Jump to content

Repositioning end stage of life hospice pts

Hospice   (3,519 Views | 8 Replies)
by Sheyi1 Sheyi1 (New) New

399 Profile Views; 1 Post

How do we reposition an end stage of life hospice pt for comfort measures

Share this post


Link to post
Share on other sites

pmabraham has 3 years experience as a BSN, RN and specializes in Hospice, Palliative Care.

2 Articles; 2,532 Posts; 46,497 Profile Views

If their pain is being properly managed, just reposition as you would a non-hospice-patient.

Share this post


Link to post
Share on other sites

10 Posts; 293 Profile Views

Reposition as you would for any other patient, unless patient comfort is in question.

Share this post


Link to post
Share on other sites

NurseAgatha has 5 years experience and specializes in Skilled Nursing Rehab.

10 Posts; 2,048 Profile Views

Even in end stage of life, repositioning is especially important if they have pressure sores. This prevents wounds from worsening, possibly even allowing them to heal, which is in favor of the patient's comfort.

Share this post


Link to post
Share on other sites

ClaraRedheart has 6 years experience as a BSN, RN and specializes in Med-Surg.

302 Posts; 7,626 Profile Views

On 12/4/2018 at 11:38 AM, NurseAgatha said:

Even in end stage of life, repositioning is especially important if they have pressure sores. This prevents wounds from worsening, possibly even allowing them to heal, which is in favor of the patient's comfort.

Thank you! Good to hear this from a hospice patient! I am not a hospice nurse, but I had a patient that would be transferring to hospice the next day. The patient would scream any time you tried to turn her from side to side and would not stop until you returned her to her back. I had asked "since the patient will not be going until tomorrow, do you think it would be wise if I obtained a pressure relief mattress so that her skin doesn't break down? The nurse replied something to the effect of "Well, when she goes to hospice, they're not going to reposition her anyways. She's not eating anything, so she's going to get pressure sores, and if the natural death process doesn't kill her first, she'll get an infection in her pressure sore and die from that". He seemed like a nice guy, but I was kind of horrified at the honesty.

Share this post


Link to post
Share on other sites

calliope26 has 7 years experience as a BSN and specializes in Med Surg, Hospice, Wound Care.

29 Posts; 1,411 Profile Views

On 12/4/2018 at 12:38 PM, NurseAgatha said:

Even in end stage of life, repositioning is especially important if they have pressure sores. This prevents wounds from worsening, possibly even allowing them to heal, which is in favor of the patient's comfort.

At the very end of life, pressure injuries do not heal. It's an expected part of the dying process--poor nutrition and poor circulation, thus, no healing. Repositioning is for comfort only, and I do not reposition people who are clearly less comfortable after being gently turned.

Share this post


Link to post
Share on other sites

vampiregirl has 10 years experience as a BSN, RN and specializes in Hospice.

1 Article; 699 Posts; 13,690 Profile Views

This is one of those topics for which there are several different perspectives. Also, it comes down to what is best for an individual patient and their unique circumstances.

In most cases I find the benefits of repositioning outweigh the burdens. It promotes skin integrity, allows for assessment of incontinence and in most cases promotes patient comfort. Certain positions also help with secretion management (in the realm of comfort).

Patient assessment and symptom management are considerations prior to repositioning. Patient communication is also important - even if they are not responding to caregivers. Smooth/ well coordinated repositioning makes a huge difference in patient comfort. Draw sheets can be very helpful, as can having adequate pillows to support the patient in a new position. Ensuring a patient is positioned properly (good alignment) and reassessing comfort after repositioning is also important.

Edited by vampiregirl

Share this post


Link to post
Share on other sites

Tenebrae has 8 years experience as a BSN, RN and specializes in Mental Health, Gerontology, Palliative.

1 Article; 1,547 Posts; 11,246 Profile Views

On 12/5/2018 at 6:38 AM, NurseAgatha said:

Even in end stage of life, repositioning is especially important if they have pressure sores. This prevents wounds from worsening, possibly even allowing them to heal, which is in favor of the patient's comfort.

Evidence supports that a pressure relieving mattress is just as effective in preventing pressure injuries. Also interesting to note, a pressure injury can start in under 45 minutes

Bear in mind when the person is dying, they have little to no nutrition in their body, their fluid intake is minimal. You arent going to heal a pressure injury

And speaking from the point of a nurse and also a family member, if you insisted on turning my mum every 2 hours just to tick your boxes I would be hacked off

Share this post


Link to post
Share on other sites

Kittypower has 8 years experience.

8 Posts; 471 Profile Views

It's really a case by case basis. Hospice patients can be admitted with a prognosis of 6 months or less. Many are not actively dying and not re-positioning a patient who still has months to live would make them more likely to develop a wound. When a patient is actively dying, yes, wounds will not heal. However, I have had plenty of patients with wounds that did heal. The type of mattress, how close the patient is to death, whether or not they already have wounds, there are a lot of things to consider when determining when and how to re-position patients.

Share this post


Link to post
Share on other sites
×

This site uses cookies. By using this site, you consent to the placement of these cookies. Read our Privacy, Cookies, and Terms of Service Policies to learn more.