Practitioner nurses have the responsibility of recognizing a patient's signs, administering medications, offering symptom alleviation measures, collaborating with other healthcare givers to help a patient nearing their end of life's understanding, adaptation, and comfort. Hudak & von Gunten (2016) explained that the practitioner nurse also has the role of encouraging family engagement and patient in decision making that entail giving directives in line with the patient's preferences. The nurse has the primary responsibility of helping the family identify surrogates as per any agreements made earlier or the patient's condition ( Odejide, Uno, Murillo, Tulsky & Abel, 2019) . The practitioner nurse is mandated to enhance the incorporation of evidence-based care as per the conditions of the end of life care. Other significant roles include supporting clinical expertise and certified development which is designed to offer compassionate, dignified, and excellent end of life care ( Hudak & von Gunten, 2016) . With the difficulty that comes with a patient's death, a nursing practitioner has the duty of providing ad integrating palliative care services as required by the patient's family members.
Approaching a Family Who requires Hospice Care
Family, in this case, refers to anyone close to the patient nearing their death in affection, care, and knowledge. They include all biological and natural family members. For a family who wants everything to be done to them and has limited time, the best approach is emotional and practical support, and this includes social/cultural, emotional/practical, spiritual, and physical/environmental support ( Oberoi-Jassal, Pope & Jassal, 2019) . For such a family, communication is an essential thing; updating them on all aspects of care they need. Three levels of care and involvement are critical for the family, and this will entail participation in care, communication, and facilitating family gatherings. Schneiter, Karlekar, Crispens, Prescott and Brown (2019) argued that clear decision making is mandatory for the nurse that will involve collaborative and regular updates on all activities about the patient. On the involvement of care, family members should be updated on all issues about the patient with precise arrangements on how to make visits. The nurse should develop a shared approach for the dying person ( Oberoi-Jassal et al., 2019) . An enabling environment should also be created that allows for physical care requirements, communication, and close collaboration on the involvement of care with other healthcare professionals. Having full responsibility for a dying patient is involving and requires utmost dedication from the nurse ( Schneiter et la., 2019) . When death is nearing, it is essential to inform the family members so that they do not miss the opportunity to communicate with the dying patient.
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Best Time to Involve Hospice Care
Hospice care is offered by a team of health professionals to a dying patient who is nearing death. The primary aim of hospice is to comfort the sick patient and help the family members by providing practical support, respite care, and counseling. Hudak and von Gunten (2016) stated that the goals of hospice are to give support to the best of the remaining life and within the limited time available. The best time to introduce hospice care is when all the options of treatment have been exhausted, and there is little that can be done for the patient.
Dealing with Patients and Families who refuse Hospice Care
Patients and families refuse hospice care for various reasons, and this is never a strange occurrence. It is very critical for the healthcare giver to understand the position of the patient and family at such times ( Nickolich, El-Jawahri, Temel & LeBlanc, 2016) . When a nurse is faced with a family and or patient who refuse hospice care, it is important to listen attentively to what they say. Hudak & von Gunten (2016) maintained that the nurse should never judge, argue, or persuade them. It is after that, important to listen to their reasons for not wanting hospice care. Listening and understanding are very important at this juncture. It is then that the nurse validates the families and patient's emotions and should not rush them to making a decision. The nurse should then offer reassuring, professional knowledge and facts about hospice care. Reassuring facts such a hospice care increasing longevity of life is essential for the family and patient ( Oberoi-Jassal et al., 2019) . The nurse should then organize for a hospice professionals to meet the family and patient. The hospice team often provides reassurance on what hospice care entails from an expertise point of view. At this juncture, the nurse should share the patient's concerns and give all the support needed. At the end of the discussion, it is essential to respect the wishes of the patient and family while at the same time, give them alternatives ( Hudak & von Gunten, 2016) . It is important to note that hospice care very crucial and, in many cases, provides patients and family members positive results with long life to the patient. A patient should not be pressurized into the idea of hospice care.
Choosing Hospice Care
Most patients who initially refuse hospice care end up choosing and loving it. The family is also, on many occasions; end up appreciating and enjoying the whole plan of hospice care to their loved one. Hospice care is never about lost hope, and should always be viewed as care that is full of hope and second chances in life ( Hudak & von Gunten, 2016) . Discussion with loved ones should take a more optimistic approach when everyone is in good spirits and health with grand plans of planning. In planning for the discussion, it is essential to involve all members of the family and emphasizing to them that it is necessary to discuss to help in making informed choices. The entire discussion should be structured key among them is the significance of hospice, and the part played by the family, patient, and the hospice staff.
Discussion with Family
During the meeting, it is crucial to avoid all distractions; turn off the television, mobile phone, and anything that may cause a disturbance. All through the discussion, it is vital to choose the right words, speak carefully, and clearly ( Oberoi-Jassal et al., 2019) . The hospice staff should listen very keenly and often use encouraging worlds. The most important aspect of the meeting and discussion is to reassure the family and patient that they will get all the support from the healthcare professionals that include the nurses, physicians, and hospice staff.
References
Hudak, C. D., & von Gunten, C. (2016). “The Talk:” Discussing Hospice Care. Current oncology reports , 18 (7), 46.
Nickolich, M. S., El-Jawahri, A., Temel, J. S., & LeBlanc, T. W. (2016). Discussing the evidence for upstream palliative care in improving outcomes in advanced cancer. American Society of Clinical Oncology Educational Book , 36 , e534-e538.
Oberoi-Jassal, R., Pope, J., & Jassal, N. (2019). Hospice Care. In Pain (pp. 937-939). Springer, Cham.
Odejide, O. O., Uno, H., Murillo, A., Tulsky, J. A., & Abel, G. A. (2019). Goals of care discussions for patients with blood cancers: Association of person, place, and time with end ‐ of ‐ life care utilization. Cancer .
Schneiter, M. K., Karlekar, M. B., Crispens, M. A., Prescott, L. S., & Brown, A. J. (2019). The earlier the better: the role of palliative care consultation on aggressive end of life care, hospice utilization, and advance care planning documentation among gynecologic oncology patients. Supportive Care in Cancer , 27 (5), 1927-1934.
