I am not a hospice nurse yet, although I just got hired by an inpatient hospice facility and start orientation in April, but as an RN in a mid-sized hospital who worked Med/Surg and Oncology I had several patients who did die while they were hospitalized with a do not resuscitate status. The main thing I always did was ask the family what they needed. Every family grieves differently. Some wanted to be called in if their mother's BP dropped below a certain number, for example, even if she was otherwise stable. Others would tell me something like, "If she dies in the night, call us first thing in the morning." As those two extremes show, no two families want exactly the same end of life experience, so ask, ask, ask them what they want. When they want to be called, if they would like a clergyman called in at a specific point, etc. When it really did get down to being the actual moment of death, I would normally offer them some privacy to grieve together and then tell them to just let me know when they were ready for anything else. I never rushed the family away or called the funeral home until I was sure that the family was completely done with their grief process for that moment. The last thing I would ever want is to look back on a family member's death and remember a nurse who hurried me through the process and acted like she wanted me to go home when I wasn't ready just yet, so I tried to be empathetic to the families who would not want to be treated that way either. If the family shared my particular belief system, then we would discuss that their family member was finally in heaven and free of pain, if they didn't share my belief system then I didn't discuss spiritual matters at all. If someone doesn't believe in heaven, the last thing they want to hear is something like, "Well, at least your dad's in heaven now." Why upset them and apply my belief system to them when they didn't share it? Other than those things, I think your intuition helps you through these kinds of situations. Intuition, empathy, and common sense. Just treat them how you would want to be treated and you can't go wrong.