Content That ixchel Likes

Content That ixchel Likes

ixchel, BSN, RN 42,852 Views

Joined Jun 3, '11. Posts: 5,158 (75% Liked) Likes: 19,713

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  • Sep 17

    Quote from LadyFree28
    Keep posting palliative care information! Your posts are very valuable in terms of making those who don't specialize but encounter end of life issues have extra tools in the nursing toolbox!

    Thanks for letting me know that you find those posts helpful!
    I am invested in re-integrating palliative care into primary bedside nursing and want bedside nurses to have the tools they need to provide end -of - life care. We will see much more of that in the future as our population ages and lives longer (not necessarily with more quality of life though...).
    The other day I thought about a palliative care round up once in a while here for nurses who want to stay up to date in all things palliative and hospice.

  • Sep 17

    LadyFree, I think you are awesome. You and I have much in common. I'm worried about you because of the giant banner at the top of our page.

    Know that I admire you and enjoy your posts. I'm glad you got to post this.

  • Sep 17

    Quote from nutella
    I learned why so many projects fail how to initiate and start projects with all the science that is actually present. I also learned how to calculate costs /budgeting for projects, stakeholder management. Now that I have more solid knowledge about how to really plan and execute a project I hope to use that for some quality improvement project I am planing.

    I learned that there are still physicians out there who believe that palliative care is only appropriate "when the patient is ready and there yet" - meaning basically 2 days to live. Never mind that it is not the same as hospice care and focuses on prevention of suffering, increasing the quality of life in serious illness, and tries to help patients to align the goals for care/care plan with their values and wishes.
    And - how is it beneficial to say "Hi - the doctor told you that you have 2 days to live - what are your wishes and goals?"

    When talking about serious illness a conversation method that is not so much focused on the medical detail but on the patient values and goals is more effective and the rest will usually follow. But - those conversations need to happen earlier in the disease, more, and better according to the research from the Ariadne Lab

    Clinicians learn how to talk to patients about what matters most and be change agents for better care | Ariadne Labs

    If you have time and are interested in child birth /maternal care or improvements in surgery or end-of-life care check out their webpage !
    Their training and workshop has transformed the way my team approaches serious illness conversations.
    We started to use this conversation guide for those conversations though have to adapt it for acute care as patients may be sicker and in crisis :

    Redesigned Serious Illness Conversation Guide supports more, better and earlier conversations about what matters most | Ariadne Labs

    What was especially important for me to learn is that there is a huge difference between saying "I am concerned" (more of a medical jargon) and "I am worried about you / I am worried that your time might be shorter than you think it is" (empathy and emotion focused). I learned that the effect is different. I had a hard time to say " I am worried" - it does take away some distance and signals that something serious is going on plus a person cares.

    And I would like to also put out that as palliative care team we do not see a patient with a set agenda. I learned that a lot of healthcare workers still think that our job is to "make that patient DNR/DNI" or "make that patient CMO" or that if a person has not changed their mind about their code status to what the nurse thinks is the "right code status" for patient after seeing palliative care I have not achieved anything. There is no set agenda!!! The goal is to explore the goals and values, discuss what is going on, what is important, identify palliative care needs, sometimes symptom control. If it also happens that somebody decides to change code status fine but if not that is also ok. People need time to process things.

    I learned that due to my age fitness kickboxing is pushing it at times... as a martial artist I like the fitness kickboxing stuff because I do not have time to focus on martial arts right now and I am too old now for any sparring or competitions. The fitness aspect is great though and I have gained back a lot of strength and mobility. Not to mention that exercise is good to relieve stress.

    I have signed up for American Sign Language to build some basic vocabulary. I probably wrote already some while ago that the appropriate pain scale to use in non hearing patients is usually Wong Baker.

    Looks like most of my writing is related to palliative care (again).
    Keep posting palliative care information! Your posts are very valuable in terms of making those who don't specialize but encounter end of life issues have extra tools in the nursing toolbox!

  • Sep 17

    Quote from OrganizedChaos
    I don't know if I want to get back into nursing in the future. I didn't renew my license & I don't know if I want to. I have awhile to decide but the thought of working at a job I hate or going back to school is just so unpleasant.

    Any input would be appreciated.
    Don't let your license lapse, please Cheerios!

    Please. You never know.

    *hugs*

  • Sep 17

    Quote from OrganizedChaos
    I don't know if I want to get back into nursing in the future. I didn't renew my license & I don't know if I want to. I have awhile to decide but the thought of working at a job I hate or going back to school is just so unpleasant.

    Any input would be appreciated.
    I think at least keeping your license active while not working is a better advantage to letting for lapse.

    You are also in a position where you are about to bring another life into the world; once they start school and are settled into their studies, you may find yourself at the kitchen table too doing homework.

  • Sep 17

    I learned why so many projects fail how to initiate and start projects with all the science that is actually present. I also learned how to calculate costs /budgeting for projects, stakeholder management. Now that I have more solid knowledge about how to really plan and execute a project I hope to use that for some quality improvement project I am planing.

    I learned that there are still physicians out there who believe that palliative care is only appropriate "when the patient is ready and there yet" - meaning basically 2 days to live. Never mind that it is not the same as hospice care and focuses on prevention of suffering, increasing the quality of life in serious illness, and tries to help patients to align the goals for care/care plan with their values and wishes.
    And - how is it beneficial to say "Hi - the doctor told you that you have 2 days to live - what are your wishes and goals?"

    When talking about serious illness a conversation method that is not so much focused on the medical detail but on the patient values and goals is more effective and the rest will usually follow. But - those conversations need to happen earlier in the disease, more, and better according to the research from the Ariadne Lab

    Clinicians learn how to talk to patients about what matters most and be change agents for better care | Ariadne Labs

    If you have time and are interested in child birth /maternal care or improvements in surgery or end-of-life care check out their webpage !
    Their training and workshop has transformed the way my team approaches serious illness conversations.
    We started to use this conversation guide for those conversations though have to adapt it for acute care as patients may be sicker and in crisis :

    Redesigned Serious Illness Conversation Guide supports more, better and earlier conversations about what matters most | Ariadne Labs

    What was especially important for me to learn is that there is a huge difference between saying "I am concerned" (more of a medical jargon) and "I am worried about you / I am worried that your time might be shorter than you think it is" (empathy and emotion focused). I learned that the effect is different. I had a hard time to say " I am worried" - it does take away some distance and signals that something serious is going on plus a person cares.

    And I would like to also put out that as palliative care team we do not see a patient with a set agenda. I learned that a lot of healthcare workers still think that our job is to "make that patient DNR/DNI" or "make that patient CMO" or that if a person has not changed their mind about their code status to what the nurse thinks is the "right code status" for patient after seeing palliative care I have not achieved anything. There is no set agenda!!! The goal is to explore the goals and values, discuss what is going on, what is important, identify palliative care needs, sometimes symptom control. If it also happens that somebody decides to change code status fine but if not that is also ok. People need time to process things.

    I learned that due to my age fitness kickboxing is pushing it at times... as a martial artist I like the fitness kickboxing stuff because I do not have time to focus on martial arts right now and I am too old now for any sparring or competitions. The fitness aspect is great though and I have gained back a lot of strength and mobility. Not to mention that exercise is good to relieve stress.

    I have signed up for American Sign Language to build some basic vocabulary. I probably wrote already some while ago that the appropriate pain scale to use in non hearing patients is usually Wong Baker.

    Looks like most of my writing is related to palliative care (again).

  • Sep 17

    I learned that there are 92 days, 5 hours, and 3 minutes until nursing school graduation.

    (Not that I'm counting or anything)

    I also learned:

    (1.) That balancing two clinical rotations is challenging. I have one day off to study ... and somehow see my family in there too . With 3 classes, and one a grad class, and 4 day clinicals, I'm beat. I feel like I'm failing the "I'm a decent mom" category, as I missed the first day of school (at clinical), 3 soccer games (at clinical, at class), 2 cross country meets (clinical, studying, class), and a trip to NYC (had to stay home and study). I suck.

    (2.) School nurses are superheroes. Being a former teacher, I already had great respect for them. But as one of my rotations is school nursing ... good gosh! She barely eats, kids come in all the live long day, and the parents - gah. Yet she still comes in every day with a smile.

    (3.) There are 92 days, 5 hours, and *2 minutes* until graduation ....

  • Sep 17

    Hi all!


    I have gotten permission by ixchel to host WILTW. I feel EXTREMELY honored to keep a thread going that inspires, and helps many of us who want to work or work in this business.

    This week, has been the most SOCIAL week; with enjoying the last week of summer break behind me and celebrating labor day as a unionized employee at work, the rest of the week was exciting with the increase of social cases, and my ever frustration with how social services is fragmented, in trouble, and fails the kids and the families that I see, along with actual lateral violence-not amongst nurses by the way-in my face, and support for a issue arise, it hasn't been a bad week!

    So, without further preamble what I learned this week:

    1. Nurse who are out of work or at their undesired job due to the nursing surplus in my area that want to be Peds nurses could MOST likely run social services much more efficiently and effectively.

    2. Being recorded is NOT such a bad thing when you see a trauma fellow screaming and pushing nurses during a trauma, twice in the same weekend for two different traumas.

    3. That I enjoy sedations; and this is another option when I plan my pre-semi retirement.

    4. That I will be a part of learning to be a educator on sexual assault, assault collections; we play an important part of collecting to ensure that DNA is not compromised; even if not discovered immediately, anything and any part of the process where I can assist in protect the public's health and safety, then I can be confident in supporting that justice.

    So, what have you learned this week?

  • Sep 12

    Quote from ixchel

    Depending on how the next few weeks go, I may have a story to share that hopefully others can learn from. In the meantime....

    Love to all of you!

    I hope everything works out in your favor!

  • Aug 19

    Quote from ixchel
    In my head, after I read a story by you, I secretly end it with, "then I popped a cap in his ass," and imagine you standing in glorious rock star 80s poses with smoke/steam billowing behind you as car headlights beam through it toward you. Then in totally awesome slow-mo, you light a cigarette with one of those flip lighters. You drop the lighter with some badassery, and a trail of gasoline suddently ignites. You walk forward (as badasses do), staring into the distance. And as we see you in focus, walking toward the horizon, a random (but somehow important) building blows up behind the smoke of awesome.


    eta - OP, if you need to chart in quiet then chart in quiet. I know I prefer it. And some nights you really do need to sit near a patient's room. Maybe toward the end of a shift when you're caught up, you can go see what everyone is up to.
    Have you thought about hanging up this nursing thing.. and writing romance novels?

    I didn't blow anything up.. but I did send a scathing retaliatory letter to little missy that canned me, HER manager, and HR. That facility closed a couple of years later. Karma ..she is a friend of mine.

  • Aug 17

    Quote from ixchel
    I found this thread!!!! Omg I can't believe I just found it. It was on, like, page 4 of search results.

    Guys.... There is a new thread up now. I didn't expect to actually find this thread, so I didn't save the link. I'll try to come back with it. If you happen to be better at this and you don't see I've come back here yet, please post the link!
    Here you go!

    (what was I saying about crummy search results? heh)

  • Aug 14

    I learned that I might actually know what I'm doing.

  • Aug 14

    I like the expression "Treat the patient, not the machine" and use it all the time when I teach Basic Arrhythmia, along with the story of a patient whose night nursing assistant documented a HR of 72 at 0600 by standing at the monitor banks and reading the screen.

    Day shift arrived, the new day nursing assistant went in the room to take vitals, and found the clearly dead patient in rigor mortis. Meanwhile, the pacemaker kept firing beautifully.

  • Aug 14

    Quote from jk2185
    I wish people on this site wouldn't ask damaging things such as,"are you a nurse?" or "how many years have you been a nurse?" just bc you disagree. I find this very childish and cutthroat. I wish we were all more supportive of each other. This is supposed to be a forum for discussion and learning, not bullying and chastising.
    Quote from jk2185

    As for the BLS survey. You most definitely perform the BLS survey first during a code, albeit you may do it in 3 seconds, you still do it. Even on the vented patient. Not all vented patients are sedated either...we may be trying to extubate or performing a sedation holiday. Also, not every patient in the ICU is vented; in my experience half are and half are not. ACLS is the heaviest protocol used in a code, but step one is always BLS.
    Pardon my ignorance, but I fail to see how asking "are you a nurse?" Or "How long have you been a nurse?" Is damaging, childish or cutthroat. So far, the least colleaguial and most chastising posts on this thread have been your own. Or is disagreeing with you childish and cutthroat?

    If you've been paying attention, you will have learned from this thread and this discussion. Perhaps that isn't what you wanted; perhaps you just wanted to see posts agreeing with you. Fortunately, unthinking agreement won't be found much on this forum.

  • Aug 14

    One reason I quit ICU work and went to floor nursing with a passion is I got sick of watching machines. For me they seemed to interfere with my communication with the patient. That was MY own feeling. Of course then the floors got all the things that bing and bong and we wound up running after the alarms. You really get alarm fatigue quicker than you realize. I took care of full code vent patients on the floor, those who were medically stable enough to come out of the ICU. Take a vent, a few IV lines, etc and there you are right back taking care of alarms. The alarms are also distressing to the patients and families. May be there is a way to have the alarms go to a pager that the RN carries? I don't know the answer but I know what drove me crazy. Alarms on new machines that continued to beep regardless of what you did, so we went back to what we knew, manually timing drips until we could get a different machine. Sometimes we went through 3-4 machines until we got one that worked. They were so over used that pieces of them broke off after a few months. Who knows, maybe in a fit of pique some nurse tore the machine up so they would not have to listen to it. Fluid and electrolytes, drips, antibiotics, all need close monitoring but if you can't rely on the machine they give you then what do you do? I learned timing drug and drips by drops/min. I calculated the H---l out of those things and watched the patient like a hawk. Anyone remember the chambered IV lines used in pediatrics?

    You had a measuring chamber that you put fluid in, then added your meds and stood there and watched it while it dripped. Not a perfect system but so many times I hung out in the baby's room and played, changed, bathed while the meds went in so I knew the rate and was sure that they got the right dose at the right rate, over the right amount of time and made sure there was not infiltration. Seeing as how we gave stuff like micro doses of Gentamycin which is oto-toxic it was important. Plus we were giving minute doses of the stuff. I much preferred staying with the patient over answering a machine. Maybe I am too old and need to shut up. I don't know. I just know alarm fatigue is a real problem and it does not help patients. Their anxiety goes through the roof and then you have more problems to deal with.

    There is nothing so good as the "gut" feeling of an RN. Regardless of what a monitor says, trust your gut. If you know the patient then your gut tells you how to go. I know that many docs do not understand that "nurse gut " thing but some do and if you can back up that feeling with any clinical sign at all you can usually get an order for labs, x-rays or something to help diagnose. I have had many "gut" discussions with residents and after you are correct once and they don't see you as a threat(presentation is everything) well, BAM, you have a believer. I have had more than one resident thank me for the heads up. Let the resident know you are on their side and just advocating for your patient and I have found it usually wins them over. It has certainly improved my subsequent conversations with them. After all we are a team. OK now I shut up.


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