Caring for a loved one at the end of their life can be a challenging and emotional experience. However, with the right nursing care plan in place, it can also be a time of peace, comfort, and dignity. In this article, we’ll explore the essential components of end of life care, including hospice care and nursing care plans.
What is End of Life Care?
End of life care is a specialized form of care that is provided to individuals who are near the end of their lives. This care is designed to manage physical, emotional, and spiritual symptoms and to improve quality of life for both the patient and their loved ones. End of life care can be provided in a variety of settings, including at home, in a hospital, or in a hospice.
Nursing care involves the support of the general well-being of our patients, the provision of episodic acute care and rehabilitation, and when a return to health is not possible a peaceful death. Dying is a profound transition for the individual. As healthcare providers, we become skilled in nursing and medical science, but the care of the dying person encompasses much more. Certain aspects of this care are taking on more importance for patients, families, and healthcare providers.
Hospice care provides comprehensive physical, psychological, social, and spiritual care for terminally ill patients. Most hospice programs serve terminally ill patients from the comforts and relaxed surroundings of their own homes, although there are some located in inpatient settings. The goal of the hospice care team is to help the patient achieve as a full life as possible, with minimal pain, discomfort, and restriction. It also emphasizes a coordinated team effort to help the patient and family members overcome the severe anxiety, fear, and depression that occur with a terminal illness. To that end, hospice staffs encourage family members to help and participate in patient care, thereby providing the patient with warmth and security and helping the family caregivers begin the grieving process even before the patient dies.
Everyone involved in this method of care must be committed to high-quality patient care, unafraid of emotional involvement, and comfortable with personal feelings about death and dying. Good hospice care also requires open communication among team members, not just for evaluating patient care but also for helping the staff cope with their own feelings.
Recent studies have identified barriers to end-of-life care including patient or family member’s avoidance of death, the influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided.
The best opportunity for quality care occurs when patients facing death, and their families, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.
Nursing Care Plans
During end-of-life care, nursing care planning revolves around controlling pain, preventing or managing complications, maintaining the quality of life as possible, and planning in place to meet the patient’s and/or family’s last wishes.
Here are four (4) nursing care plans and nursing diagnoses for End-of-Life Care (Hospice Care) Nursing Care Plans (NCP):
- Compromised Family Coping
- Activity Intolerance
- Pain: Acute or Chronic
- Other Possible Nursing Care Plans
Compromised Family Coping
- Compromised Family Coping
- Risk for Caregiver Role Strain
May be related to
- Inadequate or incorrect information or understanding by a primary person; unrealistic expectations
- Temporary preoccupation by a significant person who is trying to manage emotional conflicts and personal suffering and is unable to perceive or to act effectively with regard to a patient’s needs; do not have enough resources to provide the care needed
- Temporary family disorganization and role changes; feel that caregiving interferes with other important roles in their lives
- The patient provides little support in turn for the primary person
- Prolonged disease/disability progression that exhausts the supportive capacity of significant persons
- A significant person with chronically unexpressed feelings of guilt, anxiety, hostility, despair
- Highly ambivalent family relationships; feel stress or nervousness in their relationship with the care receiver
Possibly evidenced by
- Patient expressing/confirming a concern or complaint about SO’s response to the patient’s health problem, despair about family reactions/lack of involvement; history of the poor relationship between caregiver and care receiver
- Neglectful relationships with other family members
- Inability to complete caregiving tasks; altered caregiver health status
- SO describing preoccupation about personal reactions; displaying intolerance, abandonment, rejection; caregiver not developmentally ready for caregiver role
- SO attempting assistive/supportive behaviors with less than satisfactory results; withdrawing or entering into limited or temporary personal communication with the patient; displaying protective behavior disproportionate (too little or too much) to the patient’s abilities or need for autonomy
- Apprehension about the future regarding the care receiver’s health and the caregiver’s ability to provide care
- The client will identify resources within themselves to deal with the situation.
- The client will visit regularly and participate positively in the care of the patient, within the limits of their abilities.
- The client will express a more realistic understanding and expectations of the patient.
- The client will provide an opportunity for the patient to deal with the situation in own way.
Nursing Assessment and Rationales
1. Assess the level of anxiety present in the family and/or SO.
Anxiety level needs to be dealt with before problem-solving can begin. Individuals may be so preoccupied with the client’s own reactions to situations that they are unable to respond to another’s needs.
2. Determine the level of impairment of perceptual, cognitive, and/or physical abilities. Evaluate illness and current behaviors that are interfering with the care of the patient.
Information about family problems will be helpful in determining options and developing an appropriate plan of care.
3. Note the patient’s emotional and behavioral responses resulting from increasing weakness and dependency
Approaching death is most stressful when patient and/or family coping responses are strained, resulting in increased frustration, guilt, and anguish.
4. Determine current knowledge and/or perception of the situation.
Provides information on which to begin planning care and make informed decisions.
5. Assess the current actions of SO and how they are received by the patient.
Lack of information or unrealistic perceptions can interfere with the caregiver’s and/or care receiver’s response to the illness situation.
Nursing Interventions and Rationales
1. Establish rapport and acknowledge the difficulty of the situation for the family.
May assist SO to accept what is happening and be willing to share problems with staff.
2. Discuss underlying reasons for patient behaviors with family.
When family members know why the patient is behaving differently, it may help them understand and accept or deal with unusual behaviors.
3. Assist family and patient to understand “who owns the problem” and who is responsible for resolution. Avoid placing blame or guilt.
When these boundaries are defined, each individual can begin to take care of own self and stop taking care of others in inappropriate ways.
4. Involve SO in information giving, problem-solving, and care of patients as feasible. Instruct in medication administration techniques, and needed treatments, and ascertain adeptness with the required equipment.
Significant others (SO) may be trying to be helpful, but actions are not perceived as being helpful by the patient. In addition, may be withdrawn or can be too protective.
5. Include all family members as appropriate in discussions. Provide and/or reinforce information about terminal illness and/or death and future family needs.
Information can reduce feelings of helplessness and uselessness. Helping a patient or family find comfort is often more important than adhering to strict routines. However, family caregivers need to feel confident with specific care activities and equipment.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
More care plans related to basic nursing concepts:
- Cancer (Oncology Nursing) | 13 Care Plans
- End-of-Life Care (Hospice Care or Palliative) | 4 Care Plans
- Geriatric Nursing (Older Adult) | 11 Care Plans
- Prolonged Bed Rest | 8 Care Plans
- Surgery (Perioperative Client) | 13 Care Plans
- Systemic Lupus Erythematosus | 4 Care Plans
- Total Parenteral Nutrition | 4 Care Plans
1 thought on “4 End-of-Life Care (Hospice Care) Nursing Care Plans”
This helps a lot. Thanks for sharing. I use it as a tool guide to make NCP’s.