The Conference Room Where Quality is Instructed

Don’t leave your professional standards at the door.

Professionalism is essential for all licensed nurses but especially for those in the hospice industry. It is such an honor to be invited into a patient’s home to care for them at a critical time in their lives. For the patients and their families, there may never be a time that they have been so vulnerable and uncertain about their future and what comes next.

Hospice is a benefit for persons who have been diagnosed with a terminal illness and have a prognosis of six months or less to live. For some, this may have been a long struggle fighting cancer or an up and down battle with a chronic illness, and there are no other options for treatment or a cure. Moreover, for some, it may be a newly diagnosed disease, and they are in overwhelming shock.

We greet patients and their families during this incredible and defining journey and at various stages of their grief. When we do, we know that their expected outcome is hopefully, a peaceful death at home or what we in hospice call a “good death.” We must get it right!

Because we are in the community environment and not a controlled hospital setting there remains an etiquette. First and foremost, we are entering into the home of the patient, and this home is to be honored by the visiting staff. Patients come in all shapes, sizes, socioeconomic status, and educational levels. We are there to help and serve them not to judge them. We are also to be mindful of where they are in their journey and acknowledge their fears and anxiety about death and dying. We cannot drag them to the “good death,” we can walk with them.

A nursing visit for the hospice nurse is not entirely different from any other nursing visit. An assessment is required for each visit just as it would be at the beginning of your shift in a hospital or clinic setting. This opinion is a controversial one. Some in the industry do not believe that it is necessary to complete an assessment for the hospice patient on each visit. I think that you are responsible for the patient and their status during the visit. Assessments give knowledge of the patient's condition. The hospice physician and the patient's caregivers are depending upon the hospice nurse to know the status of the patient and to report the findings.

What is in an assessment? An assessment includes both objective and subjective findings. We know that in the process of death and dying, the patient’s condition can rapidly change. A stethoscope, blood pressure cuff, and a thermometer are all essential tools for the patient assessment. It should include a measurement of the blood pressure, auscultation of the lung sounds, heart sounds, and bowel sounds, and analysis of the body temperature address all systems of the body including the gastrointestinal and genitourinary systems.

The CMS hospice condition of participation rules states that the hospice patient has a right to have effective pain and symptom management. Assessment and early interventions are essential to achieving the level of comfort that the patient desires and deserves. The majority of hospice visits are in the patient’s home setting, the nurse and interdisciplinary team are independent, so character and professionalism matter. Even when no one is watching, your patients deserve your best.

Quality is a verb and is intentional!

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