Shane this is very normal. Unfortunately I lost a friend to cancer earlier this year. And sadly she was aware to the end, tough very tired as her body was shutting down. I would tell your brother to stay if at all possible, it sounds like the nurse is right. Usually a drastic change like that tells us its time for her to go and generally it happens within a few days. I'm surprised there is no in house hospice available, is she on medication for pain? The confusion is normal as she's likely not getting any nutrition and minimal fluids unless she has an IV. God bless.