life
As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.
Gone from My Sight: The Dying Experience
The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death