Your dying patient has lost their gag reflex as part of the dying process. One of the questions I implore you to ask yourself is what’s the safest route to administer liquid medications? Well, before even going to answer this question, unless contraindicated, make sure the patient’s head of the bed is at least at a 30 to 45-degree angle (I prefer the latter).

The buccal route is the safest route to administer liquid medications at the end of life in my experience. In practice, I strongly encourage you as well as the families we mutually teach to give any…


One of the most common signs of a person approaching the last few days of life is terminal restlessness.

Restlessness can manifest itself in many different ways. Just as each person is unique in their personality, idiosyncrasies, etc. terminal restlessness can be unique as well. I’ve seen terminal restlessness come in two main forms where each can include the “other” category noted below:

Hyper:

  • The patient cannot find a place to be comfortable
  • Extreme fidgeting
  • Everything hurts
  • Spasms of pain; maybe in the lower back going upward or other locations.
  • The patient frequently tries to get out of bed when…


Sunshine on my face

Some people tell me “it must be hard being in hospice…” and sadly due to HIPAA, I cannot show them a picture of what happened today… a dying person’s wish to have the sun beat on their face one last time… and we were able to make it happen. It may seem like a simple last wish, but it mattered to the patient and their family.

Why do I love being a hospice nurse? Because God uses me — a nobody from various accounts, and I’m not being humble as in the grand scheme of things I am a nobody…


One of the main challenges of new nurses is time management. In a hospital or nursing home setting, you often have coworkers to rescue you in a pinch in case you are overwhelmed; on top of having nearby coworkers, most orientation programs, as well as nursing schools, focus on time management skills in a facility setting. Yet what about time management as a visiting nurse — in home health or home hospice or both?

Let me share with you my wisdom and experience in time management in the field of a visiting nurse to hopefully help you have more time…


If you are a new nurse to hospice, one of the tasks you probably dread is doing an admission especially if you have scheduled visits the same day as the admission.

I would like to share with you some tips that when applied may help lower your stress level, and help you remain on time even in cases where you have three to four visits including recertification to do the same day.

  1. Try to have whatever paperwork your agency uses for the admission as filled out as possible, and in the order, you will go through it with the family…

Here are some ideas that may be beneficial to those of you who are relatively new visiting hospice nurses:

* Just before the week starts (I typically do this on a Sunday evening), create a rough plan (knowing that it will most likely change) for the week of whom you will see on what day in what order. In relation to what order, think of both the patient/family condition/needs and in relation to where everyone lives to you. In the best case, you can do a circle or a form of a horse-shoe. …


These are my experiences as a registered nurse caring for geriatric patients in a long-term & rehab care setting where I was the house supervisor responsible for up to 151 residents along with managing the second shift healthcare staff.

By now, you’ve probably had your temperature checked ad nauseam as you visit different locations. Yet, is checking the temperature of your elderly loved ones a good way to know if they may have COVID-19? Are you aware that according to Vital Signs in Older Patients: Age-Related Changes, “older patients are less able to mount a fever response.” …


Dear nurses and soon-to-be nurses, do you find it hard to go over DNR/Full code orders with those suffering from a terminal illness and their family/POA? How do you handle it when the patient or family want the terminally ill patient to be a full code, and for the medical community to do everything possible to keep the patient alive?

Before we go much further, review https://raven.upmc.com/CommTools/POLST-form.pdf for what we use in Pennsylvania. …


As an INFJ I’m almost constantly doing introspection. Today I was helping out with an emergency situation where one of our wonderful on-call nurses was in a car accident. During my visit with a patient I admitted yesterday who is transitioning towards actively dying, I was in bewilderment in my own mind about how comfortable and peacefully patient I am when I’m around the terminally ill and their family.

I was with the family for close to an hour and a half, some educational, some patient assessment, some a telephone call to our wonderful medical director with recommendations seeking a…


There are a lot of myths about morphine as well as other medications used at the end of life. The sad part about these myths is that while everyone is entitled to their opinion, holding an outright false opinion can lead to someone else’s suffering which could have been prevented.

If I may share three (3) experiences I’ve had as a nurse taking care of hospice patients:

1) While I was still on a cardiac floor in 2017 often being assigned hospice patients I had a terminally ill patient on an IV morphine drip (morphine going right into the bloodstream)…

Peter M. Abraham, BSN, RN

RN experience: cardiology unit at a Magnet-awarded teaching hospital, RN supervisor for a SNF/LTC with 151 residents, and rural home hospice.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store