Delayed Hospice and

the patient
By: Megan Moore

Objectives
Discuss what hospice entails
Explain Relevance to Nursing
Discuss theories pertaining to timely transition
Understand assumption
Exploring through a RCA, underlying cause
Explain inferences
Recommendations

What is the first word that comes to

mind when you hear hospice?

What is Hospice?

What is short stay Hospice?

(NHPCO;2014)

hospiceofwestalabama.org

Introduction
Relevance to nursing

Personal experience

(Themes: End-of-life and Palliative care,

2014)

Theories
Katharine Kolcaba Theory of Comfort
Relief
Ease
Transcendence

Immediate desirable outcome=comfort

(Kolcaba, Stone & Durr, 2010)

(Waldrop &Meeker, 2014)

Completed Comfort Grid

Relief

Ease

Transcendence

Physical

Diuretics,
morphine and
nasal O2
prescribed

Relief of anxiety
thru music
decreased SOB

Music about to
transport
patient beyond
discomfort
related to
terminal illness

Psychospiritual

Resolved family
conflicts

Environmental

Lighting
adjusted

Social

Daily family
visit

(Kolcaba, Stone & Durr, 2010)

Peaceful
environment
allowed
relaxation
Ongoing
support from
hospice team

Theories continued
Maslows hierarchy of Needs

https://www.saybrook.edu/forum/univ/hospice-care-better-care-anymeasure

Assessment of health care environment

Assumption: acceptance of dying

Root Cause Analysis

Lack of
education
about
hospice

Public
biases of
Hospice

HCP
discomfort
with
discussing
death/hospice

Health
care
providers
lack
education
on Hospice

Biases of Public
Going to Hospice Means.
Giving up
Hospice Kills
Only for Cancer Patients

All are proven FALSE

https://www.longtermcarelink.net/eldercare/hospice.htm
(Waldrop &Meeker, 2014)

(Dennis, 2011)

Lack of Education

http://
www.valleynewslive.com/ndtoday/home/head
lines/When-is-the-Right-Time-to-Seek-Hos
pice-Care-290079011.html

(http://www.lifemattersmedia.org/2012/12/what-is-palliative-hospice-care/)

(Bakanic, Singleton, & Dickinson, 2014)(Dennis, 2011)

Barrier

Cultural Views

Asian

Hispanics

Physicians

(Coolen, 2012)

(Lachman, 2011)

(Bakanic, Singleton, & Dickinson, 2014)

Resources

In-home care

Provide medical equipment and supplies

Teaching

Collaborative Team

Bereavement

(NHPCO;2014)

Inferences
Patient
Increase cost of healthcare
Healthcare- Nurse, Physician, Hospital
Hospice loses money

Recommendation

First, education physicians and nurses- QSEN targets knowledge,

increasing patient-centered care

Use Advanced Directives to facilitate conversation

Ethics

Collaboration/Communication

Education

Planning

(fallberg, 2015)

(ANA, 2004)

(ugaadmissions.blogspot.com
)

Conclusion

Systems failure in patient-centered care

related to a lack of education

Questions?!?

References

American Nurses Association, ANA (2004). Scope and standards of

nursing practice, second ed. Washington, DC: American Nurses Publishing

Bakanic, V., Singleton, M., & Dickinson, G. (2014). Hospice Attitudes of

Physicians and Nurse: A Pilot Study. American Journal of Hospice and
Palliative Medicine. doi:10.1177/1049909114552124

Coolen, P. R. (2012, May 1). Cultural Relevance in End-of-Life Care. In

Ethnomed. Retrieved from https://ethnomed.org/clinical/end-oflife/cultural-relevance-in-end-of-life-care

Dennis, J. (2011) "Hospice Straight Talk: Myths Meet Reality." Huffington

Post 27 2nd ed. Web. 7 June 2015.

Falberg, B. (2015, April). Dying in America: A nursing response to the

IOM's call to action. Nursing, 45(4), 14-15.

Kolcaba, K., Stoner, M., & Durr, K. (2010). In Comfort Line. Retrieved June
10, 2015, from http://www.thecomfortline.com/index.html

References (continued)

Lachman, V. D. (2011, July). Nurse's role in increasing patient access to hospice care.
MedSurg Nursing

National Hospice and Palliative Care Organization, NHPCO (2014).NHPCOs Facts and Figures
Hospice Care in America. Retrieved from:
http://
www.nhpco.org/sites/default/files/public/Statistics_Research/2014_Facts_Figures.pdf

Radulovic, J. (2010, August 19). Research Shows Patients May Live Longer with Hospice and
Palliative Care . In National Hospice and Palliative Care Organization. Retrieved June 9, 2015.

Rogers, T. (2010). Hospice myths: what is hospice really about? Pennsylvania Nurse, 1-8.

Themes: End-of-Life and Palliative Care. (2014, December). In National Institute of Nursing
Research. Retrieved June 9, 2015, from
http://www.ninr.nih.gov/aboutninr/keythemes/themes-eolpc#.VYCnG0aXpW1

Waldorp, D., & Meeker, M. (2013, August 13). Final decisions: how hospice enrollment
prompts meaningful choices about life closure. Palliative and Supportive Care, 12(3), 211221. doi:10.1017/S1478951512001113