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 critical because vital signs do not always provide clear indications when a patient is two weeks or less away from death. Suppose we hear or read certain words or phrases in the notes. In that case, we should be on high alert for the possibility that the patient is either transitioning towards actively dying or is otherwise close to transitioning.
Sleeping all day: Anywhere from 20 hours to a full day is significant.
Significant Decrease in Food and Fluid Intake: This might manifest as only taking sips of liquid, eating small bites, or refusing food and fluids altogether.
Changes in Consciousness: This includes confusion, disorientation, or becoming non-responsive.
Changes in Breathing: Irregular, shallow, or labored breathing can indicate the body’s decline.
Speaking to or About Departed Loved Ones: Sometimes, patients might start talking to deceased relatives or friends.
Expression of Farewells or Closure: Patients might desire to say goodbye or exhibit behaviors that suggest they are preparing to pass.
Changes in Skin Color and Temperature: The skin may become cool to the touch and take on a pale or mottled appearance.
Pain and Discomfort: An increase in discomfort or pain not effectively managed with medication. The phrase “hurts all over” is typically a significant sign.
Communicating any observed changes to the hospice team is essential, as they can provide guidance and support based on their professional experience. However, the specific signs and timeline can vary from person to person. Hospice nurses and caregivers work together to ensure the patient’s comfort and dignity during this stage of life.
Sleeping All Day
When a patient begins to sleep for extended periods, it can be a sign that their body is conserving energy as it approaches the end of life. The body’s systems gradually slow down, increasing the need for rest. Hospice nurses often observe that patients in their final weeks experience drowsiness and fatigue, leading to prolonged periods of sleep. Decreased physical activity is a natural response as the body shifts focus from sustaining everyday functions to preparing for the final stages.
Decreased Appetite: Eating Bites and Sips
The phrase “eating bites and sips” resonates deeply in hospice care. As patients approach the end of life, their appetite and interest in food diminish. This can be attributed to the body’s declining metabolic needs and the redirection of energy from digestion to more vital functions. Consuming only insignificant amounts of food symbolizes the body’s transition from nourishment to acceptance of its impending journey. Caregivers and family members might notice their loved ones taking fewer bites and sips as the body’s energy requirements decrease, providing an opportunity for them to offer comfort through companionship rather than insisting on food intake.
Changes in Consciousness
During the advanced stages of a patient’s life-limiting illness, changes in consciousness can become apparent, offering insights into their physiological and neurological state. Confusion and disorientation may arise as the body redirects its resources towards vital functions, leaving less energy for cognitive processes. This cognitive fog can lead to patients becoming increasingly unaware of their surroundings, disoriented about time and place, and struggling to recognize familiar faces. Another significant change is the potential for a patient to become non-responsive. This state is often described as a deep sleep-like condition where the patient is difficult to rouse, responds minimally to external stimuli, and might have extended periods of unresponsiveness. These changes reflect the body’s natural progression towards the end of life, as it reallocates resources to focus on essential functions while allowing the patient to retreat from the external world. For caregivers and hospice professionals, recognizing these shifts in consciousness is vital for providing appropriate care and ensuring the patient’s comfort during their final journey.
Changes in Breathing and Picking at Things
A patient’s breathing pattern can change significantly as the body’s systems gradually shut down. Breathing might become irregular, shallow, or labored. This can be distressing for both caregivers and family members to observe. Still, it’s crucial to understand that changes in breathing are a part of the body’s natural progression toward the end of life. Additionally, patients might exhibit behaviors like “picking at things not present.” This can be attributed to altered mental states and a shifting focus of attention. Hospice nurses, caregivers, and family members must offer a serene and calming environment, ensuring the patient’s comfort throughout this process.
Speaking to Loved Ones Passed
One of the heartrending aspects of the end-of-life journey is the patient’s inclination to communicate with loved ones who have already passed away. This phenomenon is often seen as a way for patients to find solace and reassurance as they prepare to cross the threshold of life. The phrase “speaking to loved ones passed” signifies a deep emotional and spiritual process. As caregivers and family members witness this, it’s important to recognize it as a natural response to the transition, offering a chance to provide comfort and companionship during this time of reflection and connection.
Saying Goodbyes and Increased Physical Weakness
Expressing farewells and closure takes on profound meaning as a patient nears the end of their life. Phrases such as “telling family members they will die very soon” might arise from a patient’s desire to prepare their loved ones emotionally. These conversations, while difficult, allow patients to find peace and resolution in their relationships. Simultaneously, caregivers and family members may notice increased physical weakness in their loved ones. This weakness is often a result of the body’s systems slowing down and the muscles gradually losing their strength. Physical support and reassurance can enhance the patient’s comfort during this time.
Changes in Skin Color and Temperature
As a patient’s body approaches the end of life, various physiological changes occur, often manifesting through skin color and temperature alterations. A noticeable drop in body temperature can result from the gradual slowing of metabolic processes, and this cooling effect may be felt by caregivers when they touch the patient’s skin. Additionally, the skin might assume a pale or mottled appearance, indicative of reduced blood circulation as the body prioritizes vital organs. This change in skin color, coupled with the coolness, occurs as a natural response to the body’s focus on conserving energy for its essential functions during the final stages of life. While these shifts can be disconcerting to witness, they underline the body’s preparation for the imminent transition, signaling that the patient is moving toward the final moments of their journey.
Pain and Discomfort
The experience of pain and discomfort can take on unique dimensions as a patient nears the end of their life. While discomfort is common in serious illnesses, an escalation in pain that is no longer effectively managed by medication might signify that the patient is reaching a critical stage in their journey. The phrase “Hurts all over” can be particularly telling, indicating a widespread and intense level of discomfort transcending localized pain. This marked increase in pain might stem from a range of factors, including the body’s diminishing ability to respond to medication, shifting metabolic priorities, or the progression of the underlying condition. This sign is crucial for caregivers and hospice professionals, as it can provide insight into the patient’s overall condition and evolving needs. Addressing pain and discomfort at this stage becomes a matter of medical intervention and providing the patient with the highest possible quality of life during their last moments.
Conclusion
Understanding the trigger words that could signify a patient’s imminent passing is a profound aspect of providing compassionate end-of-life care. For hospice nurses, caregivers, and family members, these cues offer an opportunity to create an environment of love, support, and dignity. While these trigger words can provide insight into a patient’s condition, it’s important to remember that everyone’s journey is unique. Consulting with experienced hospice professionals and maintaining open communication can ensure that the patient’s needs are met in the most caring and empathetic manner possible. The focus remains on embracing the patient’s last moments with respect, comfort, and grace.
