1. THE HOSPICE TEAM

2. 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

3.  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 HOSPICE NURSE

4.  Provide assistance with the personal care of the patient HOME HEALTH AID

5.  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 SOCIAL WORKERS

6.  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 CHAPLAINS

7.  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 WHAT DOES A HOSPICE PROGRAM PROVIDE?

8.  May wish to have an accountant or lawyer help sort through financial and legal issues  Review things: insurance policy, finances, Will, etc. FINANCIAL & LEGAL ISSUES

9.  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 FUNERAL ARRANGEMENTS

10.  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 LIVING WILL

11.  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 DO NOT RESUSCITATE (DNR)

12.  Person will eventually fall into a deep sleep, coma, and usually die in 1 to 3 weeks WHAT HAPPENS IF ARTIFICIAL HYDRATION OR NUTRITION ARE NOT GIVEN?

13.  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 WHAT ARE THE STAGES OF GRIEF?

14. SIGNS OF DEATH

15.  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:

16.  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. AS A HEALTHCARE GIVER, YOU NEED TO KNOW THE SIGNS OF DEATH:

17.  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:

18.  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 CARE OF BODY AFTER DEATH:

19.  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 POSTMORTEM CARE BEGINS AS FOLLOWS:

20.  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:

21.  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:

22.  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:

23.  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 BEGIN THE PROCEDURE:

24.  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 APPLY THE SHROUD:

25.  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 REPORT THE FOLLOWING: