1. Vital Signs in the dying are not vital
Emily K. Blau
Arizona State University
([Photograph of sick man], n.d.)

2. Background and Significance
Obtaining a standard set of vital signs in dying patients is not only unnecessary it is not comfort
The goal of hospice
at the end of life
is comfort!
([Photograph of dying woman], n.d.)

3. A standard set of vital signs include
Blood Pressure
Temperature
Pulse Rate
Oxygen Saturation Level
Respiration rate
Optional observational/less invasive signs include
Urinary output
Appetite and thirst level
Changes in level of consciousness
Quality of respirations and skin color
Gentle tactile assessment of skin temperature and pulse

4. PICO(T) In hospice patients during their final weeks of life
does obtaining vital signs
using the standard process compared to
collecting observation “vital signs”
more accurately predict eminent death?

5. Methods of Research Medline PubMed Article 1: Resulted in 3 articles

6. Statistics of hospice patients at the end of life
Article 1 with Appraisal
Statistics of hospice patients at the end of life
STANDARD
Only 36% of patients had a significant drop in blood pressure
Only 36% had a temperature >99.6
82% were refusing to eat or drink
91% had an apical pulse of >100
73% were non-verbal
73% had shallow or labored respirations some with long periods of apnea
64% had blank stares
64% had a decrease in urinary output
OBSEVATIONAL or LESS OBTRUSIVE
Lindley-Davis (1991)

7. “The findings of this review support the explicit recognition of
Article 2 with Appraisal
“The findings of this review
support the explicit recognition of
‘uncertainty in diagnosing dying’
and the need to work with and
within this concept.
Clinical decision making needs to allow for recovery where that potential exists,
but equally
there is the need to avoid futile interventions.”
(Kennedy et al., 2014)

8. In the last weeks/days you may see:
Application
In the last weeks/days you may see:
Sleeping upwards of 23 hours a day
Dysphagia
Dysphasia
Change in quality of respirations
Increase in pallor
Eyes and mouth remaining open
Cyanosis
Tearing
Mottling on feet, knees and thighs
Cold hands, knees and feet
Waxy appearance
Diaphoresis
Terminal congestion
Terminal restlessness
Delirium
([Photograph of a man with dog], n.d.)
“… part art, part science and is often regarded as a skill of individuals
rather than an objective assessment
of signs and symptoms.”
(Kennedy et al., 2014)

9. More research is needed for the best ways to educate and guide
the thinking
of health care workers, patients and family members
in regards to the unnecessary tasks that are performed at the end of life…
and the many reasons to avoid them.

10. Vital Signs in the dying are not vital!
Are you still interfering in your patient’s sacred journey
at the end of life to obtain their vital signs?
Blank stare
Terminal
congestion
Decreased
urine
Circumoral
cyanosis
Tearing
Cold hands,
knees and feet
Delirium
Dysphagia
Dysphasia
Increased
pallor
Mottling on feet,
knees and thighs
Diaphoresis
Apical pulse
>100
Change in quality
of respirations
Refusing to
eat or drink
Eyes and mouth
remaining open
Sleeping upwards
of 23 hours a day
Sleeping upwards
of 23 hours a day
Terminal
restlessness
([Photograph of couple], n.d.)
Vital Signs in the dying are not vital!
For patient comfort use less obtrusive signs to diagnose pre-imminent death.
Evidence Based Practice Alert!
Kennedy, C., Brooks-Young, P., Gray, C. B., Larkin, P., Connolly, M., Wilde-Larsson, B., ... Chater, S. (2014, June 14). Diagnosing dying: An integrative literature review. BMJ Supportive & Palliative Care,
Lindley-Davis, B. (1991). Process of dying: Defining characteristics. Cancer Nursing, 14,

11. References
Kennedy, C., Brooks-Young, P., Gray, C. B., Larkin, P., Connolly, M., Wilde-Larsson, B., ... Chater, S. (2014, June 14). Diagnosing dying: An integrative literature review. BMJ Supportive & Palliative Care,
Lindley-Davis, B. (1991). Process of dying: Defining characteristics. Cancer Nursing, 14,
Nursing Practice (p. 106). Elsevier Health. Kindle Edition
Lusk, J. M., & Fater, K. (2013). A Concept Analysis of Patient-Centered Care. Nursing Forum, 48(2), doi: /nuf.12019
[Photograph of couple]. (n.d.). Retrieved from X&ei=SyS2U7zpI8X1oASnyIKYDA&ved=0CBwQsAQ&biw=1366&bih=624#facrc=_&imgdii=_&imgr c=W4RcsZycimcQzM%253A%3BhbCwKhtLJdQKBM%3Bhttp%253A%252F%252Fgraphics8.nytim es.com%252Fimages%252F2012%252F02%252F24%252Fscience%252Fvideo-frontal-lobe- alzheimers%252Fvideo-frontal-lobe-alzheimers- articleLarge.jpg%3Bhttp%253A%252F%252Fwww.nytimes.com%252Fhealth%252Fguides%252Fdis ease%252Falzheimers-disease%252Frisk-factors.html%3B600%3B338
[Photograph of dying woman]. (n.d.). Retrieved from ei=rvm1U8SQNc3woATNnoKYAQ&ved=0CBwQsAQ&biw=1366&bih=624#facrc=_&imgdii=_&imgr c=8z597sf_nCLUDM%253A%3BN4OpbHHfbkCAcM%3Bhttp%253A%252F%252Ftheprofileclub.ne t%252Fza%252Fwp-content%252Fuploads%252F2014%252F02%252Ftop5regrets- 150x150.jpg%3Bhttp%253A%252F%252Ftheprofileclub.net%252Fza%252Fthetop-37-things-dying- people-say-they-regret-learn-from-it-before-its-too-late%252F%3B150%3B150
[Photograph of magnifying glass]. (n.d.). Retrieved from different-association-terms- vector-illustration.html
[Photograph of man with dog]. (n.d.). Retrieved from content/uploads/2011/06/kcrg-dying-man-final-wish-400x295.jpg
[Sick man electronic photograph]. Retrieved April 10, 2014 from: G0SjQ1jojl.jpg