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 , 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, , 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 . 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 . 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 (PPS) or the Functional Assessment Staging (FAST) scale to measure the patient's level of function and .

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 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 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 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, services, or respite care. It can also include addressing any unmet needs or concerns that the patient, family, or 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 .


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.


Pain Assessment in Hospitalized Older Adults With Dementia and Delirium

Pain Assessment in Dementia – International Association for the Study of Pain (IASP)

Pain Assessment in People with Dementia: AJN The American Journal of Nursing

PAINAD Scale Offers Alternative to Assessing Pain in the Dementia Patient – JEMS: EMS, Emergency Medical Services – Training, Paramedic, EMT News

Pain Assessment in Advanced Dementia Scale (PAINAD) – MDCalc

Uncontrolled Pain and Risk for Depression and Behavioral Symptoms in Residents With Dementia

Chronic Pain & Symptom Tracker: A 90-Day Guided Journal: Detailed Daily Pain Assessment Diary, Mood Tracker & Medication Log for Chronic Illness Management

Pain And Symptom Tracker: Daily Pain Tracking Journal Detailed Pain Assessment Diary, Medication, Supplements Food & Activities Log for Chronic Illness Management

Pain Assessment and Pharmacologic Management

Adult Nonverbal Pain Scale (NVPS) Tool for pain assessment

Assessing pain in patients with cognitive impairment in acute care

FLACC Pain Scale

Pain Assessment in Advanced Dementia Scale (PAINAD)

Pain Assessment in Non-Communicative Adult Palliative Care Patients

Pain Assessment in People with Dementia

Tools for Assessment of Pain in Nonverbal Older Adults with Dementia: A State-of-the-Science Review

Understanding the physiological effects of unrelieved pain

Untreated Pain, Narcotics Regulation, and Global Health Ideologies

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

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

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

Oh hi there 👋 It's nice to meet you.

Sign up to receive updates on new articles to your inbox.

The emails we will send you only deal with educational articles, not requests to buy a single thing! Read our privacy policy for more information.

Share your love