Recognizing the velocity of changes is crucial for hospice nurses as it helps them provide the best care to patients and 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 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 of 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 worsening, and they may have trouble doing simple things like 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 means the patient's symptoms are getting more severe, frequent, or difficult 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 and adjust 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, such as blood pressure, heart rate, breathing 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 how much 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 there may be variations 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 that they may have 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 minutes. 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 and offer comfort and support.
Keeping a Journal for Better Care
Maintaining a journal documenting changes in a patient's condition can aid in care planning and 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 write down when the patient has a new symptom, a change in medication, a decline in functionality, or a change in vital signs.
Keeping a journal has many benefits for the patient's 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 having a journal, the 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 having a journal, the hospice nurses, caregivers, and families can track the frequency and severity of the changes and estimate how much time the patient has left. This can help them plan the care accordingly and prepare for the end of life.
Keeping a journal can also have emotional and spiritual benefits for the patient and the family. 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 be a way of honoring the patient's life and legacy and celebrating their achievements and values. A journal can also be a way of communicating with the patient, especially if they are unable to speak or respond. A journal can also be a way 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. By understanding these changes and interpreting their significance, nurses can ensure compassionate and effective support throughout the end-of-life journey.
