Download Nursing Facility and Hospice Collaborative Training

Nursing Facility and Hospice Collaborative Training
Created by:
Iowa Hospice
Mercy Hospice
Iowa Health Hospice Wesley Hospice
Care Initiatives Hospice
Hospice of Central Iowa
What your residents can expect from the hospice program:
 Your resident’s comfort is of utmost importance. Hospice will focus on
pain and symptom management in an attempt to maintain your resident’s
comfort.
 Your resident will be given quality care and services by the hospice staff.
 Your resident, his/her family and you will be treated with dignity and
respect.
 Your resident has the right to self-determination. In the event your
resident is unable to express his/her self-determination, the person with
decision making capacity for the resident has a right to express your
resident’s self-determination.
 Your resident will be accepted unconditionally.
 Your resident will be given a statement of his or her rights as a hospice
patient by the hospice program.
 Hospice will provide support and care for your resident’s emotional and
spiritual life.
 Hospice neither hastens death nor prolongs life.
 Hospice respects each person’s cultural differences.
What you can expect from the hospice program:
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Hospice is responsible for managing your resident’s hospice services, and
makes arrangements for any care your resident receives that is related to
the terminal diagnosis.
Hospice will work as a team to provide the needed care and services to
your resident. You can expect:
o Coordination of hospice care with facility staff.
o Communication with facility staff and other healthcare providers
participating in your resident’s care.
o Communication with your facility medical director, your resident’s
attending physician and other physicians participating in the care to
your resident to coordinate the hospice care of your resident.
o On-going documentation (in your resident’s chart) of all hospice
services provided to your resident.
Hospice will provide the following information to you:
o The most recent hospice plan of care specific to each resident.
o The hospice election form and any advance directives specific to
each resident.
o The physician certification and recertification of the terminal illness
specific to each resident.
o Names and contact information for the hospice staff involved in the
care of each resident.
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o Instructions on how to access the hospice’s 24 hour on call system.
o The hospice medication information specific to each resident.
o The hospice physician and attending physician orders specific to
each resident.
What the hospice expects from you:
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Meet the personal care and nursing needs of your residents (our hospice
patients).
Immediately notify hospice of a change in your hospice resident’s
condition.
Immediately notify hospice of the death of your hospice resident (our
patient).
Ensure hospice orientation to facility staff prior to providing care to the
hospice resident.
Pain and symptom management—your resident’s comfort:
Pain and symptom management is treated with very specific interventions
through hospice care. These interventions include medications and nonmedication methods such as massage and pet therapy, music therapy, healing
touch. Also included is an effort to treat the whole person, and hospice considers
spiritual, emotional and psychosocial interventions to help control symptoms.
The use of these various therapies is determined by your resident’s needs.
Pain Management:
 Pain medication is given around the clock. This maintains a steady level
of medicine and provides quality pain control. Constant dosing helps
break the pain cycle and minimizes the roller coaster effect that can come
from giving pain medications on a prn (as needed) basis.
 The proper amount of medication is always given. The medication is
given in the amount which is needed to control the pain to the satisfaction
of the resident without causing excessive sleepiness or other side effects.
 Medications are administered in ways convenient and comfortable to your
resident. The hospice will consider using rectal or sublingual routes
before subcutaneous, intramuscular or intravenous.
 Non-pharmacologic interventions such as massage, healing touch, music
and pet therapy, and guided imagery may be used to help maintain pain
control.
Other comfort concerns:
 Bowel programs are started for each resident receiving certain pain
medications.
 Other difficult symptoms to manage can include:
o Nausea and vomiting
o Breathlessness
o Anxiety and restlessness
o Delirium and dementia
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Hospice staff receives specific education and attend additional in-services
to understand and learn how to minimize and control these and other
symptoms.
Hospice staff is alert to facility regulations, in particular those regarding the
use of psychotropic medications that could lead to sedation and its
possible use as a restraint.
Some Principles of Death and Dying
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Location—it is important to consider your resident’s desired location of
death; for many it is their place of residence, right here in your facility.
Presence of others—the hospice philosophy encourages the
participation/presence of family/significant others during the dying
process, and will work with you and the facility staff to accommodate
additional visitors.
Environment—it is important that the environment surrounding a person at
the time of death provides a sense of peace and comfort not only for your
resident but for the family and caregivers as well. A calm, quiet
atmosphere with objects that are meaningful to the resident and family
bring added value at this time.
Comfort—hospice staff are available to provide assistance with comfort
management as well as emotional and spiritual support for the resident,
family and caregivers (which include the facility staff).
Individualized—all of us die differently; for each one of us death and dying
is a different experience. Many people die in the way that they lived and
will not experience a significant change in their personality or lifestyle
because they are at the end of their life.
Signs and Symptoms of Impending Death:
When a person enters the final stage of the dying process, two different
processes are at work. Physically, the body begins to shut down and continues
to shut down until physical activities cease. The second process which occurs is
an emotional-spiritual-mental aspect. This may appear as withdrawal from one’s
present surroundings and relationships or letting go of all that keeps one
attached to this life.
Physical Changes
 Coolness—your resident’s hands, arms, feet and legs may become
increasingly cool to the touch. At the same time, the color of the skin may
change. This is because the normal circulation of blood is decreasing to
the body’s extremities and being reserved for the vital organs.
 Sleeping—your resident may spend an increasing amount of time sleeping
and appear to be non-communicative and unresponsive. Speak to them
as you normally would, even though there may be no response.
 Disorientation—your resident may seem confused about time, place and
identity of family and friends. Identify yourself by name before you speak
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rather than ask the person who you are. Speak softly, truthfully and
clearly.
Incontinence—your resident may lose control of bowel and bladder as
those muscles begin to relax. Keep him/her clean and comfortable.
Congestion—noisy, gurgling sounds may occur with breathing. These
sounds can be concerning for the family and loved ones. What is being
heard is the collection of small amounts of fluids that accumulate in the
lungs and cause a vibration noise. The sound is caused by your
resident’s inability to cough up secretions. Gently turn your resident’s
head to the side and allow gravity to drain the secretions.
Intake decreases—your resident may want little or no food or liquid. This
means his/her body is conserving energy for other functions and getting
ready for the end phase. Do not force food or drink. Glycerin swabs or
keeping the mouth moist will keep your resident comfortable.
Urine decreases—this usually happens due to the decreased intake as
well as decrease in circulation through the kidneys.
Change in breathing pattern—your resident’s regular breathing pattern
may change to a different pace which alternates with periods of no
breathing. Hold their hand and speak gently to them.
Decreased socialization—your resident may only want to be with a very
few or even just one person.
Withdrawal—your resident may seem unresponsive, withdrawn or in a
comatose like state. They are beginning to “let go”. Continue to speak to
him/her as he/she can still hear you.
Sensory experiences—your resident may speak or claim to have spoken
to those who have already died, or see or have seen places not presently
visible to you. Affirm the experiences. These experiences are normal and
common.
Restlessness—your resident may perform repetitive and restless tasks
like picking at his/her clothes or linens. This is due to decreased oxygen
to the brain. Keep the environment calm and quiet.
Giving permission—IF YOU HAVE PERMISSION FROM YOUR
RESIDENT’S FAMILY, your resident may need to have permission to die,
to “let go”, without feeling guilty or feeling they are letting someone down.
Saying Good Bye—Help your resident’s family say goodbye to their loved
one. Take time yourself to say goodbye to your resident. It is the final gift
of love for it achieves closure and makes the final release possible. Tears
are normal and do not need to be hidden.
Bereavement services:
Bereavement services are available to your resident’s family, to other facility
residents and to facility staff. Contact the hospice program for specific
information regarding bereavement services.
Signature of employee__________________________ Date_______________
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Nursing Facility and Hospice Collaborative Training
Created by:
Iowa Hospice
Mercy Hospice
Iowa Health Hospice Wesley Hospice
Care Initiatives Hospice
Hospice of Central Iowa
I acknowledge I have read the training packet entitled “Nursing Facility and
Hospice Collaborative Training.”
Signature of employee___________________________ Date____________
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