Transcript Nursing Facility and Hospice Collaborative Training

Nursing Facility and Hospice
Collaborative Training
Presented by Care Initiatives Hospice,
Hospice of Central Iowa, Iowa Health
Hospice, Iowa Hospice, Mercy Hospice
and Wesley Community Hospice
1
What your residents can expect
from the hospice program:
Hospice neither hastens death or prolongs life.
Your resident’s comfort is of utmost importance.
Hospice will focus on pain and symptom
management in an attempt to maintain comfort.
Your resident will be given quality care and
services by the hospice staff.
Your resident, his/her family and you will be
treated with dignity and respect.
Your resident has the right to self-determination. In
the event he/she is unable to express this, the
person with the decision making capacity has that
right.
2
What your residents can expect from the hospice program:
Your resident will be
accepted
unconditionally.
Your resident will be
given a statement of
his/her rights as a
hospice patient.
Hospice will provide
support & care for
your resident’s
emotional & spiritual
needs.
Hospice respects each
person’s cultural
differences.
3
What you can expect from the
Hospice program:
Hospice is responsible for managing your
resident’s hospice services and any care related to
the terminal diagnosis.
Hospice will work as a team to provide the needed
care and services to your resident. You can
expect:
Coordination of hospice care with facility staff.
Communication with your medical director, your
resident’s attending physician and any other
physician involved in the care of the resident.
Ongoing documentation of all hospice service.
4
Hospice will provide the following
information to you:
The most recent hospice plan of care
specific to each resident.
The hospice election form and any
advance directives specific to each
resident.
The physician certification and
recertification of the terminal illness.
Names and contact information for hospice
staff involved in the resident’s care.
5
Hospice will provide the following information to you:
Instructions on how to access the hospice’s
24 hour care system.
Medication information specific to each
resident.
Orders from the hospice physician and
attending physician.
6
What hospice expects from you:
Meet the personal care and nursing
needs of your residents (our hospice
patients).
Promptly notify hospice of a change in
your hospice resident’s condition.
Immediately notify hospice of the
death of a hospice resident.
Ensure hospice orientation to new
facility staff.
7
Pain and symptom management ~
your resident’s comfort
Pain and symptom management are treated
with very specific interventions in hospice
care. These include: medication and non
medication methods such as massage, pet
therapy, music therapy, and healing touch.
We make every effort to treat the whole
person and consider spiritual, emotional
and psychosocial interventions to help
control symptoms.
8
Pain management:
Medication is given around the clock. This
maintains the steady level of medicine and
provides quality pain control.
Medication is given in the amount needed
to control the pain to the resident’s
satisfaction.
Medications are administered in ways
comfortable to the resident. Hospice will
consider using sublingual or rectal routes
before subcutaneous, intramuscular or IV.
9
Pain management:
Non-pharmacologic
interventions such
as massage,
healing touch,
music, pet therapy
and guided
imagery may be
used to help
maintain pain
control.
10
Other comfort concerns:
Bowel programs are started for
residents receiving certain pain meds.
Other difficult symptoms to manage
can include:
Nausea and vomiting
Breathlessness
Anxiety and restlessness
Delirium and dementia
11
Other comfort concerns:
Hospice staff receives specific education and
additional in-services to understand and learn how
to minimize and control these and other
symptoms.
Hospice staff are alert to facility regulations, in
particular those regarding the use of psychotropic
meds that could lead to sedation and its possible
use as a restraint.
12
Some Principles of Death & Dying
Location: consider your resident’s
desired location of death.
Presence of others: The hospice
philosophy encourages the
participation & presence of family &
significant others during the dying
process, and will work with you and
the facility staff to accommodate
additional visitors.
13
Some Principles of Death & Dying
Environment: It is
important that the
environment surrounding a
person at death provides a
sense of peace and
comfort not only for your
resident but for family and
caregivers as well.
Comfort: Hospice staff are
available to provide
assistance with comfort
management as well as
emotional and spiritual
support for the resident,
family and caregivers
(which includes facility
staff).
14
Some Principles of Death & Dying
Individualized: All of us die differently; for
each one us death and dying is a unique
experience. Many people die in the way
that they lived and will not experience a
significant change in their personality or
lifestyle just because they are at the end of
life.
15
Signs and Symptoms of Impending
Death:
Coolness: Hands,
arms, feet and legs
may become
increasingly cool to
the touch.
Color of the skin may
change. This is
because normal
circulation is
decreasing and being
reserved for the
body’s vital organs.
Sleeping: Your
resident may spend an
increasing amount of
time sleeping and
appear to be noncommunicative and
unresponsive. Speak
to them as you
normally would, even
though there may be
no response.
16
Disorientation: Your resident may seem
confused about time, place and identity of
family and friends. Identify yourself by
name before you speak. Speak softly,
truthfully and clearly.
Incontinence: Your resident may lose
control of bowel and bladder as muscles
begin to relax.
Congestion: Noisy, gurgling sounds may
occur. These sounds can be concerning for
family and friends. Gently turn your
resident’s head to the side to allow gravity
to drain the secretions.
17
Intake decreases:
Your resident may
want little or no
food or liquid. This
means his/her
body is conserving
energy for other
functions and
getting ready for
the end phase. Do
not force food or
drink. Glycerin
swabs may be
used to keep the
mouth moist.
18
Urine decreases due
to decreased intake &
decreased circulation.
Change in breathing
pattern: Breathing
may change pace
which alternates with
periods of no
breathing.
Decreased
socialization: Your
resident may only
want to be with a very
few or even just one
person.
Withdraw: Your
resident may seem
unresponsive,
withdrawn or in a
comatose state.
He/she is beginning to
“let go”. Continue to
speak to him/her as
they can still hear you.
Restlessness: Your
resident may perform
repetitive & restless
tasks like picking at
his/her clothes or
linens. This is due to
decreased oxygen in
the brain.
19
Sensory experiences: Your resident may
speak or claim to have spoken to those
who have already died, or see or have
seen places not visible to you. Affirm the
experiences. These are normal and
common.
20
Giving permission: Your resident
may need permission to die or “let go”
without feeling guilty or feeling they
are letting someone down. Encourage
family and friend to give this
permission.
Saying goodbye: Help your
resident’s family say goodbye and
take time to say goodbye yourself. It
is the final gift of love, for it achieves
closure & makes the final release
possible. Tears are normal.
21
Bereavement services: Bereavement
services are available to your resident’s
family, to other facility residents and to
facility staff. Contact the hospice program
for specific information regarding
bereavement services.
22
For further questions regarding this
hospice education or any questions
regarding hospice care, please
contact any of the following providers:
Care Initiatives Hospice, Hospice of
Central Iowa, Iowa Health Hospice,
Iowa Hospice, Mercy Hospice and
Wesley Community Hospice
23