Recognizing the velocity of change is crucial for hospice nurses, as it helps them provide the best care to patients and their families at the end of life. Hospice care aims to offer comfort and peace to those with terminal illnesses. Nurses play a vital role in providing physical, emotional, and spiritual support, monitoring symptoms, and adjusting treatment plans based on the patient’s condition.
Understanding the Velocity of Changes in Condition
Hospice nurses observe the pace of changes in a patient’s health, known as the “velocity of changes.” This includes assessing vital signs, symptoms, functional status, and communication abilities. By recognizing these indicators, nurses can anticipate needs, adjust care plans, and communicate effectively with patients and families about the prognosis.
Frequency of Changes in Condition
Frequency of Change
Typically Means Death Within
One every 4 to 8 weeks
Less than 6 months
Every 3 to 4 weeks
Less than 3 months
Every 1 to 2 weeks
Less than 2 months
Once every week
Less than 1 month
Several times per week
Less than 2 Weeks
Every day
Less than 1 Week
Several times per day
Less than 72 hours
When a patient is closer to death, there is often a noticeable increase in the speed at which their condition changes.
When a patient is closer to death, there is often a noticeable increase in the speed at which their condition changes.
Recognizing the Signs of Velocity
Decline in Functionality: The patient’s physical abilities are deteriorating, and they may experience difficulty with simple tasks such as eating, drinking, walking, or getting out of bed. This can affect their quality of life and comfort level. Hospice nurses should regularly assess the patient’s functionality and communicate with the interdisciplinary team (such as doctors, social workers, chaplains, etc.) to provide the best care plan for the patient. They should also help the patient and the family cope with the changes and offer support and guidance.
Changes in Mental Status: This means that the patient’s mental state is changing, and they may experience confusion, delirium, restlessness, agitation, or hallucinations. Various factors, such as medication side effects, dehydration, infection, or organ failure, can cause this. Hospice nurses should communicate these changes to the team and try to identify and treat the underlying causes. They should also provide a calm and soothing environment for the patient and reassure the patient and the family that these changes are expected at the end of life.
Increase in Symptoms: This indicates that the patient’s symptoms are becoming more severe, frequent, or challenging to manage. These symptoms may include pain, nausea, vomiting, constipation, diarrhea, shortness of breath, cough, or bleeding. Hospice nurses should monitor and report these changes to the team, adjusting the medication and treatment accordingly. They should also provide comfort measures, such as massage, music, aromatherapy, or ice chips, to ease the patient’s discomfort.
Decrease in Treatment Response: The patient’s response to treatments, such as medications, fluids, or oxygen, is getting weaker or slower. This can indicate that the patient’s body is shutting down and that the treatments are no longer effective or beneficial. Hospice nurses should share these changes with the team and discuss the care goals with the patient and the family. They should also respect the patient’s wishes and avoid unnecessary or unwanted interventions.
Frequent Vital Sign Changes: The patient’s vital signs, including blood pressure, heart rate, respiratory rate, and temperature, are changing rapidly or unpredictably. This can signal that the patient’s organs are failing and that death is imminent. Hospice nurses should regularly monitor these vital signs and alert the team and the family if significant changes occur. They should also prepare the patient and the family for the dying process and provide emotional and spiritual support.
The velocity of changes near the end of life can help estimate the amount of time a patient has left. Changes in functionality, mental status, symptoms, treatment response, and vital signs can indicate the patient’s proximity to death. Hospice nurses can provide appropriate care and support by monitoring these changes.
By monitoring the signs of velocity, hospice nurses can better understand how fast or slow the patient’s condition is changing. This can help them estimate how much time the patient has left and plan the care accordingly. However, this is not an exact science, and variations may occur depending on the patient’s illness, age, and other factors. The following guidelines can be used to interpret the velocity of changes near the end of life:
In the last month: The patient may experience moderate to significant changes in their condition once a week. This means that they may have noticeable changes in their functionality, mental status, symptoms, treatment response, or vital signs every seven days. For example, they may become tired, confused, or in pain or need more medication or oxygen. These changes may indicate that the patient is entering the final stage of their illness and that they may have weeks or days left to live.
In the last two weeks, the patient may experience moderate to significant changes in their condition several times weekly. This means that they may notice changes in their condition every few days. For example, they may lose interest in food and fluids, become bedridden, or have difficulty breathing or speaking. These changes may indicate that the patient is declining rapidly and may have only days or hours left to live.
In the last seven days, the patient may experience moderate to significant changes in their condition every other day or daily. This means they may notice changes in their condition daily or every other day. For example, they may become less responsive, withdraw from social contact, or change their level of consciousness. These changes may indicate that the patient is very close to death and that they may have hours or minutes left to live.
In the last 48 hours, the patient may experience changes in their condition several times daily, including by the minute. This means they may have rapid or unpredictable changes in their condition every hour or every minute. For example, they may have irregular or shallow breathing, low blood pressure, cold or mottled skin, or fixed or dilated pupils. These changes may indicate that the patient is in the active dying phase and that they may have minutes or seconds left to live.
By understanding the velocity interpretation, hospice nurses can provide the most appropriate and compassionate care to their patients and their families at the end of life. They can also help them cope with the emotional and spiritual aspects of the dying process, offering comfort and support.
Keeping a Journal for Better Care
Maintaining a journal to document changes in a patient’s condition can aid in care planning and provide emotional support. Journals help track the velocity of change, prepare for recertification visits, and provide an outlet for expressing feelings and memories. They also facilitate communication with healthcare teams and loved ones. For example, they can record when the patient experiences a new symptom, a change in medication, a decline in functionality, or a change in vital signs.
Keeping a journal has numerous benefits for patient care. First, it can help with the recertification visits, which are the periodic assessments that hospice nurses conduct to determine if the patient continues to qualify for hospice care. By keeping a journal, hospice nurses can review the patient’s history and progress and document the changes that justify the need for hospice care. Second, it can help with the velocity of change, which is the pace of the patient’s decline. By keeping a journal, hospice nurses, caregivers, and families can track the frequency and severity of changes and estimate the patient’s remaining time. This can help them plan the care accordingly and prepare for the end of life.
Keeping a journal can also benefit the patient and the family emotionally and spiritually. A journal can be a way of expressing their feelings, thoughts, and memories and coping with the stress and grief of the situation. A journal can also serve as a way to honor the patient’s life and legacy, celebrating their achievements and values. A journal can also serve as a means of communication with the patient, especially if they are unable to speak or respond. A journal can also serve as a means of sharing with others, such as friends, relatives, or support groups, who can offer comfort and support.
Keeping a journal for better care is a simple but effective tool that hospice nurses, caregivers, and families can use to provide the best possible care to their patients and loved ones at the end of life. It can help them monitor the patient’s condition, understand the velocity of change, and cope with the emotional and spiritual aspects of the dying process.
Conclusion: Preparing for the End-of-Life Journey
Recognizing the velocity of changes is essential for hospice nurses to enhance the quality of care provided to patients and families at the end of life. Nurses can ensure compassionate and practical support throughout the end-of-life journey by understanding these changes and interpreting their significance.
All the Blues in the Sky by Renée Watson – About a 13-year-old whose best friend dies on her birthday, exploring grief through counseling group experiences.
The Truth as Told by Mason Buttle by Leslie Connor – Chronicles a boy dealing with a friend’s death, a learning disability, and community judgment.
The Year of the Rat by Clare Furniss – A 15-year-old coping with her mother’s death during childbirth and caring for her baby sister.
The Dougy Center offers extensive free resources, including activity sheets, tip sheets, and guidance for children and families. They provide age-appropriate materials and have partnered with Sesame Street on grief resources.
Winston’s Wish provides comprehensive bereavement support for children up to age 25, including online chat, phone support, and downloadable resources. It also offers specialized guidance for different types of loss.
Sesame Street Communities: Helping Kids Grieve features interactive videos with Elmo and other characters, activities for expressing feelings, and family guidance. All resources are free and available in multiple languages.
The National Alliance for Children’s Grief (NACG) provides educational toolkits, connects families to local support services, and offers professional development for those working with grieving children.
GriefShare helps locate local grief support groups for families and provides daily email encouragement for those processing loss.
Enhanced Online Resources for Teens
Specialized Teen Platforms
Talk Grief—Winston’s Wish operates this dedicated online space for teenagers and young adults aged 13-25. It features peer stories and professional support.
Teenage Grief Sucks – A teen-run website opening conversations about grief where teens can read candid stories and share their own experiences.
Actively Moving Forward – A national network specifically created for grieving young adults, addressing the unique challenges of this age group.
The Dinner Party – Young adults in nearly 100 cities worldwide meet for dinner, creating community for emerging adults who’ve experienced loss.
Comprehensive Teen Support Centers
The Dougy Center Teen Resources provides age-specific materials, including tip sheets, that acknowledge “grief usually does what it wants” and doesn’t follow rules or schedules. They emphasize that there’s no right or wrong way to grieve.
Hospice of the Valley Teen Resources offers specialized materials addressing how teens grieve differently than adults, sudden versus expected death, and losing siblings or friends.
Children’s Room Teen Program provides peer support groups and activities specifically for teens to connect around shared interests while processing grief.
Interactive Support Options
Winston’s Wish offers immediate support through live chat, helpline, and text services – no waiting lists required. They also provide one-to-one sessions with bereavement specialists for teens 13 and older.
HEART Play for Young Adults connects late high school and college-aged individuals, providing space to discuss challenges of graduation, leaving home after loss, and meeting new people.
Educational Resources for Teens and Families
The JED Foundation provides mental health resources showing teens how they can support one another and overcome challenges during the transition to adulthood.
Eluna Network offers grief resources organized by specific age ranges, including detailed developmental information and support strategies for both middle school and high school students.
National Alliance for Children’s Grief provides educational toolkits and connects families to local services, with materials specifically designed for adolescent grief.
📚 This site uses Amazon Associate links, which means I earn a small commission when you purchase books or products through these links—at no extra cost to you. These earnings help me keep this website running and free from advertisements, so I can continue providing helpful articles and resources at no charge.
💝If you don’t see anything you need today but still want to support this work, you can buy me a cup of coffee or tea. Every bit of support helps me continue writing and sharing resources for families during difficult times. 💙
Compassion Crossing Academy — Free and paid online courses are available to teach caregivers, nurses, social workers, chaplains, end-of-life advocates, and educators, including death doulas, how to confidently coordinate complex care.
Currently, there is no official organization regulating end-of-life doulas (EOLDs). Keep in mind that some listed EOLDs in directories might no longer be practicing, so verifying their current status is essential.
End-of-Life Doula Schools
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Compassion Crossing Academy: While it’s not a dedicated death-doula school, it offers distinctive classes that can help a death doula expand their business. It’s a valuable resource for those eager to grow and deepen their knowledge in this meaningful field.
Remember that there is no official accrediting body for end-of-life doula programs. Certification only shows you’ve completed an unaccredited program and received a graduation certificate. It’s advisable to have discovery sessions with any death doula school you’re considering — regardless of whether it’s listed here — to see if it meets your needs. Also, ask questions and contact references, such as former students, to assess whether the school gave you a solid foundation to start your own death doula practice.
