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Content That ktwlpn Likes

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Joined Aug 17, '00. Posts: 4,639 (32% Liked) Likes: 4,658

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  • Apr 29

    That is actually a great trick, it avoids the need to remove a resident's shoes and pants in order to change a soiled pull-up. Assuming your mom is changed frequently enough that her pants don't need to be changed it is quite efficient.

    The other thought I had is, why not get your mom nighties to wear? That would avoid the dignity issue of her being only half covered. Pants are much more difficult to change in bed and often dementia patients get upset with staff waking and changing them. Also if you want them to get a good nights sleep the less time the resident is disrupted for changing the more likely they'll fall back asleep. If you haven't been speaking to the director of nursing go to her with your concerns, then the administrator, then if still not satisfied go to the regional director. Give them a chance to fix things first.

  • Apr 29

    Quote from Damiapa
    It was actually a mistake, it was from a vape pen I didn't know had weed in it, which is why I didn't think I would be positive for it it was all weird, but anyway I don't need to explain myself to anyone not like you've never made mistakes, and I said thanks for your judgement I didn't say anything about it being wrong blah blah are you on this page just to look for **** to start?
    OK- I am really intrigued here.
    You accidentally ingested the weed that caused you to fail a drug test?

    I am sure this is possible, just like at some point some kid's dog actually ate his homework. (My dog would do it.)

    No judgement from me, I truly care not whether you smoke weed, but did you seriously accidentally ingest enough THC to fail a test 6 months later?

  • Apr 26

    To get a better understanding of the challenges you need to understand the differences in culture and work flow.
    While LTC and AL appreciate hospice commonly as a vehicle to get an additional CNA for care as well as equipment (low airloss mattress, broda chair, hoyer...) they do not necessarily appreciate the involvement of the hospice nurse. I know, that sounds weird but is a fact. Some AL and LTC that have a lot of dementia pat try to get them on hospice for the additional "perks" - not necessarily because the love hospice, hospice philosophy and want to decrease suffering and end of life. That might be a motivator as well but the desire to get a broda chair, air mattress and the CNA is definitely high up on the wish list.
    Facilities do not appreciate hospice nurses coming in and be "gung ho" about anything. They can be very protective or territorial and are very sensitive about any RN coming in and "telling them what to do". There is a lot of dynamics going on that I am not going to write about but basically while they might appreciate hospice, end of life is not their priority and the sense of urgency that a hospice nurse has towards relieving suffering does not reflect their sense of urgency in most cases - leading to conflict.

    Here are some pointers to get a better relationship with facilities:
    - Make sure you have all the contracts updated / in place and review the contracts periodically with administration to ensure you are on the same page.
    - Facilities like consistency - the same liaison and nurses for one facility helps
    - Assign nurses who like that environment. If a nurse who is just fine at home hospice but despises facilities goes in there you will have problems and they will give referrals to somebody else.
    - Hospice nurses who behave like guests and are respectful do better in facilities
    - It is all about collaboration and communication. The hospice nurse needs to talk to the primary nurses and aids who take care of the resident to get a full picture and tell them they appreciate the input.
    - Never teach with an attitude. This is huge in facilities. Some hospice RN are upset when a nurse does not understand the importance of pain medication/different medication/ not giving meds. Teaching needs to be done without blame and be positive and constructive.
    - Clear recommendations and scheduled meds instead of PRN if nurses are not giving meds that the pat needs.
    - Facilities see hospice as a service providers - acting like one with quick response to referrals/equipment helps.
    - make sure the pat is seen as often as the pat would be seen at home.
    - don't create drama in the facility.

    The market has become tight as pat in facilities tend to stay on longer leading to more "profit" with less "needs". Some hospice agencies specialize in this segment and market aggressively. I know of places where companies "follow" resident's weight for example and make a call to the family once the pat appears to meet hospice criteria to take them on asap. This is usually within a tight relationship of a facility with a specific hospice that is already in the facility.
    Although pat have a choice when it comes to hospice, the nurses and administration certainly influence who gets referrals.
    If you want to create a better relationship offer education in facilities, talk to nursing director about the specific needs/problems/concerns.
    Have the hospice nurses go into facilities that enjoy that environment and collaborate well with positive communication skills.

    Thinking about this - perhaps I should write an article ....

    Good luck!

  • Apr 26

    Well, in the first place, no policy ever gets written by just one person and becomes "POLICY" without further review. Usually, someone writes a draft which is then reviewed and approved by multiple layers of administration (inc. the legal department) before it becomes official. Are these existing policies which just need updating? Or is she asking you to write new policies "from scratch"?

    I would use the same format and style in which the rest of the existing policies are written, and search the literature for the most current best practices on whatever the subjects of the policies are, and put together a draft which I would hand off to her. I'm assuming that it is a compliment and "vote of confidence" for you that she's asking you to do this (as opposed to anyone else who works there), and this could be a professional advancement for you if you want it to be. Is moving into education or administration something that you and she have talked about, or something in which you've expressed interest to anyone else there? Is this possibly a case of her mentoring you, or is she just trying to get someone else to do more of the work?

    Best wishes for your journey!

  • Apr 24

    Quote from Parakeet
    Just a clarification to my OP. I want to let you know that just because I am a Christian, does not mean that I think my classmates or any other nurse I work with are beneath me. I have met many amazing nurses who are not Christians, whom I have learned from.

    It would not be Christ-like of me to refuse to work with someone because they do not share in my faith. That would not be loving my neighbour. Do I still think they need Jesus? Absolutely! Would I share with them my faith? Yes, if they were interested or brought it up in conversation.

    The problem I am having (and I suspect others as well) is that here you say "If they are interested" yet you didn't bother to find out if your classmates were interested.

    When someone hands me a religious tract, I don't throw it back in their face. I politely say 'thank you', and then go on my way. And I throw the tract away. That isn't interest, it's respect. You seem to not understand that.

    Please answer this: how would you feel if I came up to you, pushed a pamphlet into your hands that explain Hecate and how to worship her? How would you feel if I insisted you listen to me talk about Goddess worship? Think about that for a moment. How would you feel?

    As a patient, I do NOT want a nurse to suddenly decide that since I asked for the chaplain, that is me saying 'I want to learn all about your god'. The chaplain will know how to get in touch with a pagan who can come in and talk to me.

    ETA: Please show me where in the US people are having other beliefs forced on them? Where in the US is "holy" war being waged? And where in the US are Christians not allowed to share their beliefs? I can't drive a quarter of a mile without seeing a church. I have yet to have a Jew, Sikh, Muslim, Buddhist, Pagan or Wicca try to force their beliefs on me. However, I have had a lot of fundamentalist and evangelical Christians do that, even when I was a practicing Lutheran.

  • Apr 23

    I am learning something from a conversation with my sister Margaret. First of all, people with Alzheimer's retain songs, prayer and poetry longer than speech because those things are accessed via different neural pathways. (Margaret didn't teach me that.) That's why you sometimes hear a person who hasn't spoken an intelligible sentence in years sing along with Frank Sinatra and not miss a syllable. It's also why a non-verbal patient may bust out the Lord's Prayer for no discernable reason.

    Margaret asked me for suggestions of songs, nursery rhymes and poetry that our mother knew back in the day. She read parts of the Song of Hiawatha to mom and mom recited along with her. Mom also sings along with Frankie without missing a beat.

    Ok, now I'm getting to the point, finally. What I learned is that family members know the best way to reach a person with Alzheimer's. They just need a little help pulling it out. Generic music from the 1940s did a really good job engaging my resident's when I worked in LTC. Getting specific suggestions for familiar song's prayers and poetry works even better for individuals.

    Seems simple, doesn't it? I have always HATED hearing contemporary music played in an Alzheimer's unit. The sound track of an Alzheimer's unit should serve the patient's quality of life. If the staff wants to listen to thier preferred music they should do it at home.

  • Apr 23

    Quote from Nurse Leigh
    Special snowflake, no doubt.

  • Apr 23

    Quote from Catcar1963
    My "complicated reasons" have to do with a lifetime of physical, emotional and sexual abuse, and the estrangement happened because my father was going to remarry, and her granddaughters became the focus of my father's inappropriate obsession with them. We decided we had a moral obligation to tell the girls' parents of my father's pedophelia, so that's why he won't speak to any of us. My 4 brothers and I are very close, but we're not all in the same stages of healing. So now you can see why I didn't think it was appropriate to share that here.
    My father doesn't know his privacy has been breached, and considering the volatile family dynamics, I'd rather he didn't know, but he is likely to find out since I filed a complaint.
    Speaking of moral obligations, do we not, as nurses, have an obligation to do something about a nurse's criminal activity?
    I'm going to leave aside the HIPAA stuff and just say that my personal belief is that someone who does what your father did deserves no reconciliation with the people he abused.

    You can heal and go on with your life and live it in a healthy way without being part of that abuser's life.

    And I'd never let any children near him. Ever.

    People who do this sort of thing tear up their "parent card" forever.

  • Apr 23

    Quote from Catcar1963
    My estranged father is in a health care facility after a stroke, and has no contact with me or my siblings (his choice). My brother's friend is a nurse at a facility my dad was at previously. Yesterday the nurse found my dad's psych eval, and gave it to my brother.
    My father has made an effort to reconcile with me, but not my 4 bothers.
    I should clarify that I have reconciled with my father 4 months ago.
    In your OP you wrote that you have no contact with your father, now you say that the two of you reconciled four months ago?

    My brother has no right to my dad's personal information
    The brother who got his psych eval only wanted it because he is nosey, and cannot deal with my father's estrangement in a constructive way, like therapy.
    How is your relationship with your brothers? Are your efforts on your fathers behalf solely based on your desire to advocate for him or are they influenced by the dynamics between you and your siblings?

    I hope to be an advocate for my father, and protect his rights as a patient.
    Getting my dad involved is not an option, for very complicated reasons I am not willing to share in this forum.
    Further, he is more than competent to manage his own care.
    It's difficult to offer you any advice when you don't want to share the complicated reasons which you think rules out getting your father involved in/responsible for his own advocacy. You say that he is capable and based on that fact, if it were me, I'd let him take charge of his own care and instead focus my time and energy on improving my relationship with my father. (If that was something that I wanted).

  • Apr 23

    He's estranged from you by choice. Maybe he doesn't WANT you to advocate for him.

    Quote from Catcar1963
    I hope to be an advocate for my father, and protect his rights as a patient. I think if my dad knew, he'd have someone arrested. My brother has no right to my dad's personal information, and the nurse gave it to him unsolicited.

  • Apr 23

    Um, no offense, but you keep shooting down EVERY option being given to you. I'm not sure what you're hoping for here?

    Quote from westieluv
    Thanks, that would be a great solution except that we live in an area where it gets very cold in the winter and she would literally not survive outdoors all day. I'm afraid I would come home and find a little pupsicle.

    I would really like it if our daughter could take the dog when she moves out, since it is technically her dog (birthday gift eight years ago) but she will likely end up renting at first and probably couldn't have a dog or would also end up working days so the problem would still exist.

    I do know that I am not willing to pay for doggie day care, which I'm sure is available in the city where I will be working, although I'm not sure if I could even drop her off at 5 am. That would probably be just about as expensive as having a child in day care, which I never did either, and it would probably just stress her out.

    Thanks for the good wishes with the job.

  • Apr 21

    Thank you Calliotter3! My hubby says "marketing is writing checks that nursing can't cash."

    I remember one night, I got a call at 8pm from a pending admission that I was to admit the following day. Lung ca patient, having an anxiety crisis. Initially the family called home health, said they didn't want to go back to the er, they had already been there that morning....could hospice nurse come tonight. I called and spoke with the patients son, educated that i could get an ekit out there with roxanol and ativan, and i'd call for oxygen, and I was on my way to admit. I got there, patient in no serious distress, I could hear audible expiratory crackles.....home health had been giving 1l ivf/day....wife asked when i'd be out in the morning to hang the fluids. I educated that i could hear his crackles without a stethescope, plus pt had 3+ edema lower extremities---wife said "well, then we're not ready for hospice....." i cancelled ekit, 02 (sat was 98%), called doc, and my clinical manager......

    Marketing was ******---said i should have called branch director and we could have "brainstormed...." Really? I told them it was not appropriate on an already fluid overloaded patient to give a liter of fluid daily.....I asked should I give 80iv lasix prior to daily ivf???? I told them i wasn't going to make a patient uncomfortable just to increase census and appease a family member.....

  • Apr 21

    You could train the dog to go in a specified spot indoors on a puppy pad or in a littler box.

  • Apr 21

    Doggie door? Or pay a neighborhood kid to let the dog out when they get home from school

  • Apr 20

    Quote from IVRUS
    If anyone is spewing Babel, it must be known that this is the epitome of doctrine gone wrong! If OP is a Christian, and someone asks her to pray with them... She is just as capable, and maybe more so that a priest, a minister etc. With the HOLY SPIRIT living inside of her, she can be just as capable as anyone else.
    BUT that is not the nurse's job, and why one is there to begin with. Huge boundary issue.