Comfort Care and Family Conflict at End of Life
Mrs. K is 88, has advanced dementia, and is enrolled in hospice. Her chart has a DNR order and a comfort-focused plan. She moans when repositioned, grimaces, and has a dry mouth; she takes only sips and has had little urine output. Her daughter says, 'Give her water even if she chokes-she's thirsty.' Her son says, 'Don't do anything; she's dying.' You are in the room during the argument, and Mrs. K is due for a repositioning.
1. What comfort measures can you provide within your role right now?
Read the worked answer
Focus on comfort, not on forcing food or fluid.
- Provide mouth care: moist swabs, lip balm, and gentle cleaning; a dry mouth is distressing even when the resident cannot drink.
- Reposition gently and slowly; use pillows for support and avoid pulling on fragile skin.
- Reduce noise and light; keep the room calm and private.
- Report grimacing and moaning to the nurse as possible pain or discomfort; do not assume it is 'just dying.'
- Do not force water, food, or ice chips if there is a choking risk; follow the hospice plan.
Reasoning: In hospice care, comfort and dignity are the goals. Forcing fluids can cause choking, discomfort, and fluid overload without improving comfort.
2. How should you respond to the family disagreement?
Read the worked answer
Do not take sides; get the nurse or social worker involved.
- Acknowledge both family members: 'You both want what is best for her, and you are seeing this differently.'
- Explain that the plan is comfort-focused and that you cannot decide about fluids; the nurse or hospice team can talk with them.
- Do not argue, do not promise to give water, and do not say the son is right or the daughter is wrong.
- Call the nurse to speak with the family; ask the social worker or chaplain to visit if available.
- Continue comfort care in the room while the family talks.
Reasoning: Family conflict at end of life is common and emotional. The CNA's role is to support the resident, report, and refer, not to mediate a treatment decision.
3. What will you report and document?
Read the worked answer
Document what you observed and who you notified.
- Grimacing and moaning with repositioning; dry mouth; very low urine output; sips only.
- Daughter requested water even if choking; son said not to do anything; exact words if possible.
- Comfort measures provided: mouth care, gentle repositioning, quiet environment.
- Nurse notified and asked to speak with family; social work or hospice referral requested if made.
- Do not document opinions about which family member is right.
Reasoning: Objective documentation helps the team address pain, family needs, and the comfort plan. It also protects the aide from being pulled into a family dispute.