Tips for Nurses

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.

Properly entering doctor orders

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?

Buccal vs Sublingual for Liquid Medications

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.

Understanding Terminal Restlessness

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.

Time Management Tips for New Visiting Nurses

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.

Tips for new hospice nurses doing an admission

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.

Oh hi there 👋 It’s nice to meet you.

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