General Processes

This section discusses the general processes of hospice care. The role of hospice is to deliver the most effective end-of-life care in the most efficient manner possible to all dying patients. This section defines the essential steps that need to be followed, or at least considered, in the process of caring for patients at the end of life. These steps serve as a teaching tool and reminder of the fundamental goals of patient-centered care within a larger system of health care. While there are many elements that contribute to an exceptional hospice, the interdisciplinary team is at its core. The interdisciplinary group may be composed of identical professional members as the multidisciplinary paradigm, but the role definitions are purposefully blurred and the boundaries are widely overlapping. Authority is shared, as is decision making, and innovation is encouraged wherever necessitated by patient need and circumstance. The section then outlines the clinical documentation process, which serves several important functions.

Personal, Social, and Environmental Processes

This section details the personal, social, and environmental processes of hospice care. It looks at every dimension of assessment and process of care for situations concerning abuse in the home and advance care planning and directives for health-care interventions. Moreover, the section deals with changes in body image and family dynamics and the loss of independence. It considers life closure and situations when the patient has a need to complete certain tasks before death. It also discusses misuse and abuse of controlled substances and the role of cultural differences in hospice care. Finally, this section studies situations concerning denial; grief reactions; living environment, finances, and support systems; basic home safety; and suicide prevention.

Clinical Processes and Symptom Management

This section describes condition-based clinical processes and symptom management. Shortness of breath, chest tightness, and air hunger (dyspnea) are often associated with findings of anxiety, panic, desperation, or impending doom. These symptoms are often more distressing than pain. As such, it is suggested to never delay palliative treatment for any reason. The section then explores the management of anorexia and cachexia; belching and burping (eructation); bleeding, draining, and malodorous lesions; confusion/delirium; constipation; coughing; depression; diarrhea and anorectal problems; dysphagia and oropharyngeal problems; and edema. It also looks at fatigue and weakness (aesthenia); fever and diaphoresis; hiccups; imminent death; insomnia and nocturnal restlessness; nausea and vomiting; pain; pruritus; seizures; skeletal muscle and bladder spasms; skin breakdown; urinary problems; and xerostomia (dry mouth).