As a novice nurse, it can be intimidating to care for a patient who only has a few days to live. One of the most important ways that you can advocate for your patient is to request a hospice referral from the physician.
Hospice does not mean giving up. It means ensuring that your patient and his or her loved ones receive support and care needed during this time of transition. Hospice services include management of suffering, emotional support, and education related to grief and the dying process.
A hospice referral can provide your patient with a whole team of experts. Grief counselors, social workers, nurses, pastoral care providers and palliative medicine specialists comprise the team. The team meets the needs of the family as well as the patient.
Hospice services can be provided in any setting. Patients receive services in private homes, hospitals, nursing homes, hospice houses, and assisted living facilities.
One of the ways that hospice benefits your patient is via advance pain management techniques. Hospice providers utilize many modalities to deliver medications for comfort. Specialized combination medications can be crafted to promote relaxation and well being. Medications are delivered via non invasive methods that are effective and comfortable for the patient. Hospice professionals are skilled at titrating medications to ease suffering. Doses prescribed by palliative specialists are often much higher than those used in other types of care. The whole focus is on comfort. The medications prescribed do not speed up or slow down the dying process. They simply make the process easier.
While curing is not always possible, healing can occur at any time. The hospice team is able to reassure family members that their loved ones suffering will be minimized. Families are often in crisis while a love done is dying. Unresolved relationship issues often surface. Skilled hospice professionals facilitate resolution of conflict and facilitate the grieving process. Many times, healing arises within families at this time.
The care provided to hospice patients is different then at other times during the life cycle. Much of it seems to “run against the grain” of what is done throughout the rest of life. Throughout the rest of life, the nurse’s role is to focus on curing, strengthening, hydrating, feeding, and rehabilitating. In contrast, the care provided for the hospice patient is focused on completing unfinished business, settling in, and letting go.
A common misconception is that hospice is only for patients with cancer. In reality, hospice is for any patient with a life expectancy of less than 6 months, regardless of medical diagnosis. Hospice patients may be babies or elderly. They may have been ill for a long time or recently suffered a life threatening, traumatic event.
The focus of care changes greatly during the last days of life. For example, the only medications administered are those that relieve symptoms of suffering that the patient experiences. Generally, a narcotic is ordered to relieve pain and dyspnea. An antiemetic is used if nausea is present. Anti- anxiety meds are prescribed. Some patients go through a period of terminal agitation. If terminal agitation occurs, medications are used to relieve the agony of that stage. Antipyretics are used to control fever. Medications are given to reduce terminal secretions and relieve respiratory distress. Routine meds that the patient may have taken previously are discontinued.
Contrary to the rest of life, food and fluids are no longer important. Patients are rarely hungry or thirsty. This can be very hard for families to accept. Patients are often relieved when a hospice nurse says “it’s ok not to eat”. Often they say that they are only eating because their family members want them to.
Years ago, IV fluids were administered to patients when they were no longer able to drink. That is no longer done. The dying process is the only time of life when drier is better. Studies indicate that natural dehydration during the dying process actually reduces pain. Reduced fluid volume helps make patients comfortable by reducing edema. Most patients develop terminal respiratory secretions. With less fluid, the secretions are better controlled.
Fever frequently occurs during the dying process. It is not necessarily due to infection. Generally, as the body is shutting down, the brain’s natural thermostat works poorly fluctuations in temperature result. Antipyretics and other cooling techniques are implemented to provide relief.
Give your patients the precious gift of a peaceful, comfortable and dignified passing. Suggest a hospice referral for you dying patients.