Tag: End of Life Determination

Articles dealing with how caregivers and nurses can determine an approximate end of life time period for the terminally ill.

Trigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Signs of imminent death
Hospice visits by a nurse should always include a discussion with the caregiver and family members or facility staff about any changes since the last nursing visit. This interviewing process is extremely important because vital signs do not always provide clear indications when a patient is two weeks or less away from death. If we hear or read certain words or phrases in the notes, we should be on high alert for the possibility that the patient is either transitioning towards actively dying or is otherwise close to transitioning.
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Breathing Patterns Before End of Life: Critical Clues for the Last Hours!

Breathing Patterns
This article is intended for family members, caregivers, as well as nurses new and old. As an experienced hospice nurse, I've learned that when a family member or caregiver tells me their loved one is or has "goldfish breathing" or "fish out of water breathing" or "taking guppy breaths" that the patient is now at the end of their life.
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Frequency of Changes in Condition as an Indicator of Approaching Death

In hospice care, it's crucial to identify when a patient is nearing the end of life. One method is by understanding the pace of changes in their condition, often called the "velocity of changes." This article delves into how hospice nurses can recognize and interpret this velocity as a sign that a patient might be approaching the end of life.
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End-of-Life Determinations for Newly Admitted Patients

how people die trajectory
Admitting a patient to hospice services is a difficult 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 important 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 that can help them identify if the patient is in the transitioning phase or not.
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Recognizing the Approaching End of Life

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.
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