What clinical skills for hospice? What do hospice nurses do?

  1. My bro-in-law's mom just passed away and he said that they (hospice) gave her MSO4 with a "couple drops under her tongue". I've never seen that.

    Are pain meds given IV routinely or via nebulizer or subQ?

    I'm not a hospice nurse. I used to work oncology. It was emotionally tough at times but the staff were all really close and supportive. I miss them but when we had babies, I resigned to be SAHM. That was 7 years ago.

    I'm presently working per diem at a small hospital and have been there for almost 3 years. I rarely start IVs. ANd I think I'm afraid my clinical skills - particularly starting IVs - is a fear I have in relation to being a hospice nurse. But I also have confidence that this skill can "come back" with the opportunity to actually do it.

    Anyway... what exactly does a hospice nurse do? My family often tells me that they think I'd be a good hospice nurse.
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    About MargRN, BSN

    Joined: Feb '04; Posts: 29; Likes: 3


  3. by   Hellllllo Nurse
    Sounds like your bil's mom received Roxanol, which is a thick, liquid sub lingual MS04.
    I worked inpt hospice for four years for the same company, several different locations.

    What hospice nurses do includes providing pain and sx mgmt., and emotional support to pt and family.
    Some places use IV meds. Others use periodic sc port injection, or contiuous sc infusion, aka the "clysis" method to deliver pain and sx meds. It depends on what the medical director of each facility prefers.
  4. by   aimeee
    The particular clinical skills used will vary widely according to setting. In our home hospice setting I have never seen a peripheral IV. If we do have IV meds, they are generally infused through a port or a picc line. We choose the least invasive, simplest route which will be effective. The simpler the regimen, the easier it is for patient/family to learn and manage.

    What we "do" on an average visit is assess the patient, contact the physician for orders or activate standing orders to control symptoms, educate the family regarding what to expect, how to administer meds, side effects, etc, techniques for personal care, assess family's current ability to cope, contact other members of the team (such as spiritual counselors or social workers) for support needed. Dressing changes, lab draws if needed, ordering meds, and I'm sure there are other things that don't come to mind immediately. You have a lot of autonomy.

    If you are intrigued with the notion of being able to focus on quality of life for patient's and their families, look into it!
  5. by   txspadequeenRN
    She must have received Roxanol ,it is a immediate release morphine that is used under the tongue. It starts quickly and last a couple of hours depending on the person and the amount of pain. Roxanol can be given every 15 min if needed usually this is toward the end of life . Alot of times it must be given every 1 to two hours just to get the pain under control. Roxanol is very thin not thick, it is given with a dropper or in small syringes. Hospice provides comfort care only or that is the goal. However, I have taken care of one patient on hospice with a PICC for cont morphine. We do neb tx but not when we get close to the end. ALthough I have given Morphine neb treatments close to the end works real well with respiratory decline and pain. To be a good hospice nurse you must be very compassionate, loaded with empathy and willing to deal with families in crises. You are not going to get to use your IV skills that much in hospice but you will use alot of other very important skills. Hospice is the only place I have worked where I come home at the end of the day and feel like I have actually done something good for my patients. Good luck to you...:spin:
    Last edit by txspadequeenRN on Jul 30, '04
  6. by   MargRN
    from my days on oncology. I'd just forgot about it.

    Kind of a "duh" moment. I'm actually off to work 8 hours tonight and better run along. Thanks for replying.

  7. by   3skilled
    I have several hospice pts. on my unit they are truly a blessed sort, U deal with entire grieving process for the family which is different for the patients process in my opinion. I'm big on pain controll both objective and subjection,I find the difficulty lies when resps are low and the realtity of MSIR sl and explaining to the family that the resps could fall more, with hospice its extremely major to treat the dying with extreme love and dont hurry with care , they know, and sometimes braver with u as to their family members, i enjoy comforting the pt at end of life care, i personally dont like anyone to die alone or in discomfort*
    Last edit by 3skilled on Sep 6, '04
  8. by   medsurgnurse
    Hospice is the most rewarding of all the nursing jobs I've had. You will see patients 2-3 times week, depending on their needs. And with their doctor, you will manage their pain and symptoms. Sometimes your visit will be spent just talking to the patient, you really have the chance to know the whole family. Usually a social worker an chaplain is also assigned to the patient. But even as a nurse I have helped patients and families deal with end of life issues. It took me awhile to adapt to hospice nursing, I was so focused on just nursing measures, meds, treatments, etc. I had to learn to let the patient take the lead sometimes, maybe they don't want to talk about their illness at every visit, maybe they just want to hear a good joke. But hospice can be emotionally exhausting, because eventually your patients do die. After caring for them for many months, you can get attached to them.
  9. by   leslie :-D
    and often there are many and varied ethical issues....

    there still are nurses that hesitate to give mso4 with low respirations, even if the patient is obviously in discomfort.

    i myself have personally checked with the mna and bon, with both stating that it is recognized that this will hasten death but they go by one's intent, which is to relieve suffering.

    and mso4 is never the cause of death; it's the disease process.
    but people think it's the morphine.

    when the body no longer struggles, it allows nature take its' course.

    and then you always have those families that just refuse to believe that they're loved one is going to die.....
    they need much attention and support; no false hopes whatsoever.

    you advocate for your patient 1st.
    if a family member tells you that the pt. is getting too much medicine, it is your responsibility to give the patient what they need, and not what the family wants.

    as for med surg skills, there's nothing that cannot be learned in hospice.
    of course it is always preferable to have experience in nsg.

    but if this is where your heart is, i say follow it.
    to some, it really is a calling.

  10. by   Angelica
    Quote from earle58

    you advocate for your patient 1st.
    if a family member tells you that the pt. is getting too much medicine, it is your responsibility to give the patient what they need, and not what the family wants.
    Unfortunately, if the pt is living at home and the family refuses to give meds despite exhaustive efforts to persuade otherwise, then it can be difficult (impossible?) to give the pt what they need. Those cases just wear me out emotionally.
  11. by   leslie :-D
    Quote from Angelica
    Unfortunately, if the pt is living at home and the family refuses to give meds despite exhaustive efforts to persuade otherwise, then it can be difficult (impossible?) to give the pt what they need. Those cases just wear me out emotionally.
    you are so right about that.
    i'm so used to doing inpt. hospice that i overlooked family being in control w/the patient at home....i don't know how i would handle those cases.
    i really don't.
  12. by   mjamesRN
    Let's not forget the stages of dying which affect the family members often moreso than the patient. Depression and Denial seem to be most prevalent. I spend alot of time talking family members off of emotional ledges; they of course, are an important part of your care. The most difficult scenario is when family members insist that their loved ones stay "alert" until the end, which is ridiculous: sometimes there's an underlying inheritance issue, or an unresolved reconciliation....eesh! Very emotionally-exhausting. I often wonder why I'm so tired at the end of the day when all I did was sit and listen. One of the best lines for families, patients and for yourself is "No one has control here" meaning the disease will control the destiny of everyone from that point on.

    Hospice nursing has a lot of rewards, however, you find you're in a constant state of facing your own mortality, which if anyone has a suggestion for me on this -- as I'm approaching a place in my head where I need to see more life and healing rather than (to quote Scarlett OHara) " all this death and rot and death!" LOL ---.