When a patient is close to death, hospice care becomes an essential part of their journey. Hospice nurses are crucial in providing comfort and support to patients and their families during this grim time. In this article, we will explore what a hospice nurse does during a visit for a patient who is close to death, focusing on their assessment of the patient and the common educational discussions they have with the family as well as addressing common concerns the caregiver and family may have about their loved one who is about to die.
Assessment: Observational Signs
A hospice nurse assesses the patient’s condition through observational signs during a visit. These signs can be visual, auditory, olfactory, or tactile. Some of the common observational signs that a hospice nurse may observe during a visit include:
Changes in skin color: The patient’s skin may become pale, mottled, or bluish, indicating a decrease in blood circulation
Changes in breathing: The patient may have irregular, shallow, or labored breathing, which can signify the body’s decline.
Changes in breathing sounds: The patient may make a gargling or gurgling sound indicating the death rattle.
Changes in consciousness: The patient may become less responsive or slip into a coma-like state as their body prepares for death.
Changes in body temperature: As circulation decreases, the patient’s hands and feet may feel cool to the touch.
Changes in urine output: As the body conserves fluids, the patient may produce less or have dark, concentrated urine.
Changes in muscle tone: As the patient’s body begins to shut down, their muscles may become relaxed or limp.
Changes in bowel movements: The patient may have infrequent or loose bowel movements as digestion slows.
Changes in swallowing: As the patient’s body needs change, they may have difficulty swallowing or refuse to eat or drink.
Changes in body odor: As someone gets closer to death, their body releases a unique odor that some clinicians can smell, which lets them know the patient may have one month or less to live.
Common Educational Discussions
In addition to assessing the patient, a hospice nurse has common educational discussions with the family. These discussions prepare the family for what to expect and how to best manage the patient’s symptoms. Some of the common educational discussions that a hospice nurse may have with the family include:
Pain management: The hospice nurse will discuss the various pain management options, such as medication, positioning, and relaxation techniques, to ensure the patient is as comfortable as possible.
Nutrition and hydration: The hospice nurse will explain the changes in the patient’s appetite and the importance of offering small, frequent, and easily digestible meals and fluids, as well as when not to attempt to give food and water.
Personal care: The hospice nurse will guide the patient in assisting them with personal care, such as bathing, oral hygiene, and changing positions, to maintain their comfort and dignity.
Emotional support: The hospice nurse will offer emotional support to the patient and their family, providing a listening ear and resources for counseling or support groups if needed.
Preparing for the end: The hospice nurse will discuss the signs and symptoms that indicate the patient is nearing the end of life and the family’s options for being present.
After-death care: The hospice nurse will explain the steps to take after the patient’s death, such as contacting the funeral home and completing the necessary paperwork.
Common Caregiver and Family Concerns
The hospice nurse should spend time with the caregivers and the family (even if by telephone) exploring areas of concern, fear, and other common emotions when a loved one approaches death. Some of the most common concerns and fears I’ve had families share over the years that the hospice nurse should always address is as follows:
The above is a sample of typical caregiver and family concerns and fears. A good hospice nurse will actively listen with their ears and watch for body language with their eyes, intent on sensing areas that should be explored to help the caregivers and families be prepared for what is to come as the patient heads towards a good death.
Conclusion
Hospice nurses provide vital support and comfort for patients and their families during their end-of-life journey. Through their patient assessment, educational discussions with the family, and addressing common concerns, they ensure that the patient’s final days are as comfortable and peaceful as possible. Hospice nurses help families navigate this grim time by providing compassionate care and guidance and ensuring their loved ones receive the best care.
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, 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 the 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 guidance for families. All resources are free and available in multiple languages.
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 provide 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.
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