Are my pts "brain dead"?

OCNRN63, RN · Jan 5, 2014

Networking how?99% of the Pdn nurses are also only working PDN(At least the ones I know).I did network,which is how I found the second agency.I am just grateful to have a job I really like.What's wrong with working Pdn? We have skiils other specialties don't.Also,you do REALIZE there is a RECESSION going on,right?I do think you are being....telling me to network under these circumstances.As if jobs are plentiful.....geezers.I do hope you know private duty isn't limited to the bedroom,as we also have school cases.

Find a topic in nursing that interests you, then look for conferences that pertain to the conference. You will get to meet other people there. That's how you network.

Based on your posts, I get the impression that you really don't want to improve yourself professionally. Punch in, do your 8-12 hours, punch out. Footdrag on doing your CEUs till the last minute; maybe even not do them at all, then lie on your license renewal and cross your fingers, hoping they don't audit you.

You really don't want our help. I don't even know what it is you want.

dudette10, MSN, RN · Jan 6, 2014

This is probably totally irrelevant and possibly even wrong -- but I feel like this entire thread completely embodies how isolating and even alienating from the rest of the nursing and medical community PDN can be, especially when you fall into PDN as a new-grad (like the OP) and never get the chance to leave.
*I* started in PDN as a new-grad BSN before I went into acute care. In acute care, I can bounce questions and ideas off NPs, doctors, and my dozen or so RN coworkers. When I started in PDN, I was pretty much confined to the insular world of (maybe) the same on/off coming nurse (who may or may not have had odd ideas about things) and the family who also may or may not have some misinformation or even outright crazy ideas floating around.
So....yeah...

I think your post is completely relevant. I work acute and PDN now, and it is very isolating. I can't imagine doing PDN as a new grad. Your OTJ learning is limited to your case.

nurseprnRN, BSN, RN · Jan 6, 2014

Yes,you must be the perfect nurse who never,ever makes mistakes,never drinks alcohol,and is a saint.Yeah,gotcha.

I've made mistakes, I had a nice big slug of good port watching the return of Downton Abbey last night, and I think sainthood would be boring, especially since it so often seems to require virginity. But I have never once committed fraud such as you describe yourself doing.

OK, I get it, now you're worried. You should be.

nurseprnRN, BSN, RN · Jan 6, 2014

"The ventilator won't work on a corpse," he said. "In a corpse, the ventilator pushes the air in, but it won't come out. Just the living person pushes the air out."Anyone????

:roflmao:

Love it. While it is possible for a conscious person to do an intentional forced exhalation, in normal chests (including yours while you're asleep or not paying conscious attention to your ventilation), the air comes into the chest passively,driven by atmospheric pressure after the descending diaphragm creates a partial vacuum in the chest. It is expelled passively by the normal elasticity of the pleurae and chest wall, not "pushed out" consciously. A conscious person can do a glottal stop to perform a Valsalva maneuver to close the airway and prevent air exit, but someone with an ET tube or trach tube has no way to do that. Even a pediatrician should remember that much from med school.

nurseprnRN, BSN, RN · Jan 6, 2014

30 years ago there was no real internationally accepted declaration of brain death. We lacked the sophisticated equipment and guidelines to determine true brain death. It is clear that Karen Ann Quinlian was not brain dead as she had brain stem function, she breathed. The true debate started about then when we (the medical community) discovered that we cold interfere and keep someone "alive" who in fact have no chance at recovery. Medicine had reached a point in technology that exceeded expectations and now has an ethical dilemma on their hands. Quantity versus quality.
I disagree with lmccrn respectfully as the knowlege and drugs has grown....the capabilities of sustaining a beating heart have increased. Jahi has a 13 year old non diseased heart which can continue for sometime with the assistance of heavy drugs and machines to support her B/P and oxygenation. But they will still fail.

Thirty years ago there was indeed near universal statutory definition and application of the term "brain death." Karen Quinlan was said to be "brain dead" in the popular vernacular of 1976, but since she lived off the vent for many years after it was removed, she clearly didn't meet the criteria for the diagnosis. (We are getting old, my friend-- it seems like yesterday!) From the estimable Wikipedia:

Legal history[edit]

Traditionally, both the legal and medical communities determined death through the end of certain bodily functions, especially respiration and heartbeat. With the increasing ability of the medical community to resuscitate people with no respiration, heartbeat, or other external signs of life, the need for a better definition of death became obvious. This need gained greater urgency with the widespread use of life support equipment, which can maintain body functions indefinitely, as well as rising capabilities and demand for organ transplantation.

Since the 1960s, laws on determining death have, therefore, been implemented in all countries with active organ transplantation programs. The first European country to adopt brain death as a legal definition (or indicator) of death was Finland, in 1971. In the United States, Kansas had enacted a similar law earlier.^[1]

An ad hoc committee at Harvard Medical School published a pivotal 1968 report to define irreversible coma.^[2] The Harvard criteria gradually gained consensus toward what is now known as brain death. In the wake of the 1976 Karen Ann Quinlan controversy, state legislatures in the United States moved to accept brain death as an acceptable indication of death. Finally, a presidential commission issued a landmark 1981 report – Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death – that rejected the "higher brain" approach^[^{clarification needed}^] to death in favor of a "whole brain" definition. This report was the basis for the Uniform Determination of Death Act, which is now the law in almost all fifty states. Today, both the legal and medical communities in the US use "brain death" as a legal definition of death, allowing a person to be declared legally dead even if life support equipment keeps the body's metabolic processes working.

Esme12, ASN, BSN, RN · Jan 7, 2014

Yes we are getting old....but it wasn't "common" to declare brain death as we know it today until the late 70's as we know it today and outside academic centers.

Since the 1960s, laws on determining death have, therefore, been implemented in all countries with active organ transplantation programs. The first European country to adopt brain death as a legal definition (or indicator) of death was Finland, in 1971. In the United States, Kansas had enacted a similar law earlier

Which I believe was 1968. I should have said 40 years ago...ah...time flies.