The hospice team
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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

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
Hospice Nurse medically directed team

  • 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
Home Health Aid medically directed team

  • Provide assistance with the personal care of the patient

Social workers
Social Workers medically directed team

  • 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 medically directed team

  • 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
What does a Hospice Program Provide? medically directed team

  • 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
Financial & Legal Issues medically directed team

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

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

Funeral arrangements
Funeral Arrangements medically directed team

  • 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
Living Will medically directed team

  • 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
Do Not Resuscitate (DNR) medically directed team

  • 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
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
What are the Stages of Grief? 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

As a healthcare giver you need to know the signs of death
As a healthcare giver, you need to know the signs of death: given?

  • 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 death1
As a healthcare giver, you need to know the signs of death: given?

  • 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: given?

  • 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 death1
Care of body after death: given?

  • 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
Postmortem care begins as follows: given?

  • 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
Begin the procedure: given?

  • 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 procedure1
Begin the procedure: given?

  • 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 procedure2
Begin the procedure: given?

  • 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 procedure3
Begin the procedure: given?

  • 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
Apply the shroud: given?

  • 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
Report the following: given?

  • 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