THE HOSPICE TEAM

Hospice care is provided through an interdisciplinary, medically directed team

This team approach to care for dying persons typically including:

- Physician- Nurse- Home Health Aid- Social Worker- Chaplain- Volunteers

Makes regularly scheduled visits Provide pain management and symptom control

techniquesKeeps primary physician informed of patient’s

conditionProvide complete spectrum of skilled nursing care

and are available 24/7

HOSPICE NURSE

Provide assistance with the personal care of the patient

HOME HEALTH AID

Provide assistance with practical and financial concerns

Emotional support & counseling Bereavement follow-upEvaluate need for volunteers & support services

needed by the familyFacilitate communication between family and

community agencies

SOCIAL WORKERS

Provide spiritual support to patients and familiesOften serving as a liaison between them and their

spiritual communityAssist with memorial services and funeral

arrangements

CHAPLAINS

Around the clock nursing services about and beyond the usual nursing care

Training of family members in patient care, as appropriate

Spiritual and emotional support for both patient and family

Help with practical matters associated with terminal illness

Speech, occupational and physical therapiesCoordination of services and care with the patient's

family doctorBereavement and support groups for familiesExpert management of physical symptomsEnd of life issues

WHAT DOES A HOSPICE PROGRAM PROVIDE?

May wish to have an accountant or lawyer help sort through financial and legal issues

Review things: insurance policy, finances, Will, etc.

FINANCIAL & LEGAL ISSUES

Perhaps most diffi cult part of processTalk with families about preference; burial vs.

cremationHow service/ceremony with be conductedNo detail is too smallHelp with funeral provider selection; price and

options

FUNERAL ARRANGEMENTS

Written legal document that describes the kind of medical treatments or life-sustaining treatments wanted if terminally ill

LIVING WILL does not select someone to make decisions for you

LIVING WILL

Another kind of advanced directiveA request to not have cardiopulmonary resuscitation

if heart stops or stop of breathingDNR order is put in medical chart by doctorAccepted in all states If no directive is given staff will do all they can to

resuscitate

DO NOT RESUSCITATE (DNR)

Person will eventually fall into a deep sleep, coma, and usually die in 1 to 3 weeks

WHAT HAPPENS IF ARTIFICIAL HYDRATION OR NUTRITION ARE NOT GIVEN?

Denial- This isn’t happening!

Anger- Why is this happening to me?

Bargaining- I promise I’ll be a better person if…

Depression- I don’t care anymore

Acceptance- I’m ready for whatever comes

WHAT ARE THE STAGES OF GRIEF?

SIGNS OF DEATH

Movement, muscle tone, and sensation are lost. Usually begins in the feet and legs and eventually spreads to the rest of the body

Mouth muscle relax, jaw drops. Mouth stays open; often peaceful facial expression

Peristalsis and gastrointestinal functions slow down. May be abdominal distention, anal incontinence, fecal impaction, nauseas and vomiting

Circulation fails an body temp rises. Person feels cool/cold, looks pale, and perspires heavily. Pulse is fast, weak and irregular. Blood pressure begins to fall

AS A HEALTHCARE GIVER, YOU NEED TO KNOW THE SIGNS OF

DEATH:

Respiratory system fails. Slow or rapid and shallow respirations may be observed.

Mucus collects in the respiratory tract. Pain decreases as the person looses consciousness.

Some may be conscious until the moment of death.Absence of pulse, respirations, and blood pressure.

Pupils are fixed and dilated.

Doctor determines that death has occurred and pronounces the person deceased.

AS A HEALTHCARE GIVER, YOU NEED TO KNOW THE SIGNS OF

DEATH:

Care of body after death is called POSTMORTEM CARE

Care begins as soon as Dr. pronounces the patient deceased

Precautions and blood borne pathogens standards are followed

Done to maintain good appearance of body/prevent discoloration and skin damages

Includes gathering valuables/personal items for the family

Right to privacy and right to be treated with dignity and respect still apply

CARE OF BODY AFTER DEATH:

2 to 4 hours after death, rigor mortis develops- Stiff ness of skeletal muscles that occurs after

deathPositioning body in normal alignment before rigor

mortis seats inFamily may wish to view the body before taken to the

funeral home; body should appear in a comfortable & normal position

In Some facilities, the body is prepared only for viewing; funeral home will complete postmortem care

CARE OF BODY AFTER DEATH:

Begin by washing your hands and then collect the following:- Postmortem kit if used in facility (gown, two tags,

gauze squares, safety pins)- Valuables list- Bed pad protectors- Wash basin- Bath towels- Washcloths- Tape dressings (if necessary)- Disposable gloves

POSTMORTEM CARE BEGINS AS FOLLOWS:

May need to ask for assistanceMay need to refer to the procedure manualProvide the privacyRaise the bed to the best level for good body

mechanicsMake sure the body is flatPut on glovesPosition body supine: arms and legs are straight,

place pillow under the head and shoulders

BEGIN THE PROCEDURE:

Close the eyes; apply moistened cotton balls gently over the eyelids if the eyes do not stay closed

Insert dentures if facility policy; if not place in labeled container

Close the mouth. Remove jewelry expect for wedding rings; list jewelry

removed. Place and list in an envelope; give to familyPlace cotton ball over the ring and secure it in place

with tape, if need be

BEGIN THE PROCEDURE:

Remove drainage bottles, bags, and containers. Leave tubes and catheters in place if autopsy is performed

Bathe soiled areas with plain water; dryPlace a bed protector under the buttocksRemove soiled dressing and replace with clean Put a clean gown on the body.Brush and comb hair if necessary

BEGIN THE PROCEDURE:

Fill out ID takes; tie one to an ankle or right big toeCover the body to the shoulders with a sheet if family

is to viewCollect persons belongings; put in marked bagRemove all used supplies, equipment; make sure

room is neatLet family view body; provide privacy; give

belongings to the familyPlace the body on the shroud or cover with sheet

after family has left the room

BEGIN THE PROCEDURE:

Complete identification information on the ID tagsBring the top down over the headFold the bottom up over the feetFold the sides over the bodySecure the shroud in place with safety pins or tapeAttach the second ID tag to shroudLeave the body on the bed for the funeral directorStrip the patients room after body has been removed.

Wear gloves.Remove the glovesWash hands

APPLY THE SHROUD:

Time the body was taken by the Funeral Director; identify them

What was done with the jewelry and personal belongings

What was done with dentures (if need be)Anything else thought head nurse should know

REPORT THE FOLLOWING: