Expect the unexpected
Although hospice care is predicated on a well-organized plan of care, experience and flexibility are often required to provide the comfort and support needed by the dying and their loved ones. The following are just a few anecdotal examples of the complex hospice care delivery environment.
- A doctor refers a patient to hospice services. The nurse goes to the home to find the patient is actively dying. In some cases, the patient may die before the admission process is complete.
- A patient has been on the hospice program for a few weeks. He develops a sudden change in his respiratory status. He and the family panic. They cut off the Do Not Resuscitate (DNR) bracelet and call 911 and go to the ER for treatment.
- A patient with severe kidney disease has decided to go onto hospice care and avoid dialysis treatment. She learns her granddaughter is getting married in a few months. She decides to come off the hospice program and go on dialysis so she can attend the wedding.
- A nurse comes to the patient’s house to put on the new DNR bracelet. The patient asks the nurse since he did not expire on the date on the bracelet will the date on the new bracelet be the real day he dies.
- A dying patient, with approximately a month to live, turned over his house to his surviving son. The son tells his father and mother they must move out in a week.
- The dying man’s ex-wife is the primary care giver, even though both the dying man and his ex-wife have remarried. This is fine with all family members, including the new wife.
- A man with a terminal illness is doing well on the hospice program. He receives news his daughter has died suddenly.
Families have unique ways of dealing with the dying process. Unique occurrences happen within their lives also. Nurses need to be there to gently guide the process to avoid major complications at the same time respecting the uniqueness of the family system.
This course will be retired or reviewed by 12/31/2019