What Hospice Nurses should assess every visit
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The most up to date version of this article can be found at https://nurse.2abraham.com/index.php/2023/05/12/what-hospice-nurses-should-assess-every-visit/
While not every single visit needs to address educational needs preparing the patient, friends, family, and caregivers for the patient to have a “good death,” every nursing visit should involve making the following assessments in addition to the standard “physical assessment:”
- Is the patient imminent which typically means the patient can die anytime to within two weeks? If yes, adjust visit frequencies accordingly, and communicate with your IDG team, the immediate care team, and family.
- Is there a change of condition for the current visit that either occurred just before you got there or just after your last visit? If yes, plan for a PRN visit the next day, communicate with your IDG team, the immediate care team, and the family.
- What is the current velocity of declines, and where does that frequency place the patient in terms of how much longer they may be alive? If there have been several changes over a few days, reconsider if the patient may be imminent, and act accordingly.
- Does the patient plan of care, which includes their medication and treatment regimen, effectively managing the patient’s systems such that the patient is comfortable and able to engage in life to the degree their disease process and environment allows for them to do so? If not, then work with the appropriate parties to adjust the plan of care and communicate appropriately.
- What medications need to be refilled keeping in mind the next nursing visit date, holiday’s, weekends, etc.
- Is there anything else the team can be doing to support the patient in maximizing their life under the current situation?
Resources
Hospice is about Living: https://pmabraham.medium.com/hospice-is-about-living-6eec3104cb97
Preparing for a Good Death: Topics to Cover with Hospice Patients and Their Families: https://pmabraham.medium.com/preparing-for-a-good-death-topics-to-cover-with-hospice-patients-and-their-families-604c0ff09e64
Hospice is Comfort Care: https://pmabraham.medium.com/hospice-is-comfort-care-4997942fd763
Velocity of Changes in Condition as an Indicator of Approaching Death: https://pmabraham.medium.com/velocity-of-changes-in-condition-as-an-indicator-of-approaching-death-40af6c08e2e0
Recognizing Terminal Restlessness: https://pmabraham.medium.com/tips-for-new-nurse-terminal-restlessness-ad2511a355b3
Terminal restlessness in the completely nonverbal patient: https://pmabraham.medium.com/terminal-restlessness-in-the-completely-nonverbal-patient-d986ad689da0
Delirium vs terminal restlessness: https://pmabraham.medium.com/delirium-vs-terminal-restlessness-7666395de497
Interviewing and Observation as part of the assessment: https://pmabraham.medium.com/interviewing-and-observation-as-part-of-the-assessment-59e427e55bd7
Recognizing the approaching end of life: https://pmabraham.medium.com/tips-for-new-nurses-on-recognizing-the-approaching-end-of-life-df3eaa4b3bde
The dying process at the end of life: https://pmabraham.medium.com/the-dying-process-at-the-end-of-life-9804fe1e3b36
The last hours of life: https://pmabraham.medium.com/the-last-hours-of-life-d9b9248a55d5
Considerations for increasing hospice visit frequencies: https://pmabraham.medium.com/considerations-for-increasing-hospice-visit-frequencies-faa96b412332
