Hospice nurses play a vital role in providing quality care and comfort to terminally ill patients and their families. They must make accurate and timely assessments of the patient's condition, needs, and preferences every visit. This article will outline the key aspects that hospice nurses should assess every visit, in addition to the standard physical assessment.
Imminence of Death
One of the first things that hospice nurses should assess every visit is whether the patient is imminent, which typically means the patient can die anytime within two weeks. This can be determined by observing signs such as rapid weight loss, decreased appetite and fluid intake, changes in breathing patterns, increased confusion and restlessness, and reduced responsiveness. If the patient is imminent, the nurse should adjust the visit frequencies accordingly and communicate with the interdisciplinary group (IDG) team, the immediate care team, and the family. The nurse should also provide education and support to prepare them for the patient's impending death.
Change in Condition
Another essential aspect that hospice nurses should assess for every visit is whether there is a change of condition for the current visit that occurred either just before the nurse got there or just after the last visit. A change of condition can include new or worsening symptoms, such as pain, nausea, anxiety, agitation, bleeding, or infection. It can also include changes in the patient's goals of care, such as requesting more or less aggressive treatment or expressing a desire to discontinue hospice services. If there is a change of condition, the nurse should plan for a PRN visit the next day, communicate with the IDG team, the immediate care team, and the family, and document the change and the interventions in the patient's record.
Velocity of Declines
A third aspect that hospice nurses should assess for every visit is the current velocity of declines and where that frequency places the patient in terms of how long they may be alive. The velocity of declines refers to the rate and extent of the patient's physical, mental, and functional deterioration. It can be influenced by factors such as the type and stage of the disease, the patient's age and comorbidities, and the patient's adherence to the care plan. If there have been several changes over a few days, the nurse should reconsider if the patient may be imminent and act accordingly. The nurse should also use tools such as the Palliative Performance Scale (PPS) or the Functional Assessment Staging (FAST) scale to measure the patient's level of function and prognosis.
Hospice Plan of Care
A fourth aspect that hospice nurses should assess every visit is whether the patient's hospice plan of care, including their medication and treatment regimen, effectively manages the patient's symptoms and enhances their quality of life. The care plan should be individualized, holistic, and consistent with the patient's goals and preferences. It should also be reviewed and updated regularly by the IDG team based on the patient's changing needs and condition. If the plan of care is not effective, the nurse should work with the appropriate parties to adjust the plan of care and communicate appropriately. The nurse should also monitor the patient's compliance with the hospice care plan and address any barriers or concerns.
Medication Refills
A fifth aspect that hospice nurses should assess every visit is what medications must be refilled, considering the next nursing visit date, holidays, weekends, etc. The nurse should ensure the patient has adequate and timely access to the medications needed to manage their symptoms and prevent complications. The nurse should also educate the patient, family, and caregivers on using, storing, and disposing of the medications safely and appropriately. The nurse should also coordinate with the pharmacy and the physician to order and authorize the medication refills as needed.
Additional Support
A sixth and final aspect that hospice nurses should assess every visit is whether there is anything else the team can do to support the patient in maximizing their life under the current situation. This can include providing emotional, spiritual, social, or practical support, such as counseling, chaplaincy, volunteer services, or respite care. It can also include addressing any unmet needs or concerns that the patient, family, or caregivers may have, such as financial, legal, or ethical issues. The nurse should also acknowledge and validate the patient's feelings and experiences and express empathy and compassion.
Conclusion
Hospice nurses have a challenging and rewarding job of caring for patients facing the end of life. They must make comprehensive and ongoing assessments of the patient's condition, needs, and preferences every visit. Following the six aspects outlined in this article, hospice nurses can provide optimal care and comfort to patients and their loved ones.
