ixchel, BSN, RN 37,919 Views
Joined Jun 3, '11.
Posts: 4,986 (75% Liked)
I really, really, really love hospice care. Even in my nightmare first nursing job when everything was new and I was always unsure of myself and my skills, I was comfortable caring for the dying and tending to their families. I haven't had a great number of patients who are comfort measures only, but I've had a sprinkling at each job.
People who are grieving the anticipated loss of a loved on are fragile, angry, and intense... and it doesn't bother me. "My mom is in pain and you need to do something about it Right Now" is a-ok coming from the son of a hospice patient - who really was in pain and I was able to explain to him that I was at that very moment taking action to get her meds adjusted (the family was actually there to make the decision of whether or not to go to palliative measures, and the transition was a little bumpy). "Any idiot can see this isn't acceptable" coming from the son of a LOL who is perfectly alert & oriented but whose O2 sats dropped a few points after getting IV pain meds in ED for a fracture will have me fuming for years.*
*Insults don't usually stick in my craw, but it's the first time someone has been that direct about an insult in front of me. The daughter was saying this to someone on the phone as she threatened to take mom home AMA - while the charge nurse and I were trying to make her happy by turning up the volume on the continuous pulse ox that the daughter decided was necessary. The gall of someone calling nurses "idiots" for not obsessing over a perfectly stable pt's nearly-normal VS will stand out in my memory.
This patient had a number of children present most of the day, and they asked me about my previous hospice experience and thanked me for being able to handle it. I told them it's a privilege to help preserve comfort and dignity at the end of someone's life.
I learned that drug addicts will try any number of wild concoctions to enhance the high or decrease side effects. I'm honestly not sure anyone would benefit from hearing the specifics of that...
I learned that waiting on a second opinion is just as scary as knowing you don't trust the doc who's been responsible for your care. I have a diagnostic test on Monday that will hopefully point toward whatever the heck is going wrong in my body. I feel like a pebble in the surf, being worn down a little at a time from constant pain. I know others have it much, much worse, though, and I try to smack a little self pity out of myself now and then.
Ixchel, I have been thinking about you, and I'm glad you're doing well. I am especially glad you can sleep on your belly - that's the best feeling! I love sleeping on my belly.
Home Dobutamine iv therapy becomes more "popular" for heart failure patients who have no other option left.
Ixchel - I am sorry you are somewhat struggling after surgery. I think that when a person had chronic pain, there is a lot attached to it, emotionally and physically. Also, if you had been on chronic pain medication before surgery and are able to reduce now you may perhaps feel a touch of withdrawal at times creating anxiety...not that I am saying that is what is going on but it is something that I have seen in patients.
However, I wish you a speedy recovery and that things will straighten out and healing will continue on all levels.
What I learned this week:
There is the National Patient Safety Foundation that offers some great information for health care professionals but also patients and caregivers, some of it is very useful for patients. The goal is to empower patients and caregivers to take charge of safety for example with transitions or medications. Here is the link in case you are curious:
For Health Care Professionals - National Patient Safety Foundation
Advanced Care Planning : A big part of my job. I learned this week that it starts to sink in with some physicians that an acute situation is not the ideal time for advanced care planning and asking somebody who is in acute distress "do you want us to do everything" will most likely result in the person nodding. Unless they had a discussion with their healthcare provider already and have decided to change their code status. This is why advanced care planning is so important and should also include a conversation with the MD/NP about their wishes in terms of resuscitation, especially when the person has a serious illness, or chronic serious illness and such. Unfortunately, providers are not trained sufficiently and often do a poor job with those discussions. Plus there is a huge discomfort attached to any end-of-life discussion.
However, some providers finally understanding why palliative care likes to see patient outpatient in the office. In that setting, when they are less acute sick, the NP and MD have the time to sit down and start and continue a discussion about code status and advanced care planning in general. They collaborate with other professionals like oncology and PCP. Here is a general link for advanced care planning:
and another link for "the conversation":
The Conversation Project - Have You Had The Conversation?
Home Dobutamine iv therapy becomes more "popular" for heart failure patients who have no other option left. While I understand the desire to maximize heart function, I feel conflicted when the person is in general low functioning due to advanced illness and not a candidate for left heart assist device or transplantation. If somebody has a lot of comorbidities and is unable to leave the bed most of the times - does this add anything to the quality of life? Of course I can see why a person who is looking into maximizing their life span may grab that straw but I think it is an option that needs to be explored carefully. There can be significant costs and overall quality of life may not be much better or not better at all in some cases (in my opinion). And patients need to understand the implications and the degree of their illness. There should always be a discussion about the bigger picture with the cardiologist.
Here is a link with some general information about home infusion of positive inotrope medication in home care:
I also learned (again) that patients often have problems to understand their illness and put it all together.
The National Patient Safety Foundation (mentioned above) has in initiative that targets that problem and encourages patients to ask 3 questions:
Ask Me 3: Good Questions for Your Good Health - National Patient Safety Foundation
In fact, I did not know about this initiative but have been writing down questions with patient to ask their provider or specialist so they get a better understanding. Most commonly I write down with patients questions like "what is my diagnosis" "what does it mean?" "what is my prognosis?" "what are treatment options?" "what are next steps?". I found that this really helps the patient (or advocate/relative/HCP) to stay on track when the provider meets the patient. Often, patients are so stressed out and anxious that they forget to ask those questions or do not speak up when they do not understand medical English. I have met patients who had cancer stage 4 and had no understanding of what it means, or who patients who did not know what kind of surgery they had - sometimes leading to tragic misunderstandings (I thought I was cured). And I am not blaming anybody - the problem is that communication is often limited and patients do not speak up or misunderstand and the provider thinks they have an understanding.
I learned a lot about sanitation in nail salons as I did some research on it. I usually avoid nail salons and prefer to do my own pedicure. But I really wanted some nice looking feet for my mini vacation and decided to do some research. I found a place that is a short drive out and was actually able to relax while my feet were done. Knowing what to look for is really helpful including that not all salons follow the law and cut corners plus going on days where it is crowded due to a "special" they may not pay as much attention to the required sanitation time. And apparently it is not good to go on the day you shaved your legs because it increases the risk for infections. One physician also mentioned that those "whirlpool" functions can be questionable as bacteria can harbor in there -- uahhhh!
And last but not least - my diet efforts have not resulted in much change. Now I am back to counting calories with an app and scan all the food plus I had the NP increase my Hormone Replacement Patch dose. And I started fitness kickboxing and have been going three times a week for 30 minutes, which is all I can do right now. Seriously - I am so out of shape because for the last year I have focused mainly on weights (I had surgery last year and had to start from square 1 after). The heavy duty cardio part of fitness kickboxing leaves me with a dark red face, subtle nausea for some while after exercising, and the realization that everybody else there is much younger AND in better shape.
As a patient approaching 6 weeks post op from spinal fusion, I have learned...
...that the torso I see from the side in the mirror doesn't look like mine. My lordosis is gone.
...I am thankful to have cut my med list down so much.
...being really skinny means my hardware presses against my skin and incision site when I bend. I really hoped this would stop by now.
...I never knew how much I relied on pain to be the friend who cautioned me to hold back. I've felt anxiety over losing the pain.
...^^^^ that??? It's crazy.
...I CAN SLEEP ON MY BELLY!!!!!!!!
...I'm EXTREMELY bad at unknown. My post op appt this week will show whether I am fusing at all yet. I just want to know.
...the hardest lesson is this mountain of defeat I'm feeling after such a big few months. I'm seeing pics of graduation, celebrations of employment, and worthy bragging moments on my facebook historical posts. I felt like life was hard then, I celebrated something hopefully becoming easier. It didn't though.
I've lost my muchness, guys. Lots of it.
...it comforts me to know my LEO hubs and his coworkers have devised an apocalypse plan. I also just realized being nurses makes us all valuable (like, save the nurse, kill that guy instead, valuable).
So what have you learned? (And please, if you can, bring it back to nursey since I couldn't! (Sorry, mods!) We need to stay yellow.)
You guys!!! I got in!!!
This is why it is so important for nurses to receive comprehensive sexuality education. Biological sex is not the same as gender identity.
Furthermore, there are not only two chromosomal sexes. There is a small percentage of the population that are born intersex, who are forced to conform to a binary gender expression in order to not face harassment when choosing a restroom.
This conversation has steered into the territory of framing the issue around the "comfort" of transfolks, when really it's a huge safety issue. Forcing them into the bathroom of their biological sex opens them up to violence and harassment. Let's not overlook the masculine looking women being currently harassed for using the women's restrooms now that these laws are being "enforced".
If this was really about sexual predators and keeping children safe, it would be illegal for boys to use the same bathroom as adult men, who are by far the biggest threat to their safety when it comes to sexual abuse.
Any of you hiring? [...] Clonidine overdose can be treated in part with narcan.
I sleep best with someone laying on me. Weird, huh?
People actually do sing "Staying Alive" during chest compressions.
This week I learnt extubating under deep sedation reduces the risk of laryngospasm, and that helps for patients who have a known or unknown diagnosis of asthma.
Can one say "GOOD morning", if it hasn't been so good?
Instead I will say "HIYA Ixiechicksie-eL!
Don't see you very often since I am mostly sort of Blue-side-ish kind of person...
Sorry you've been up, too early, too.
Hey, go over to the Blue Side and check out the end of the Sunday 5/15 GM thread...Ted has posted something beautiful..."SLEEP" sung by a virtual chorus of round-the-world folks. The second posting, SLEEP 0.2, is more audible and better edited...
I'd like to put it on a loop tape, to fall asleep by.
Pea-of-the-Ess: "Stirring the Schlitz" comes from some of The Do's cartoons earlier in this thread. Dint wancha to think the twist of phrase was mine. DD's the twisted one here , ain't ya, Davey?!
So i have been quietly following this thread all weekend and giving this some thought. And my position on this does not change. The contents of someone's underpants in none of my business. But that being said - someone along the way here did bring up a good point about communal showers. I dug around a bit and tried to find some sort of semblance of directive already in place - but as this is a "hot button" issue - the media and websites are so focuses of the bathrooms that locker rooms and their adjoining showers are simply a passing thought. I poked around on Jazz Jenning's site (that's the girl with the reality show) to see if she made any mention - nope - just excited to change at Target and pee in peace. To me this is small potatoes. If a girl looking like Jazz Jennings walked into the bathroom and used the stall next to me, I'd think nothing of it. Most females of all ages would. But into a communal shower I wondered if Jazz would even bother? Go full bore into showering? I'm really not sure... Do schools even require kids to shower? Mine does not.
Onto my next thought - suppose a school does require a kid to shower - what about the female to male that now has to fit in with his male and threatened peers? If they realize now in said communal shower that this person who outwardly looks male due to hormones is missing a penis will they react violently towards him?
Perhaps these are baseless thoughts. Perhaps i am waaaayyyy over thinking things. Perhaps it has been too many years since i've been in a school locker room and things don't work like that anymore, so shut up, Flare and sit down.
My bottom line is and always will be keeping students healthy and safe in school. If that means they use my office - fine. If that means transgender students use a bathroom they feel comfortable in - fine. If that means constructing a single shower - well, i've been fighting for that for life skills for years... but that, friends is a different topic.
Hmmm. What have I learned this week?
I learned that I am no longer the "greenest" nurse on my unit and was able to fix multiple issues a newbie was having without second guessing myself or needing help myself ( ).
I learned that just because you've been a nurse for ages, it doesn't necessarily mean you know more than your coworkers. Times change and if you didn't change with 'em, you might be wrong.
I learned that I have qualified for enough financial aid that my FNP degree (which starts in August!) will be covered, even if I have to drastically cut my work hours.
I learned that even though I'm stressed and irritated and work on a unit undergoing INSANE amounts of change... I still love being a nurse! ...most of the time. LOL
Do we have to come up with words for non-transgender people calling them cisgender because developing thicker skins isn't an option?
I am so, so sorry for this diagnosis, again. (((Hugs)))
This week I learned, though I feel like a better title might be "Lately I learned" as I haven't posted in a WILTW thread in a while:
1. I finally got my admissions decision (since my last WILTW post). I got in! I'll now be working full-time and going to school part time. This should be interesting. Getting to tell two of the three people who wrote my letters and seeing their *genuine* positive reactions was amazing. The third person had a positive reaction but it can be hard to tell if they're genuinely happy.
2. I got some really good advice. About the same situation, from multiple people.
3. I had a blast at a conference I wasn't relishing the idea of driving to and from in the same day. The drive wasn't so bad, and the conference was great.
4. I have made some amazing friends through my professional organization.
5. I shouldn't underestimate the ability of humans to decide to do stupid things.
6. Sometimes it's just *way* better not to know the story of what happened to some of the patients we take care of.
7. I've become the default human ping pong ball (again).
8. I am doing the best I can - I own what I need to own. If I make a mistake I learn, and if applicable apologize. I have increased my self-awareness about specific things, and that has to be good enough for me.
9. One of my friends from another care area is having a rough time. Unfortunately it looks like s/he may need referral to one of the physician groups I work with. They asked me for help identifying a preference of who to see. They also asked me for advice on staff to choose as part of the team that cares for them should they end up having a procedure. They also insisted I'd be chosen too.
10. Friday the 13th. That crap is real. It'd be worse if I'd been on the inpatient adult or pediatric code teams (we gave up counting the number of codes overhead paged).
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