Asking for Hospice Nurses Expertise and Help

[Nurse Beth, MSN]

Dear Nurse Beth,

I am a new hospice RN how do I approach a family about burial arrangements when they tell me they are not ready to talk about this now yet the patient is declining?

Dear New Hospice Nurse,

I am crowd sourcing your question in hopes some hospice nurses can help out here :)

Best wishes,

Nurse Beth

[meanmaryjean, DNP, RN]

Why do they have to talk about burial arrangements when the patient is still alive? Seems like it can wait.

[Katillac, RN]

It's important to wait until they're ready, even if that means after the patient dies. When I have a case like this, I bring it up again gently when the patient is actively dying and I've talked with the family about the significance of what we're seeing. Sometimes I tell families that as hard as it may be to think about the end now, immediately after a loss it can be even more difficult to make choices and plans, but that it's entirely up to them.

[amoLucia]

Maybe discussing the use of pulling in the services of clergy as a comfort measure for the pt (if they wish) might open the door???

[Susie2310]

My first thought was, "Isn't this the family's business?" I know that I wouldn't have appreciated being asked this question by a hospice nurse during a very painful, emotional time. What does the family's burial plans for the patient have to do with hospice?

[Katillac, RN]

My first thought was, "Isn't this the family's business?" I know that I wouldn't have appreciated being asked this question by a hospice nurse during a very painful, emotional time. What does the family's burial plans for the patient have to do with hospice?

It's very much the family's business. But just as when a patient is discharged from acute care the case manager or discharge planner offers assistance with finding appropriate services after discharge, the hospice case manager or social worker assesses to see if there are needs for support or assistance around making final arrangements. When I educate about what happens at the time of death, I let the family know that when they're ready, the funeral home will be called to receive the patient. Often I then ask if the decision has been made about who is to be called. Of course if the family responded with any reluctance to engage, I would support their right to privacy around the answer.

Hospice staff don't ask to satisfy curiosity, it's part of seeing if there are unmet needs.

Although for many it's difficult thinking about the end, it's been my experience it's even tougher to not have made a decision about the funeral home. In the hours right after the death, which can be the most emotional of the process, decision making is often complicated and harder than it would have been days or weeks earlier. Because hospice staff know this, we seek to give the family the opportunity, though it's by no means mandatory, to avoid this hardship.