Pain
This type of pain results from damage to body tissues and is often described as aching or throbbing.
What is nociceptive pain?
When a family asks, “How much time do they have?” a helpful response starts with this.
What is acknowledging uncertainty and focusing on signs of change?
A palliative resident becomes increasingly short of breath at rest. Vitals are stable, and O₂ is already in use. What medication might be given to ease their sensation of breathlessness?
What is low-dose morphine or hydromorphone?
This principle means treating each resident with respect, honoring their choices, and protecting their sense of self.
What is dignity?
Nurses can support families by preparing them for this phase, which includes signs like mottling, irregular breathing, and less responsiveness.
What is the active dying phase?
This class of drugs is the cornerstone of moderate to severe pain management in palliative care.
What are opioids?
When speaking with a demanding family member, this type of body language shows you’re engaged and respectful.
What is open and non-defensive body language?
A family is upset that their father is not eating or drinking. You assess the resident and find they are actively dying. What would be an appropriate response?
What is to explain that loss of appetite is a natural part of dying, and forcing food or fluids can cause discomfort?
Allowing residents to make these—even small ones, like choosing music or clothing—supports autonomy and dignity.
What are choices?
When a family asks about suffering, it is helpful to explain this concept and how it's managed.
What is total pain (physical, emotional, spiritual) and the comfort measures in place?
This tool is commonly used to assess a patient's level of pain.
What is ESAS or PAINAD?
When a family is in denial about the resident’s decline, the nurse should respond with this kind of approach.
What is a gentle, compassionate, and honest approach?
A resident nearing end of life is gurgling with noisy breathing. They are unconscious and not in distress. What is your next best action?
What is administer PRN scopolamine or glycopyrrolate and reposition the resident?
Families often feel helpless. Inviting them to do this (e.g., read, sit close, offer gentle touch) can support both them and the resident.
What is participate in care or presence?
This kind of team meeting can help align goals of care and reduce confusion or conflict between staff and families.
What is a family care conference or goals-of-care meeting?
This term refers to medication given regularly to maintain baseline pain control.
What is an around-the-clock (ATC) dose?
Nurses can prevent some conflicts with families by doing this regularly, especially around changes in a resident’s condition.
What is proactive communication or early updates?
A family member insists on giving their mother water, but the resident is choking and cannot safely swallow. What should the nurse do?
What is explain the risk of aspiration and suggest comfort measures like mouth swabs?
This care planning process involves talking about the resident’s goals, wishes, and what matters most to them.
What is advance care planning or goals-of-care discussions?
This is a key phrase to avoid when discussing dying, as it may sound abrupt or insensitive.
What is “There’s nothing more we can do”?
This is the fast-acting medication given to treat sudden episodes of pain despite regular pain control.
What is breakthrough pain medication (or PRN)?
When a family repeatedly asks for things outside of what’s reasonable or policy, a nurse should set these respectfully.
What are boundaries?
A resident’s daughter is angry and accuses the staff of “giving up.” The resident is clearly dying and non-responsive. What is a therapeutic way to respond?
What is acknowledge her emotions, validate her grief, and explain that the team is focused on providing comfort?
Preserving hope at the end of life may include helping the resident do this—such as creating a legacy project, writing letters, or saying goodbye.
What is find meaning, closure, or leave a legacy?
A family says, “You’re giving up on Mom!” An appropriate response would be to clarify this goal of care.
What is comfort-focused or quality-of-life care?