A hospice nurse asked if we, the medical caregivers, should be taking scheduled or frequent blood pressures when caring for someone whose end of life is approaching. That question made me think about how tuned into medical procedures we healthcare workers are. Blood pressures, lab work, pulse, respirations, and temperature — all routinely taken and recorded.
My answer is NO we do not need to take a blood pressure (or any of the other routine medical procedures) every visit, and particularly when the active, imminent dying process has begun.
What are we going to do with that knowledge? What can we do? What will it tell us that we don’t already know? This person is actively dying. Other more important signs tell us that death is approaching: congestion, changes in breathing, awareness level, a weak pulse, or mottling - a discoloration of hands and feet. Those signs tell us what we need to know about the patient’s condition. Who needs the blood pressure?
As death approaches, taking a blood pressure is one more unnecessary intrusion for the patient and for the family. Will what you learn affect anything? Are you going to do anything about it? NO. Will taking a blood pressure bring comfort and relieve fear? NO.
With today’s emphasis on time management and visit length, let's use the time and contact with the patient and caregivers to address everyone’s fear, to give them guidance on how to support their person. Our work is beyond medical procedures. Our work is to comfort. It is reassurance that nothing bad is happening.
Words, time, support, and reassurance are the medicines and procedures that are appropriate as death approaches.
Something more about… Stop Chasing Vitals. Start Comforting.
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2 comments
Myrtle Cardwell Lvn
Good information
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BK Books replied:
Thank you, Myrtle. Blessings! Barbara
Good information
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BK Books replied:
Thank you, Myrtle. Blessings! Barbara
Paula Schneider
In my hospice career, I worked for three different hospices. In the one that was not associated with a hospital, we were not expected to take any vital signs ever. In the two that were associated with a hospital, we were expected to take vital signs at every visit. It obviously was not a Medicare requirement and so I concluded that it was perhaps a joint commission requirement. I never was sure about that, but I had to do as I was told. I found out that the patient’s family are usually the ones who want the vital signs taken. It was such an exercise in futility, for as you said so wisely, it wasn’t going to make any difference one way or the other.
My own personal experience with being with my husband as he was making his transition was that an hour before he stepped through the veil into the next world, his blood pressure was taken (not by me, but by a nurse friend who wanted to have it done) and his oxygen level was checked by oximeter. I will never understand this, but both were completely normal. I remember turning to my nurse friend and just looking at her in amazement. An hour later he slipped through the veil.
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BK Books replied:
In my hospice career, I worked for three different hospices. In the one that was not associated with a hospital, we were not expected to take any vital signs ever. In the two that were associated with a hospital, we were expected to take vital signs at every visit. It obviously was not a Medicare requirement and so I concluded that it was perhaps a joint commission requirement. I never was sure about that, but I had to do as I was told. I found out that the patient’s family are usually the ones who want the vital signs taken. It was such an exercise in futility, for as you said so wisely, it wasn’t going to make any difference one way or the other.
My own personal experience with being with my husband as he was making his transition was that an hour before he stepped through the veil into the next world, his blood pressure was taken (not by me, but by a nurse friend who wanted to have it done) and his oxygen level was checked by oximeter. I will never understand this, but both were completely normal. I remember turning to my nurse friend and just looking at her in amazement. An hour later he slipped through the veil.
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BK Books replied: