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continued from page 2 How It’s Used at Chapters At our hospice programs, an RN begins gathering information as part of the initial patient assessment. This includes a thorough medical-history review and an initial conversation with the patient and family. During this first meeting, the RN asks two important questions: What have the doctors told you about your situation and what do you want for yourself and your loved one(s)? The RN also explains what the patient and family should expect from us. This initial conversation is tremendously important since it reveals what the patient and family understand about the patient’s medical condition. It also helps to identify their psychosocial, emotional and spiritual needs, and sheds light on what the family is prepared to accept—be that caring for the patient with the hope of an improved prognosis or allowing the patient to experience a natural death. If the patient is alert and oriented, the conversation is held with both the patient and family. If the patient is comatose, obtunded, or intermittently awake, we safeguard and respect the patient’s known desires through advance directives. If the patient is only partially aware, we ask family members to be present while our staff talks with the patient and strives for answers to the bottom-line questions: Do you understand that you are very, very sick? Do you want to try to get better or are you ready to let go and pass on? If the patient seems to be interacting, but does not respond to a particular question, we then explain to the family that we interpret the answer as “I don’t know.” When withdrawal of life support is an issue, we are equally direct and clear in the questions we pose to the patient: “You know the tube you have down your throat? Your family tells me you want that tube out, is that right? Do you want that tube removed even if it means you will die?” While this questioning may seem harsh, when voiced with compassion, it reassures the patient and family that we are here to honor the patient’s wishes and do what he or she wants. If the patient is alert and aware enough, this questioning usually elicits a response. 4 NewsLine
Our practice is to follow the patient’s expressed wishes. If the patient has been interacting, but does not answer a particular question, we interpret this as “I don’t know,” and then stop the process. If the patient is unresponsive, we rely on advance directives. In the absence of advance directives, we identify the legal decision-maker according to our policy. We conclude the conversation by explaining what to expect from us, what might be needed from them, and who will be their contact persons at our program. Our admitting nurse then notifies the receiving team to anticipate this complex case, and arranges for a social worker and chaplain to meet the patient and family to assess the psycho-social-spiritual aspects of their lives and the implications for care. This is the time to clarify who is considered “family.” Is the patient legally married to one partner, but currently living with another who has assumed that role? Does the staff at the patient’s long-term care facility consider themselves family and want to be informed of the patient’s care at every stage of decline? If there is complex care to be rendered, is there someone who is willing and able to assist in a caregiving capacity? If so, who will be training them? What exactly are the orders and instructions for that care? Finally, does your organization’s policies and procedures support the care that is needed and requested? During our review of the case, a nursing director or chief clinical officer reviews all policies that apply to the patient’s situation. Any questions that surface from this review must then be addressed. In Practice: The Case of Jimmy Jimmy was a 32-year-old man with Down Syndrome, whose multiple medical conditions had brought him to a terminal state. He had been a long-term resident of a group home that cared for the developmentally disabled until his care required admittance to the area hospital. The group home and hospital were about 150 miles away from his parents’ home, which was located in our service area. Now, given his illness, his parents wanted to have him closer to them. Pages and pages of records about Jimmy arrived at our hospice for review. The physician and staff at our hospice house reviewed every page, looking for clues about the best way to manage his care. We learned that Jimmy was in fourcontinued on next page A nursing director or chief clinical officer reviews all policies that apply to the patient’s situation. NewsLine 5
Page 1 and 2: The Monthly Membership Publication
Page 3: Important Points About the Proposed
Page 7 and 8: When Jimmy arrived at the hospice h
Page 9 and 10: The Complex Case Format Courtesy of
Page 11 and 12: Short Takes: • Results from the E
Page 13 and 14: The Guidelines in Practice Staffing
Page 15 and 16: Let’s now turn to the portion of
Page 17 and 18: LPN partnership to this portion of
Page 19 and 20: cases of an anticipated weather eme
Page 21 and 22: NHPCO would like to thank all the c
Page 23 and 24: BAYADA Hospice • Moorestown, NJ T
Page 25 and 26: What you don’t know can hurt you
Page 27 and 28: • A 60-year-old female with metas
Page 29 and 30: attendance at APTA and NHPCO confer
Page 31 and 32: Advertisement HEALTHCARE CONSULTANT
Page 33 and 34: 2014 Circle of Life Award: Call for
Page 35 and 36: Avow advancement team, with creativ
Page 37 and 38: New Online Courses from NHPCO’s E
Page 39 and 40: SPRING 2013 Hospice Patient and Vet
Page 41 and 42: Lighthouse of Hope Fund Provides Me
Page 43 and 44: Run to Remember: A Look at Two Spec

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