Chapter 100 Notes on Hospice Nursing from Wolters Kluwer Health

Hospice: A philosophy of care that is focused on providing compassionate care in the final stage of life.
- Aims to allow individuals to die at home, free of pain, and surrounded by loved ones.
- Care can be provided at home, in a hospice center, a hospital, or a skilled nursing facility.
- Focuses on physical and emotional comfort rather than curing the illness.
- Serves clients with chronic illnesses in terminal stages, such as end-stage renal disease (ESRD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and Alzheimer's disease.

Provide pain relief while helping clients remain alert and meet basic needs.
Assist clients in managing physical symptoms and emotional concerns while focusing on quality of life rather than cure.

The hospice movement began in 1967 in London and has evolved significantly since its inception.
- Medicare has set conditions for hospices to receive funding.
- Organizations like the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care and Hospice (NAHC) establish standards and provide resources for hospice care.

Primarily community-based or independently operated programs.
Must provide an interdisciplinary team approach led by a qualified physician.
Comprehensive support provided to both clients and family members.
- Includes bereavement support for at least one year following the client's death.
Services offered include high-tech therapies when necessary, such as intravenous medications or supplemental oxygen.

Important to manage symptoms related to terminal illnesses and maintain quality of life through:
- Do Not Resuscitate (DNR) and Do Not Intubate (DNI) directives.
- Non-invasive approaches to alleviate suffering, focusing on comfort.
- Emotional support to clients and families, addressing fears of abandonment or uncontrolled pain.

Recognizes the stress and emotional burden caregivers face, also known as compassion fatigue.
- Signs include emotional breakdown, exhaustion, depression, and difficulty concentrating.
Respite care is available, offering caregivers periodic breaks from their responsibilities, enhancing their well-being.

Offers emotional support through empathic communication and help in reconciling with loved ones.
Chaplains available to provide spiritual care in consideration of the client's cultural and religious beliefs.
- Addresses spiritual concerns to enhance the emotional well-being of clients and families.

Essential component of hospice services, providing support to families after a client's death.
- Encourages participation in grief support groups and memorial activities.

Focus on basic needs:
- Nutrition and Hydration: Managing anorexia, nausea, and dehydration with care.
- Personal Care: Addressing skin integrity, odor management, and emotional concerns such as anxiety and depression.
- Pain Management: Utilizing medications judiciously to alleviate discomfort and enhance quality of life.
- Focused on ensuring clients can attain restful sleep and maintain dignity in their final days.

Prioritizes the management of pain with minimal medications while keeping clients conscious as much as possible.
- Various methods include oral, sublingual, and transdermal routes for drug administration.
- Emphasis on using medications for comfort without concern for addiction due to end-of-life circumstances.

Special considerations for children include thorough communication and adjustment of medications based on children's sizes and needs.
- Emotional needs must also be addressed with sensitivity and openness.

Nurses responsible for:
- Preparing the family and environment after death.
- Ensuring dignified handling of the body and documentation required post-mortem, including medication disposal as per agency policy.

The essence of hospice care is centered around dignity, comfort, and quality of life during the final stages of life. Openness, emotional support, and practical assistance are critical in delivering this compassionate care.