Hospice Nursing Diagnosis and Nursing Care Plan

Hospice Nursing Care Plans Diagnosis and Interventions

Hospice Nursing Care Plans Diagnosis and Interventions

Hospice care is a type of nursing care provided to patients nearing the final days of their lives. A team of healthcare specialists delivers services to increase comfort for critically ill patients by minimizing pain and meeting physical, psychological, social, and spiritual needs.

Hospice care also offers counseling, temporary care, and practical support to families.

Hospice provides four stages of care. The four levels are as follows:

  • Routine Home Care. The most typical level of hospice care. Routine home care includes nursing and home health aide services in hospice care.
  • Continuous Home Care. When a patient needs continual nursing care during a crisis.
  • General Inpatient Care. Providing short-term care at the hospital as a treatment for pain and symptoms.
  • Respite Care. A facility that offers short-term care when the patient’s caregiver requires a break.

The Goal of Hospice Care

Unlike other forms of medical treatment, the goal of hospice care is not to treat the underlying condition. Having the highest quality of life for as long as feasible is the goal of hospice care.

Hospice care prioritizes decency, respect, and the requests of the patient.

The Philosophy of Hospice Care

Hospice care offers compassionate care to persons in the final stages of incurable conditions or aging, allowing them to live as fully and pleasantly as possible.

The hospice philosophy acknowledges that death is the last stage of life and honors life without attempting to accelerate or delay it. It focuses on giving options and support to the person and family so that everyone may be completely present.

Dame Cicely Saunders, who established the first contemporary hospice, mentioned, “You matter because of who you are.” Every patient deserves treatment with respect, even in the last hours.

Eligibility for Hospice Care

  • Hospice care is available to adults with terminal illnesses and a lifespan prognosis of six months or less.
  • Children and adolescents can also receive hospice care. Children are subject to different hospice service and coverage rules and regulations than adults.
  • Patients diagnosed with the conditions listed below. Still, it is not limited to those conditions: cancer, cardiovascular diseases, dementia, Parkinson’s disease, lung disease, stroke, chronic renal disease, cirrhosis, and Lou Gehrig’s disease. These conditions more frequently receive hospice care.

Where is Hospice Care Offered?

Hospice care is delivered at home most of the time, with a family member functioning as the primary caregiver—hospitals, skilled nursing facilities, outpatient care centers, and hospice institutions also offer hospice care.

There are occasions when hospital admission is necessary, regardless of where hospice care is delivered. For example, if treatment at home is unsuccessful, it can indicate that it requires hospitalization.

Types of Services Under Hospice Care

In the United States, most hospices follow Medicare regulations by delivering quality services.

  • Time and services the hospice care team provide visits to the patient’s home by the hospice doctor, nurse, medical social worker, health assistant, and counselor/ adviser.
  • They are administering prescription medications for symptom management, which include pain relievers.
  • Medical devices include hospital beds, walkers or wheelchairs, and medical supplies like oxygen, bandages, and catheters.
  • Any additional Medicare-covered services the hospice team recommends are necessary to treat the patient’s pain and other symptoms of their terminal illness.
  • Short-term hospitalization.
  • Caregiver short-term respite
  • Counseling for grief and loss

On a case-by-case basis, according to the hospice team’s assessment, the patient’s condition, the severity of their symptoms, the hospice team’s set care goals, and other factors, the following services can also be granted:

  • Occupational and physical therapy
  • Services in speech-language pathology
  • Dietary counseling

Advantages of Hospice Care

Hospice care is holistic and interdisciplinary, provided by specialists and hospice volunteers. These skilled individuals work to satisfy the requirements of the patient and any family members or private caregivers. Hospice personnel is always available when patients, family members, or personal caregivers want to support. Additionally, hospice care is accessible every day of the week, including holidays, for 24 hours.

Disadvantages of Hospice Care

The limitations imposed on the various treatment modalities represent a potential disadvantage of selecting hospice care. Finances are the main factor that hinders families from seeking hospice care. Hospice care may cause financial issues. In the United States, Medicare benefits offer a daily amount once a patient engages in this caregiving program to cover all medical costs. Another disadvantage is the disapproval of some diagnostic tests of the patients. When a patient joins hospice care, the agency providing services is now financially responsible for paying for any procedure the attending physician orders.

The Hospice Care Team

If the patient is not getting treatment at a hospice care center, one of the hospice professionals will regularly visit the patient at home or another location. Hospice care services are available every day, seven days a week, including holidays.

A hospice care team usually consists of the following:

  • Doctors. The primary care physician and a hospice physician or medical director will manage the care plan for the patient. The primary physician is their choice. A hospice physician or your previous physician could be here.
  • Nurses. Hospice nurses are responsible for keeping patients comfortable and offering treatments that prolong their lives. They organize the hospice care staff. Nurses will come to the patient’s home or another location to provide care services.
  • Home health assistants. Home health assistants can participate in routine care such as dressing, bathing, and feeding.
  • Social worker. Social workers offer guidance and support to the patient. Additionally, they can make recommendations for other assistance programs.
  • Pharmacist. Pharmacists supervise medications and recommend the most beneficial methods for reducing symptoms.
  • Volunteers. Trained volunteers provide a wide range of services, such as companionship or respite for caregivers, assistance with transportation, or other practical necessities.

Who Covers the Costs of Hospice Care?

In the United States:

  • Medicare covers most hospice patients in the United States. Provides all types of care and services and includes equivalent coverage in most states. While there may be minimal co-payment for medications and respite care, there is no deductible for hospice treatments.
  • Many privately purchased health insurance plans, such as those obtained through an employer or on a state or federal health insurance exchange, offer a hospice benefit; nevertheless, the level of hospice care and treatments they cover may vary from Medicare and from plan to plan as well.
  • Tricare provides hospice insurance to military families.
  • The Veterans Health Administration has partnerships with regional community hospice providers and provides hospice care. There is no co-pay for veterans with the VHA Standard Medical Benefits Package.

In the United Kingdom:

  • Hospice care is free for UK citizens, with the cost covered by a combination of NHS funds and voluntary contributions from the public. There are limited places available, but they can check with their local hospice to know what is available. The patient can reach out to the hospice independently, but the team will generally need a referral from a doctor or nurse.

How to Qualify for Hospice Care Services

  • A hospice doctor and a second physician (typically the patient’s attending physician or specialist) must attest that the patient meets particular medical eligibility criteria demonstrating that the life span is until six months or less than if the disease or condition takes its ordinary course. Different standards apply depending on the ailment or condition.
  • A doctor who is familiar with a patient’s medical history refers them to hospice care, and the hospice doctor then validates their eligibility.
  • Self- and family referral is an option (the patient and family may get in touch with hospice directly). However, eligibility needs to be verified by doctors before treatment can begin.

Additional Conditions to be Eligible for Hospice Care

1. Providing care in a private home setting

Receiving hospice in a private home usually necessitates the presence of a family caregiver(s) or another caregiver, who could be a friend or someone hired to offer caring services. Find out more about providing hospice care here.

2. Duration of Stay

In terms of eligibility requirements and duration of stay, hospices must comply with strict government regulations.

 Possible reasons for care modifications include the following:

  • Extensions provide hospice care through benefit periods of two 90-day intervals followed by an unlimited number of 60-day periods. Although medical eligibility generally depends on the doctor’s assessment that the patient has a life span of six months or less, neither the patient nor the doctor pays if the patient survives over six months. As long as their medical eligibility is verified, the patient may get qualified for hospice care once more.
  • If a patient’s condition starts to recover or improves enough, they may no longer be medically eligible for hospice care. The patient is “discharged” from the hospice service at that point, and their Medicare benefits resume as they had before selecting hospice care.
  • Some hospice patients may seek curative therapies, such as participating in clinical research for a new medication or treatment. To accomplish this, the patient must “revoke” their decision to receive hospice care.

Discharged patients or those who decide to stop receiving hospice care may re-enroll as long as they fulfill the medical eligibility requirements.

Hospice Nursing Diagnosis

Hospice Nursing Care Plan 1

Compromised Family Coping

Nursing Diagnosis: Compromised Family Coping related to terminal illness secondary to receiving hospice care as evidenced by the patient expressing or confirming a worry or complaint about how the SO handled their health issue, having difficulty providing care, and a change in the caregiver’s health.

Desired Outcomes

  • The patient will find the resources they need to handle the problem within themselves.
  • The patient will describe their expectations and understanding in more realistic terms.
  • The patient will handle the matter in their own way.
Hospice Nursing InterventionRationale
Evaluate the amount of anxiety in the family and/or SO.Before problem-solving can start, the anxiety level needs to be addressed. People may be too preoccupied with their responses to situations to notice the needs of others.
Create a rapport and appreciate the family’s terrible circumstances.Helps SO to be open to discussing issues with staff and to accept what is happening.
Identify the degree of perceptual, cognitive, and/or physical disability. Analyze the patient’s condition and any present habits that are obstructing the patient’s care.It will be useful to know family issues while deciding on options and creating a suitable care plan.
Keep an eye out for the patient’s emotional and behavioral reactions brought on by growing dependency and frailty.The most difficult time as a patient or family member approaches death is when their coping mechanisms are stretched, which causes them to feel more frustrated, guilty, and distressed.
Help the patient’s family and friends understand “who owns the problem” and who is in charge of finding a solution. Avoid assigning guilt or blame.Each person can start taking care of themselves and stop taking care of others in inappropriate ways once these boundaries are established.

Hospice Nursing Care Plan 2

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to terminal illness secondary to receiving hospice care as evidenced by reports of fatigue and an inability to carry out daily tasks, expression of lack of interest or lack of desire for an activity, low energy, and drowsiness.

Desired Outcomes: 

  • The patient will determine the performance-harming elements and, whenever practical, eliminate or lessen their effects.
  • The patient will adapt their lifestyle according to their energy level.
  • The patient will explain their understanding of the probable loss of ability in light of the current situation.
  • The patient will maintain or slightly improve their capacity for physical activity as shown by a manageable level of weariness or weakness.
  • The patient will stay clear of discomfort and/or difficulties that can be avoided.
Hospice Nursing InterventionRationale
Analyze the patient’s sleeping habits and take note of any changes in their thinking or conduct.Fatigue can be made worse by a variety of factors, including lack of sleep, emotional distress, medication side effects, and the development of a disease process.
Schedule activities for the patient’s most energetic times. Activities should be adjusted as needed, either by reducing the intensity or by stopping altogether.Prevents overexertion and permits some activity according to the patient’s capacity.
Encourage the patient to take care of themselves, sit in a chair, and visit with loved ones if at all possible.Gives one a sense of control and a sense of achievement.
Teach the patient, their family, or their caretaker how to conserve energy. Insist on the importance of scheduling regular rest periods after activity.Improves performance while sparing the limited energy available, preventing the onset of fatigue.
Display proper ADL execution, ambulation, or position adjustments. Determine safety concerns, such as the usage of assistive devices, bath water temperature, and keeping furniture out of the path of travel.Safeguards the patient or caregiver from harm while performing tasks.
Promote a healthy diet and the use of supplements as needed.To provide the energy needed for action.

Hospice Nursing Care Plan 3

Anticipatory Grieving

Nursing Diagnosis: Anticipatory Grieving related to terminal illness secondary to receiving hospice care as evidenced by alterations in eating habits, sleep schedules, activity levels, libido, and communication patterns

Desired Outcomes: 

  • The patient will recognize their emotions and convey them effectively.
  • The patient will maintain their normal daily routine while planning for the future and looking ahead one day at a time.
  • The patient will talk about their awareness of the dying process and their emotions of support as they go through grief.
  • The patient will discover their spiritual resources and strength to find meaning and purpose in their loss and grief.
Hospice Nursing InterventionRationale
Assist in the patient’s or family’s building of a trustworthy bondBefore the patient and/or family can feel comfortable opening up personal lines of communication with the hospice team and addressing delicate issues, trust must exist.
Determine the patient’s and/or the SO’s current stage of grief. Explain the procedure as necessary.Understanding the grieving process helps patients deal with their feelings and/or reactions more effectively by reaffirming their normality.
Create a welcoming, uncritical environment. Employ therapeutic communication techniques such as affirmation, active listening, and others.Encourages and supports frank discussion of feelings and worries.
It is advisable to express thoughts and/or worries out loud, and it is acceptable to express sadness, rage, and rejection. Recognize that these feelings are normal.The patient may feel more comfortable expressing their feelings if they realize that intense, frequently conflicting emotions are typical in this hard scenario and are experienced by others.
Be on the lookout for erratic behavior, hostility, and other acting-out traits. Limit the patient’s inappropriate behavior and refocus the patient’s thoughts.Signs of inadequate coping and the need for further therapies. The sufferer can keep control and their sense of self-worth by avoiding damaging behavior.
Inquire directly about the patient’s mental condition while keeping an eye out for symptoms of crippling sadness, declarations of helplessness, and the wish to “end it immediately.”When a patient is freshly diagnosed with an advanced disease process or after being released from the hospital, they may be particularly vulnerable. A patient may consider suicide if they are concerned about losing control or about how well they are managing their pain.
Refer to the hospice team, the visiting nurse, or a home health agency as necessary.Supports the patient and/or SO in fulfilling their physical and emotional needs and can support the care that family and friends can provide.
Identify the need for and the ideal time to take antidepressants and/or drugs for anxiety.May reduce anxiety and improve coping, especially for patients who don’t need analgesics.

Chronic Pain 

Nursing Diagnosis: Chronic Pain related to terminal illness secondary to receiving hospice care as evidenced by the report given verbally or coded, preoccupation with pain, changes in food, weight, sleep, and energy levels, and altered capacity to carry out desired tasks, protective or guarded behavior, change in muscle tone, expression of emotion (restlessness, moaning, crying, irritability), and sympathetic-mediated responses.

Desired Outcomes:

  • The patient will verbalize that the pain is reduced or managed.
  • The patient will describe the techniques to feel relieved.
  • The patient will follow the medical regimen prescribed.
  • The patient will use the recommended relaxing techniques and diversionary activities.
Hospice Nursing InterventionRationale
Identify any potential psychological or physical reasons for pain.Numerous elements that are connected to pain may interact and heighten the level of discomfort felt.
Evaluate the patient’s behavioral and psychological responses as well as their sense of pain.Identifies the patient’s needs and pain management techniques that are effective or ineffective in the past. People who have an external locus of control could be reluctant or incapable of managing their discomfort.
Encourage the patient and family to share any sentiments or worries they may have concerning drug usage.Inaccurate information about drug usage, anxiety about addiction, or oversedation may make it more difficult to manage discomfort.
Verify the use of analgesics and narcotics in the past and present (including alcohol).Could shed light on what has or hasn’t worked in the past, or it could have an impact on the therapeutic strategy.

Hospice Nursing Care Plan 5

Anxiety

Nursing Diagnosis: Anxiety related to terminal illness secondary to receiving hospice care as evidenced by a state of loneliness, loss of control, fear of death, increased hopelessness, and feelings of powerlessness.

Desired Outcome: 

  • The patient will express less anxiety verbally.
Hospice Nursing InterventionRationale
Analyze the patient’s level of anxiety, fears and worries, capacity to communicate needs, and anxiety symptoms.Gives the details required for interventions that will reduce anxiety and increase comfort.
Give the patient the option of rating their degree of anxiety as minor, moderate, severe, or incapacitating.Rating the anxiety level determines the judgment of whether anxiety levels have improved or gotten worse.
Encourage the expression of worries and inquiries on the final stages of the illness; respond to all queries honestly based on what the prognosis has been communicated to the family.Allows for the expression of emotions and fears, which lowers anxiety.
Allow a family friend to watch the child or stay with the patient when the parents are away during stressful situations.Encourages child comfort and offers assistance at moments of worry and anxiety.
Be compassionate and reassuring while remaining cool, and be there for the patient whenever they need assistance.Reduces anxiety by encouraging the child’s comfort and love.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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