Latest Comments by MunoRN

Latest Comments by MunoRN

MunoRN 26,420 Views

Joined Nov 18, '10. Posts: 7,255 (68% Liked) Likes: 17,232

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  • 1
    elkpark likes this.

    Quote from MrNurse(x2)
    On the surface, the need for crowdfunding seems distasteful. Ask yourself why. We have 60 years of expecting the government to care for us, we have also lost our sense of community. There should be no welfare system in this country if we all would just have empathy, it is something that was much more abundant in the early 20th Century. We have become a selfish society, and crowdfunding has become the glimmer of humanity in a pretty dark place. Then the author decides to play the have/ have not card, so progressive of her. In my area there are constantly jars at convenience stores, raffles, auctions and bingo for those who "have no access to technology", and these efforts normally are sufficient. For those who want to fault our health care system, be aware we have single provider health care, it's called the VA, and we all know what happened in the last few years. Much more direct and efficient for community to solve a problem than government.
    I would assume this isn't really what you mean, but are you really suggesting jars at convenience stores and bingo would be a viable way to pay for our health care? How would that work? When someone shows up in the ER having a heart attack, would they then have someone put a donation jar on the counter at a convenience store and wait until it can cover their heart cath or OHS?

    The VA is actually a very good example of why paying what we feel like paying towards healthcare doesn't work. Unlike Medicare, the VA is not funded based on what it takes to provide healthcare to the people it covers, it's funded based on what Congress feels like paying, which is generally far less than what it costs to actually provide healthcare to everyone the VA covers, and you're right, that doesn't work very well.

  • 0

    There actually not much agreement that SCD's are contraindicated in a current DVT, so it would sort of depend on what view the ordering MD takes on the subject.

    It used to be thought that patients with DVT's should be on bedrest, this was not based on any actual evidence. Multiple studies have shown that bedrest does not prevent complications in the treatment of DVT and actually does the opposite, so as it turns out patients with DVT should not only be allowed to ambulate, but should be encouraged to do so.

    Since the basic purpose of SCD's is to mimic the effect of walking on venous flow, they were considered contraindicated with current DVT when we used to think that ambulation was contraindicated. The best way to treat DVT is to prevent it, and patients a hx of DVT are at an established risk for developing a new DVT and therefore are the most important patients to either ambulate regularly or apply SCD's to.

  • 0

    I've found this to be a good source for comparing and shopping for available plans, it's sort of like Kayak.com but for health insurance:
    Health Insurance

  • 0

    Quote from steti1221
    I literally turn the pt. on their hip... none of this pillow under the back and "they are on their side" it doesn't relieve anything.... I turn them, pillow in upper back, THEN i slide my arm closest to the upper half under their hip, my other arm over them and pull their lower half back... this puts them in a V shape....it's a bit difficult on larger pt and takes pratice because it can REALLY hurt your back if not done properly, but it's most effective....
    then pillow between the knees..
    You can fold the pillow under the back to hold them up if needed....
    Using a pad to help turn them on their hip, is sometimes helpful, just make sure you don't pull the pad and not them lol....

    Hope my imaginary example makes sense
    The general goal of pressure ulcer prevention is to even distribute the patient's weight as evenly as possible over the available body surface, which means avoiding focusing the patient's weight on a single bony prominence, which is putting the patient directly onto their hip in a full side lying position should be avoided or at least used sparingly.

  • 1
    srercg likes this.

    The term "client" had been around in some settings for a while, then around the year 2000 a work group with the ANA recommended that we use the term "client" as a general replacement for "patient". It was only after this switch that they actually studied the effects of this terminology and as a result they quickly reversed their recommendation, although by that point it had already made it into textbooks and general academia and there was no turning back.

    The term we use to refer to someone indicates how we view that person and our relationship with that person. "Client" refers to a participant in a financial transaction or business relationship, while "patient" refers to someone in a therapeutic relationship. As it turns out, patients don't generally like to be seen as a source of revenue, they prefer to know that we see them as someone in need of nursing care.

  • 1
    Anonymous865 likes this.

    Quote from Pangea Reunited
    I would imagine those percentages vary greatly by hospital/region/unit, etc. I would bet my life that nowhere near 83% of the patients I work with are paying for anything.
    Quote from OldDude
    Haha...take another drink of the koolaid...our local pedi hospital get 96% of it's income from medicaid...
    I'm not sure how being on medicaid is equated with not paying anything at all towards healthcare. The vast majority of those on healthcare have at least paid into medicaid in the past and the majority are currently paying into medicaid since the majority of medicaid recipients work.

  • 21
    SnowShoeRN, tcvnurse, val421, and 18 others like this.

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • 1
    toomuchbaloney likes this.

    Quote from tntrn
    You mean you think having your taxes increase by thousands each year is a good thing?
    I don't generally support Sanders, but as to your question; my family's tax would go up by about $10k/year, yet that would go to replace my private insurance plan that I pay $15k/year for, among other things. So why wouldn't I want to pay $10k more in taxes to save $15k + in other costs?

  • 12
    val421, Conqueror+, canoehead, and 9 others like this.

    If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.

  • 4
    Zelda, RN, jdub6, Altra, and 1 other like this.

    There are certainly some nursing environments where teamwork just doesn't ever happen, but for the most part in my experience nursing is a team sport, in which case other nurses aren't only allowed but often expected to look up basic info on patients in their vicinity since it's quite likely they will be involved in the patient's care in one way or another; either assisting in direct care or collaborating with the assigned nurse in some way.

  • 5
    LTCNS, iShaybie, NutmeggeRN, and 2 others like this.

    Is she a meth dealer or a former meth dealer? You refer to her as a convict but describe her has an ex-convict.

  • 6
    srercg, exhaled, PMFB-RN, and 3 others like this.

    Quote from mushyrn
    My feelings about the BSN as entry haven nothing to do with someone who is already a nurse and working. I am talking about the FUTURE. Where do we want our profession to go?

    If we want to legitimately be considered as a "profession", we CANNOT continue to degrade further nursing education and courses. We cannot degrade those wanting a higher education level. A bachelors degree is the MINIMUM, repeat, MINIMUM entry to practice in any other profession that is respected and in high esteem. This is the present and the future.

    Again, I AM talking about the first time college students who are entering the nursing profession. It should be a BSN entry only going forward. It shouldn't be some trade job that requires 15 months of training. We may as well be plumbers (not that anything is wrong with plumbers, but we should aspire for more). I don't see why people are so against this.
    An ADN isn't 15 months or a vocational degree, thus the term "LVN" (V=vocational). Things were different 20 or so years ago, but currently ADN programs, either through competitive necessity or state mandate, use a curriculum that is comparable to BSN curriculum, and both include about a year of pre-reqs and 2 years of program. What ADN's lack compared to BSN's is about a year's worth of general electives (art history, etc), and it's doubtful this translates into measurable differences in patient outcomes.

    The ADN program in my area has used previous bachelor's degrees as an admission criteria, and has had so many applicants with previous degrees that now it's a requirement for application. In my BSN program not a single student had a previous degree, so if more education should always be the requirement then why are we allowing BSN's with no previous degrees to practice on a level equal to multi-degree ADN grads.

    I think there's broad agreement that what quality education for nurses, and this is the main reason why BSN-as-entry to practice hasn't become the established standard, it would degrade the quality of nursing education. We know one of the most important determinants of quality nursing education is clinical availability, moving our nursing student capacity to BSN programs would only move us backwards in terms of quality of educational experience. What makes more sense is to spread out clinical demands to broader areas that can better support those demands, and move BSN curriculum to those programs, which is what is already happening, so what else should change?

  • 18
    val421, cayenne06, LARPingRN, and 15 others like this.

    I think once the argument is focused on who's "fault" it is and what counts and doesn't count a fall to blame someone for then the process has failed. What the focus should be is to how best care for the patient, and just leaving them in bed because there's no chair alarm isn't what's best for a recovering ICU patient. It may not seem like it, but chair time is essentially a work-out for a patient recovering from a critical illness, and research shows improved outcomes for patients who get two periods of chair time per day. All efforts should be made to avoid preventable falls, but you still have to take into account what's best for the patient overall.

  • 7

    At every place I've worked we don't withhold any treatments or other medical care that the patient is still consenting to just because they decline a particular recommendation. If an ED is a CMS participant, which the vast majority are, then they are required to follow the Federal Patient Bill of Rights which requires that patients who refuse any treatment or recommendation not be punished by withholding other aspects of care. You can certainly withhold treatments, medications, etc that would no longer be safe given a particular refusal, ie a patient who doesn't want their BG checks but wants the high end of their sliding scale insulin. Ideally, if a physician does chose a "my way or the highway" view of things then nursing staff are there to advocate for basic nursing principles, including that a patient's plan of care must take into account the patient's views, including what they want and don't want.

    We handle an AMA discharge just like any other, even if it's the patient initiating the discharge rather than the physician, the physician still writes for discharge meds, they dictate a discharge summary, etc.

  • 0

    Quote from juanitarn
    I think marijuana is a crutch. I hate to think I am being cared for in the hospital by persons who need a crutch. Marijuana is not only illegal in most states it is psychologically additive. A well adjusted person does not need a mind lifting drug. I am against the use of marijuana in all cases especially by persons who are supposed to be mirroring good health practices to help create healthy individuals in our care.
    If anything that can be described as a "psychological addiction" (as opposed to a physical addiction) is a "crutch" that should prevent someone from being a nurse, then I'm not sure who would be left to still be nurses.

    I'm psychologically addicted to mountain biking and skiing, if I can't do one of those things at least once a week then I get irritable, anxious, preoccupied, distracted, etc. Same goes for reading in bed before going to sleep, as I discovered with our first child and the "no lights on" in the bedroom rule that came with her. Because of my issues with using these "crutches" am I unfit to be a nurse?


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