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Repositioning end stage of life hospice pts

Hospice   (2,239 Views 9 Comments)
by Sheyi1 Sheyi1 (New Member) New Member

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

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pmabraham has 3 years experience as a BSN, RN and works as a Hospice RN Case Manager.

2 Articles; 45,070 Visitors; 2,494 Posts

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

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195 Visitors; 10 Posts

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

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NurseAgatha has 5 years experience and works as a Floor Nurse at a SNF.

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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.

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ClaraRedheart has 4 years experience as a BSN, RN and works as a Med-Surg Tele Nurse.

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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. 

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calliope26 has 5 years experience and works as a Staff Nurse.

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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.  

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vampiregirl has 10 years experience as a BSN, RN and works as a Hospice Nurse / EMT / Firefighter.

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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

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Tenebrae has 6 years experience and works as a Registered Nurse in Gerontology.

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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

 

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Kittypower has 8 years experience.

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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. 

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