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

Published on September 27, 2023

Updated on December 25, 2023

Daughter Kissing Her Dying Mothers Forehead

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 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.

  • Sleeping all day: Anywhere from 20 hours to a full day of sleep 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.
  • Picking at Things We Cannot See: Often an early sign of terminal .
  • Speaking to or About Departed Loved Ones: Sometimes, patients might start talking to deceased relatives or friends.
  • Expression of Farewells or Closure: Patients might express a 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 : An increase in or pain that's not effectively managed with medication. The phrase “Hurts all over” is typically a significant sign.

It's essential to communicate any observed changes to the hospice team, 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, and the need for rest increases. Hospice nurses often observe that patients in their final weeks experience and fatigue, leading to prolonged periods of sleep. The decrease in physical activity is a natural response as the body shifts its 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 the realm of . 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. The act of 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, if at all, 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

As the body's systems gradually shut down, a patient's breathing pattern can change significantly. Breathing might become irregular, shallow, or labored. This can be distressing for both caregivers and family members to observe, but 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. It's important for hospice nurses, caregivers, and family members to 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

The notion of 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. Providing 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 take place, often manifesting through alterations in skin color and temperature. 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 towards 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 that transcends 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. For caregivers and hospice professionals, this sign is crucial to recognize, as it can provide insight into the patient's overall condition and their evolving needs. Addressing pain and discomfort at this stage becomes not only a matter of medical intervention but also a matter of 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.

Resources

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

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

The Importance of Caregiver Journaling

Reporting Changes of Condition to Hospice

Interviewing and Observation as part of the Hospice Assessment

Breathing Patterns Before End of Life: Critical Clues for the Last Hours!

Signs that someone is in their last days or hours of life

Signs of Approaching Death

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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The Art of Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

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