The Hospice Team

1. The Hospice Team

2. 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

3. Hospice Nurse • Makes regularly scheduled visits • Provide pain management and symptom control techniques • Keeps primary physician informed of patient’s condition • Provide complete spectrum of skilled nursing care and are available 24/7

4. Home Health Aid • Provide assistance with the personal care of the patient

5. Social Workers • Provide assistance with practical and financial concerns • Emotional support & counseling • Bereavement follow-up • Evaluate need for volunteers & support services needed by the family • Facilitate communication between family and community agencies

6. Chaplains • Provide spiritual support to patients and families • Often serving as a liaison between them and their spiritual community • Assist with memorial services and funeral arrangements

7. What does a Hospice Program Provide? • 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 therapies • Coordination of services and care with the patient's family doctor • Bereavement and support groups for families • Expert management of physical symptoms • End of life issues

8. Financial & Legal Issues • May wish to have an accountant or lawyer help sort through financial and legal issues • Review things: insurance policy, finances, Will, etc.

9. Funeral Arrangements • Perhaps most difficult part of process • Talk with families about preference; burial vs. cremation • How service/ceremony with be conducted • No detail is too small • Help with funeral provider selection; price and options

10. Living Will • 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

11. Do Not Resuscitate (DNR) • Another kind of advanced directive • A request to not have cardiopulmonary resuscitation if heart stops or stop of breathing • DNR order is put in medical chart by doctor • Accepted in all states • If no directive is given staff will do all they can to resuscitate

12. What happens if artificial hydration or nutrition are not given? • Person will eventually fall into a deep sleep, coma, and usually die in 1 to 3 weeks

13. What are the Stages of Grief? • 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

14. Signs of Death

15. As a healthcare giver, you need to know the 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

16. 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.

17. Care of body after 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

18. Care of body after death: • 2 to 4 hours after death, rigor mortis develops • Stiffness of skeletal muscles that occurs after death • Positioning body in normal alignment before rigor mortis seats in • Family 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

19. Postmortem care begins as follows: • 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

20. Begin the procedure: • May need to ask for assistance • May need to refer to the procedure manual • Provide the privacy • Raise the bed to the best level for good body mechanics • Make sure the body is flat • Put on gloves • Position body supine: arms and legs are straight, place pillow under the head and shoulders

21. 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 family • Place cotton ball over the ring and secure it in place with tape, if need be

22. 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; dry • Place a bed protector under the buttocks • Remove soiled dressing and replace with clean • Put a clean gown on the body. • Brush and comb hair if necessary

23. Begin the procedure: • Fill out ID takes; tie one to an ankle or right big toe • Cover the body to the shoulders with a sheet if family is to view • Collect persons belongings; put in marked bag • Remove all used supplies, equipment; make sure room is neat • Let family view body; provide privacy; give belongings to the family • Place the body on the shroud or cover with sheet after family has left the room

24. Apply the shroud: • Complete identification information on the ID tags • Bring the top down over the head • Fold the bottom up over the feet • Fold the sides over the body • Secure the shroud in place with safety pins or tape • Attach the second ID tag to shroud • Leave the body on the bed for the funeral director • Strip the patients room after body has been removed. Wear gloves. • Remove the gloves • Wash hands

25. Report the following: • 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