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The Hospice Team. Hospice care is provided through an interdisciplinary, medically directed team T his team approach to care for dying persons typically including: Physician Nurse Home Health A id Social Worker Chaplain Volunteers. Hospice Nurse. Makes regularly scheduled visits

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The Hospice Team

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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


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


Home Health Aid

  • Provide assistance with the personal care of the patient


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


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


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


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.


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


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


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


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


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


Signs of Death


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


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.


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


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


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


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


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


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


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


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


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


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