ParrotHeadRN 3,482 Views
Joined: Nov 26, '02;
Posts: 153 (3% Liked)
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Thank you all so much for your words of encouragement and suggestions. As a newbie to hospice, some of the threads I've been reading have such depth that I was totally out of my league and had to reread some things several times before I could start to grasp what was being said. But at the same time, I am glad that I have just an inkling of awarenss before I actually go out into the field that my job is going to be so much more than I ever thought.
I'm still trying to wrap my brain around a "conscious death" and what really means. That is a concept I had never even heard uttered before.
I hope you experienced nurses keep up that kind of dialogue and as I grow in this field maybe someday I can join in.
I was thinking that the title of this thread is wrong, because isn't ALL of Hospice spiritual?
I've been trying to catch up on the thread about a good death and have to say I am feeling a bit overwhelmed. I can do symptom management out the wazoo, no problem, and I love to ameliorate pain and suffering. However, it didn't really occur to me that I would be tending to pain and suffering other than physical.
The simple questions that one poster posed, "will I go to hell?" "what will my death be like?" I have NO idea how to answer. I don't know that I will be able to answer. I don't have a great comfort level myself with spirituality, please don't get me wrong, I WANT to be spiritual but am not exactly sure even what I believe except that I believe in some kind of higher power and some kind of afterlife. But that's about as far as I go right now.
It's been a long term goal of mine to work with hospice, and I am so honored and proud to work for the organization that I started with, it really does have a wonderful reputation and really cares about the clients. But now I'm thinking OMG I really don't know if I should be doing this!
Then I wonder, is the spirituality I see expressed here a direct result of working in Hospice? I don't know the answer, which is why I am posting. Honestly, I dont' even know the question. I am just feeling inadequate and not sure I can serve my patients well.
My mouth actually fell open when I read that! It is so true and I never even thought of it. Having only been in the acute care setting through my nursing career, I can't tell you how much I've already learned in this first week of sitting through a hospice orientation and also reading through the hospice threads.
Hospice nurses ROCK :bowingpur
A quote from Fast Fact #20:
Opioids should be done on the basis of a percentage increase. In fact, this is reflexively done when opioid-non-opioid fixed combination products are prescribed; going from one to two tablets of codeine/acetaminophen represents a 100% dose increase. The problem arises when oral single agents (e.g. oral morphine) or parenteral infusions are prescribed.
Increasing a morphine infusion from 1 to 2 mg/hr is a 100% does increase; while going from 5 to 6 mg/hr is only a 20% increase, and yet many orders are written, "increase drip by 1 mg/hr, titrate to comfort." Note: some hospitals and nursing units have this as a standing pre-printed order or nursing policy.
In general, patients do not notice a change in analgesia when dose increases are less than 25% above baseline.
There is a paucity of clinical trial data on this subject. A common formula used by many practitioners includes:
moderate to severe pain increase by 50-100%, irrespective of starting dose mild-moderate pain increase by 25-50%, irrespective of starting dose. When dose escalating long-acting opioids or opioid infusions, do not increase the long-acting drug or infusion basal rate more than 100% at any one time, irrespective of how many bolus/breakthrough doses have been used.
These guidelines apply to patients with normal renal and hepatic function. For elderly patients, or those with renal/liver disease, dose escalation percentages should be reduced.
The recommended frequency of dose escalation depends on the half-life of the drug. Short-acting oral single-agent opioids (e.g. morphine, oxycodone, hydromorphone), can be safely dose escalated every 2 hours. Sustained release oral opioids can be escalated every 24 hours, and for Duragesic â (Fentanyl transdermal), methadone or levorphanol, no less than every 72 hours is recommended.
I took care (briefly) of a pt several years ago that had it after several doses of an ATB I can't recall. It was AWFUL. We shipped her to a burn unit VERY quickly. Her skin was just SLOUGHING off, we couldn't keep lines in her because they just slid off. She was screaming and we couldn't give her enough morphine to even touch her. The doctors taking care of her had NO idea what to do with her. At one point one of my coworkers said "her hand is degloving" and the doc just said "we expect that" and walked out. Meanwhile 3 of us were in the room trying to put silvadene dressings all over her body. It seemed all we were doing was hurting her more. By the time she left, she was screaming "just let me die!" All 3 of us (the nurses) were in tears by the time she left. The docs, of course, were long gone. It was some time ago and it's STILL fresh in my mind. HORRIFIC.
Really only one field week, even with no hospice experience?? Whoa. I've been looking at other threads and there is SO much I don't know. I hope there's someone around I can call! lol
Diane, thank you SO much for sharing that. It gave me chills.
One of my absolute favorites:
"Upon the Seashore"
I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other.
Then someone at my side says: "There, she is gone!"
Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear her load of living freight to her destined port.
Her diminished size is in me, not in her. And just at the moment when someone at my side says: "There, she is gone!" there are other eyes watching her coming, and other voices ready to take up the glad shout: "Here she comes!"
And that is dying.
-- Henry Van Dyke
Gosh it's been SO long since I posted to allnurses, although I visit all the time. I'm starting a new job Monday, as a Case Manager for the local non-profit hospice. I am SO excited. Hospice was my long term goal when I was in school, but in the mean time I found and fell in love with critical care, life got in the way, blah blah blah. But I was forced to make a career change and here I am!
Monday just starts the organization orientation which lasts for 2 weeks and then I go into the field with my preceptor. I am sure I will have tons and tons of questions as this is an entirely new field for me and a completely different focus from acute care. But I do have 2 questions:
What do you all consider to be a reasonable orientation for a complete hospice novice?
They will pay .50/mile. Is that the norm? I have nothing to compare it to and am just curious.
One of my faves is when pts come into the ER asking for "diLAHda." That happened pretty frequently. I've also had a request for diladid. I think a couple of times I actually let out a little snort.
Thank you. At least I know I'm not crazy!
I am sitting here with a fever of 102 looking for the chat link and can't find it. I realize that in my current state I might be looking right at it. Can anyone direct me to it?
Speaking as a recent ED nurse and as a mother of a child that had chronic ear infections, I just want to reassure you that you did the right thing for your child. When my son was two, he had constant ear infections and there were several times I took him to the ED, either because I couldn't get him in to see the doc or because he woke up in the middle of the night screaming in pain. No way would I have let him suffer because it might irritate the staff (which it didn't).
While I am definitely not one to run to the doc for myself, I do tend to err on the side of caution when it comes to my child. Better to be safe than sorry and I'd rather hear "There's nothing wrong with him" then "You should have brought him sooner." IMHO
You were being a good parent.
What an awesome story momster, thanks for sharing!
My baby will be 16 in a month, but of course, it's still as fresh as if it were yesterday.
I was 21, living with my parents; my (now ex) husband was a drunk and staying at the local VA center. My mother was an OB nurse and I was to deliver at "her" hospital and she said she didn't want my husband there. She really hated him. With good reason, of course!
It was a Thursday night, my mother was at work, and I was doing jumping jacks! I laugh at that girl now, but she was tired of being pregnant. Whether or not they had anything to do with it, I'll never know. Probably not. Eventually though, I do start having little twinges of pain, not really sure what they are but they are coming fairly regularly. I call my mother at work and she comes home. Not really a whole lot going on, just these fairly regular twinges. Well, more than twinges, but I'm still not sure if I'm really in labor. I went to the bathroom to pee and my water broke. Went out to tell my mother (the OB nurse!) and she freaks out! "OMG are you SURE?????" Then of course, I doubted myself so I went back to the bathroom and still had a steady leak, was pretty sure I wasn't still peeing. Back out to tell mom that yes, I'm sure. Went downstairs to the basement to get a towel to put in my underwear. Halfway down the stairs I had my first REAL contraction BAM!!!!! Stopped me in my tracks, bent me over double and then I completely understood what it means when people say "if you aren't sure if you're in labor, you aren't." What a difference, WOW.
All the while I'd been in touch with my husband and I wanted him there. So after mom and I were on the way to the hospital, I told her I wanted to stop and pick him up. She was PISSED, but she did. Well, turns out we picked him up at a bar!!!! Now, I was in labor, so wasn't really paying attention, but I remember him stumbling down a hill and my mother saying "he's drunk!" Such fun. At that point, my contractions were about 5 minutes apart and mom was more worried that I was going to have the baby in the car, so there wasn't too much said about my drunk husband.
Got to the hospital, mom started my IV, and actually gave me a fleets enema. (By that time I didn't care.) Somewhere in there I vomited. And I got a shot of demerol. Worst mistake ever. I don't remember where I was when I got to the hospital, but I got stuck at 3 cm's for HOURS literally after the demerol. And it didn't help with the contractions, it just made me sleep in between. When a contraction hit, I'd sit up, suffer through and then go right back to sleep. I do know that I did NOT want to be touched at all and the nurse kept telling my husband to rub my back. I was not ugly or rude at all, was really scared to death, and didn't say boo. Finally hubby told the nurse "I really don't think she wants me touching her!" and that stopped that for a while. I remember my father showing up at some point on Friday morning. I just woke up and there he was. By that time I didn't care who saw what, my modesty was completely obliterated. The day nurse on Friday at one point got me out of the bed and put me in a rocker. She then proceeded to massage my abdomen. OMG it was torture. But being the terrified little girl I was, I just gritted my teeth and suffered through it. I did not want to be touched at all. I know now that she was doing the right thing but wow, it was bad.
Around 3pm Friday I started transitioning. Sat STRAIGHT up in bed and said "I'm scared." Hubby was sober by then and was being good, surprisingly supportive. I remember mom and him exchanging snipes throughout the night. Anyway, he told me not to be scared, that it would all be okay. I'm guessing they checked me and found me fully dilated so they wheeled me to the delivery room while I was having a pushing contraction. They told me not to push and to let go of the sides of the stretcher so they could get it through the doors. DON'T PUSH??? LET GO???? Were they kidding??? Like I had any control over any of it by that point.
When they put me on the delivery table, they tried to put my legs up in stirrups. I remember saying "Oh no no no that hurts," and grabbing behind my thighs. Thank goodness no one tried to put my legs back in those stirrups, because I had my son out of there in less than 15 minutes. I know now it's McRobert's position, and I can't imagine how long it would have taken me if I'd had to stay in the stirrups. UGH.
So I pushed him out, he was fine, I was a nervous wreck because of mom and hubby. Mom made me cry because she said I was mean to my father because I was shy and wanted him to wait a minute before he came in while I was trying to nurse. The one ray of sunshine was my discharge nurse, Kate. I told her that mom was mad because hubby was there and she said "well, that doesn't matter as long as you were happy." I still remember how relieved and safe she made me feel at a time when I was not only post partum and hormonal but caught up in a dysfuctional family situation. I still love her for that.
Goodness this was a book, sorry! Again, awesome thread and I can't wait to read the rest!
I, too, am going to days THIS WEEK after YEARS of nights. I'm also switching to a new unit as well, so I've got lots of changes coming up. PLUS I've been doing ED for a year and this is a stepdown unit. I wonder about the pace as well and how I'm going to handle it. But days will work for my life a lot better than nights right now. That's one thing I love about nursing, the flexibility!
I work in a small 13 bed ED and at night we have 2 nurses. When we are busy, we are unable to have an appointed triage nurse, much less spare someone to do triage rounds. Whoever is not busiest at the moment will just run out to triage when the bell rings. It would be awesome if we had a nurse simply for triage at night. However, even during the day the triage nurse ends up helping out in the back when it's crazy. Which sort of defeats the purpose of a triage nurse.
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