Hospice care question

[dannygirl04]

We haven't learned much about hospice care and I'm in the middle of a project about it. I'm having a difficult finding information about things a nurse can do to support the family while their loved one is in the hospital in hospice care. I have stuff like offer to contact the chaplain or family's clergy person, provide the family with community resources, allow privacy. But what else should I add?

Also what discharge considerations would you identify, assuming the patient was going to leave the inpatient unit of the hospital and do hospice at home?

Thanks!!

[Okami_CCRN, BSN, RN]

While you want to provide the family with privacy you also want to keep them informed of the dying process. We live in a society where many are no exposed to the natural process of death and dying. It is important to inform the family that the patient will eventually become unresponsive, that their breathing may become erratic, explain about pain/anxiety management.

When you discharge someone to home with hospice it is important to provide them with the number of the nurse in charge of their hospice care, provide them with ways to alleviate pain and again educate them on what is to be expected.

[meljonumd]

I'm currently volunteering in an in-patient hospice, and I do patient care there.

I would suggest including family teaching on basic personal care and body mechanics? Families are now faced with caring for a person who is bed bound or needs a lot of help to move, and they are at a high risk for injury if they don't know how to move them properly.

Also, people are scared to move or touch a person who is "dying." They are scared they are going to keel over at any moment. But showing them how to be comfortable can go a long way to making the experience better.

[RunBabyRN]

Make sure you consider patient preferences in with this.

Also, educate the family on what to expect as their loved one approaches their final breaths. The breathing, the sighs, there are so many things they often don't know and they can be terrifying to see in a loved one.

[dudette10, MSN, RN]

Don't forget the nursing care we provide simply as human beings supporting one another: attentive listening, encouraging self-care for family members, creating a calming environment, etc. As for discharge to home considerations, does the family have all the equipment they need at home, giving suggestions on the most appropriate place in the home to set up equipment (both for the family and the patient). Some hospices patients may not be "actively dying" but they do have a life-limiting illness that can't be treated or they have chosen not to treat due to a poor prognosis even with it. In those cases, they may go home with feeding tubes, which can be scary for family members. Has enough time been allowed during the inpatient stay to provide adequate teaching, have procedures/orders been written down in a way that the family understands, do they know who they can contact with questions (even if it is in the middle of the night)? Have they been given a chance to do hands-on care while inpatient? If the patient needs assistance with basic ADLs, the family must be given a chance to do it with supervision because the anxiety will be reduced if they have been hands on and are assured they are doing it "the right way."

[dannygirl04]

Thanks for all of the help! My presentation today went really well!