Download Hospice

HOSPICE CARE
Prepared by
Nesreen farouk
police officer
2nd Term Doctorate Degree
Under Supervision of
Dr. Namat Alla GOMA
lecturer of Medical-Surgical Nursing,
Faculty of Nursing
Ain Shams University
2010
Out Lines
 Introduction.
 Definitions.
 History of Hospice.
 Characteristics of Hospice.
 Goal of Hospice Care.
 Advantages of Hospice Care.





Disadvantages of Hospice Care.
Myths of Hospice Care.
Hospice Care team.
Hospice care services.
Ethical and Legal issues regarding hospice
care.
 Nursing Role for patient who dies at home.

Application for nursing process in hospice
care for dyeing patient.
Introduction
There is a common belief that a hospice is
where everyone goes to die. That is not true.
Hospice care is based on a philosophy of
emotional, spiritual, physical support, and
comfort for people in the final phase of life
twelve to fourteen days, after which many
patients return home.
Hospice
Hospice is a philosophy of care.
The
hospice
philosophy
or
viewpoint accepts death as the
final stage of life.
Hospice Care
Hospice care is meant for the time when
cancer treatment can no longer help you,
and you are expected to live 6 months or
less& when a life-limiting illness no longer
responds to cure-oriented treatments
Hospice Care Program
It is a Program that provides a
centralized
plan
of
palliative
and
supportive services to dying persons
and their families.
Hospice Concept
It offers a comprehensive program of care
to patients and families facing a life
threatening illness. Hospice is primarily a
concept of care, not a specific place of
care.
Hospice History
In 1967
Dame Cicely Saunders, a
British physician, was the first to apply the
term "hospice" to specialized care for the
terminally ill.

Believed in holistic hospice care,
combining the talents of physicians,
nurses, social workers to address every
aspect of patient care.
In 1981
The hospice concept to
discuss the needs of terminally ill
patients and their families. It is
goal was to restore dignity, and
add value to the last months of
patients' lives.
In 1985
The hospice continued to
grow and meet the needs of more patients
from a larger area.
In 1997
A strong team of dedicated
professionals had been assembled and was
now servicing many places. The name was
changed to the now-familiar Hospice Care
Team.
Characteristics of Hospice
It is a major unit of care for patient
and family.
Its services are extended to the
family during the time of
bereavement ( shock ).
Hospice care can be discontinued
with agreement of the patient,
family and attending physician.
Goals of Hospice Care
Enable patients to continue an alert,
pain- free life.
Manage any symptoms.
Affirm life and does not hasten or
postpone death.
Treats the person rather than the disease.
Focus on quality rather than length of life.
Provide family-centered care.
Involve the patient and the family in
making decisions.
Hospice care can be given in the
patient's home, a hospital, nursing
home, or private hospice facility.
Care is provided for the patient and
family 24 hours a day, 7 days a week.
Advantages of Hospice Care
Provide specialized palliative care.
Provide expertise for difficult problems.
Allows terminally ill children and their
families to remain together in the comfort
and dignity of their home.
Rely on knowledge and skill of an
interdisciplinary team of professionals.
Advantages (Cont.)
Treats the client, not the disease.
Emphasizes the quality of life, not the
duration
Provide expert in managing pain and
symptom.
Allow a terminally ill person to be as
comfortable and pain-free as possible.
Disadvantages of Hospice
 Restrictions placed on the various
aspects of treatment.

Hospitalizations are discouraged once a
patient is under hospice care.
 Participation in experimental treatments
or
clinical trials isn’t allowed as they are
considered life-prolonging.
Some treatments or procedures that
are considered life- prolonging, such as
tube feeding may not be covered.
Pressure on places may restrict
length of stay.
Need to secure funding.
Seven Myths of Hospice Care
 Myth #1: Hospice Care Means Giving Up Hope.
 Myth #2: Patients can only receive hospice
care for a limited amount of time.
 Myth #3: Hospice Is Only for Cancer Patients.
 Myth #4: Hospice Is Only for Patients who Are
Close to Death or Actively Dying.
 Myth #5: A patient needs Medicare or
Medicaid to afford hospice services.
 Myth #6:A physician decides whether a
patient should receive hospice care
 Myth #7: : Once a patient elects hospice
care, he or she cannot return to traditional
medical treatment.
Hospice Care Team
Doctors.
Nurses.
Primary care giver .
Spiritual counselors.
Social workers.
Volunteers.
Role of the Physician
Directed the services required to the
patient
Obtain admission history and physical
examination, prescribed tests and
medication.
Follows the client throughout the illness
and certifies death.
Role of the Nurse
Makes an initial home visit to assess.
Observe the patient ongoing condition
and discuss findings with team members.
Administer the medications as prescribed
patient compliance and evaluate .
Determine the effects of medication
regimen.
Answer the questions and assist other
team members as needed.
Work with staff members to assist the
family in bereavement and reorganize
their lives.
Ensure that each patient’s care is maximized.
Role of Primary Care Givers
Identify changes in the patient s
condition that might not be noticeable to
others.
Suggest approaches to care that meet
with everyone’s approval.
Role of Volunteers

Provide emotional support run errands
assist with physical care.

Help with child care and house hold tasks.

Provide care for their families.

Provide special empathy and understanding.
Spiritual Counselors
Many
people
in
hospice
care
have
connections to some spiritual services in
their community, but the hospice can provide
additional services, if desired.
Social Workers:
Social
workers
provide
counseling
and
support. They can also help patient sort out
insurance and other financial concerns.
Bereavement Counselors
Trained bereavement counselors offer
support and guidance for loved one's
family during and after his or her death.
They continue to provide support for up
to a year after loved one's death.
Hospice Care Services
 Interdisciplinary team.
 Pain and symptom control.
 Spiritual & Respite care.
 Home care and inpatient care.
 Family conferences.
 Bereavement care.
 Staff support.
 Coordination of care
Hospice Care Settings
Home Hospice Care.
Hospital-Based Hospices.
Long Term Care Facility-Based
Hospices
Ethical and Legal Dimensions Regarding
Hospice Care
Advance Directives.
Euthanasia.
Passive Euthanasia.
Active Euthanasia.
Assisted Suicide.
Terminal Weaning.
Cardiopulmonary Resuscitation.
Comfort Care.
Life-Sustaining Treatment.
Relation between Loss and
Hospice Patient
Definition of Loss
It is actual or potential situation in
which a valued person objects or
situation is changed or removed.
Sources of Loss
 Loss of loved or valued person.
 Loss as an element of illness.
 Separation from an accustomed
environment
and
provide security.
people
who
Types of Loss
Actual loss.
Perceived loss.
Anticipatory loss.
Maturational loss.
Situational loss.
GRIEF
Definition
It is a emotional and behavioral
reaction to loss, it occurs with loss
caused by separation as well as with
loss
caused
by
death.
Grief
is
manifested in thoughts, feeling, and
behaviors.
DEATH AS A FINAL LOSS
Definitions
Dying
It is a process of decline in body functions that
results in death.
Death
is a final cessation of all vital functions in a
person.
Types of Death
• Heart Lung Death.
• Cerebral or Brain Death.
.
Manifestations of Impending Death
Relaxation of the facial muscles
Difficulty swallowing.
 Gradual loss of the gag reflex.


Diminished body movement and reflexes.
Cyanosis of the extremities.
 Weak, and irregular pulse.
 Low blood pressure.
 Coldness of skin.
 Rapid, shallow, irregular or abnormally,
respirations.

Changes level of consciousness.
THE DYING PERSON'S BILL OF
RIGHTS
o Should be treated as living human being.
o Maintain a sense of hopefulness.
o Should have the right to be cared.
o
Let he/she express feelings and emotions
about death in his/her own way.
o Participate in decisions.
 Should not leave him/her to diealone.
 Be free from pain.
 Should have questions answered
honestly.
 Should obtain help from family.
 Discuss and enhance religious or
spiritual
STAGES OF DYING

Denial and isolation.

Anger "why me?“

Bargaining.

Depression "crying and not speaking
much“.

Acceptance "preparing to death”.
Nursing Role for a Client Who Dies at Home
 Remove all equipmen
 Prepare the body for transportation.
 Make sure the physician has been notified.
 Refer the family to a bereavement support
group.
Application of Nursing Process to
Care Dying Person
Physical & Emotional Assessment
 Assess holistic client conditions.
 Assess discomforts of dying client.

Assess patient's and family's emotional
condition.
 Assess adequacy of coping behavior.
 Assess patients attitude toward death.
Spiritual Assessment
 Assess religious belief, need for hope.

Assess client and family's attitude toward
death and dying.
 Assess client's preferences concerning death
desire to be at home or in a hospital or hospice
setting,

Assess decisions concerning resuscitation,
advanced life support, organ donation.
Nursing Diagnosis
 Ineffective breathing pattern related to
disease progression

Fear related to death
 Grief related to loss.
 Powerlessness related to terminal illness.
 Ineffective coping related to increased
emotional and physical dependence on other.

Planning
 Deciding on realistic goals, both long
and short term for the dying client.
 Planning to meet the physical,
emotional, developmental and spiritual
needs.
 Support client's self-esteem by asking
for their opinions and make decisions
with the client not for the client.
Implementation
 Meeting the client's physical needs.
 Meeting psychological needs.
 Meeting spiritual needs.
 Psychological support.
 Therapeutic communication.
 Maintenance of self-esteem and sense of
dignity.
 Promoting comfort.
 Prevention of loneliness.
 Providing a soothing environment.
 Meeting family needs.
Evaluation
Evaluation activities include the following:
Listening to the client's reports of feeling in
control of the environment surrounding death.
Observing the client's relationship with
significant others.
Listening to the client's thoughts and feelings
related to hopelessness or powerlessness.
Application of Nursing Process to Care
of Hospice Patient's Body after Dying
Assessment
Determine that the patient is dead by ABC.
Determine if the physician and family have
been notified.
Notify the nursing supervisor.
Check the medical record for the name of the
mortuary where the body will be taken.
Planning
 Contact the mortuary and inform them.
 Ask when mortuary personnel may be
expected to arrive.
 Contact any individuals involved in organ
procurement.
 Obtain a postmortem kit or supplies for
cleaning, wrapping, and identifying the body.
Implementation
o
o
o
o
o
o
o
o
Pull the curtains about the bed.
Don gloves.
Remove all medical equipment
connected.
Remove hairpins or clips and dentures.
Close the eyelids.
The body is carefully batted.
Place the body supine with the arms
extended at the side or folded over the
abdomen.
 Place a small rolled towel beneath the
chin to close the mouth.
Apply one or more disposable pads
between the legs and under the
buttocks.
 Attach an identification tag to the ankle
or wrist.
Wrap the body with a sheet.
* Tidy bedside area and dispose of
soiled equipment.
* Remove gloves and wash your hands.
* Leave the room and close the door.
* Make an inventory of valuables and
send them to an administrative office.
* Notify housekeeping after the body is
removed from the room.
Evaluation
The body is cleaned and prepared.
The body is transferred to mortuary
Document
Assessments that indicate patient is died.
Time of death.
Persons notified of death.
Care of the body.
Time body is transported to the morgue.
Postmortem Care
Care of the body after death (Involves
cleaning and preparing the body to
enhance its appearance during viewing
at the funeral home, ensuring proper
identification and releasing the body to
mortuary personal.
Any Question?