I need some advice from my fellow nurses. If you have physical therapy/rehab experience even better!!!
Im a home health nurse, ive been with my patient for going on 2 years now. Ive seen her experience alot of discomfort, but lately her pain levels have just been horrid.
She is 27, non ambulatory, her spine has scoliosis with severe lordosis so she spends 75% of her life on her belly, her primary dx is CP, but also has mod-severe brain damage, so her cognitive age is about the equivalent of a 1-2 yr old. Also has very violent temper tantrums regularly, and bcz her pain has been so much worse lately you can only imagine how much worse her frustration level has rose. She also has frequent spasms in different areas of her body that are not seizures, especially in her back, legs and feet/toes.
She has been on the same med regimen for about 7 years now:
AM
-ChloralHydrate
-Benedryl
-Zantac
-Baclofen
-Tylenol PRN
PM
-Tylenol PRN
-IBU PRN
-Phenobarbital
-Baclofen
-Zantac
-ChloralHydrate
-Benedryl
She has a doc appt in 3 weeks.
I love her to death and just want to help her. The only exercise so far that we do and she can tolerate is; 1) stretching/pulling both legs while she is on her stomach 2) bending each leg so the knee is at a 90 degree angle while she is on her back at best maybe x4 each leg.
My main concern/question is are there some other things I can be doing to stretch her legs, help with back spasms and pain...??? And also I will be accompanying the pts mom to her doc appt. Is there anything I need to say? Maybe to the mother... or directly to the doctor? I don't want to step on the mom's toes... HELP!!
Specializes in Complex pedi to LTC/SA & now a manager.
Thanks for your input. I appreciate insight from more seasoned nurses and experienced individuals. However, I do feel as though your starting comments were a bit judgmental and belittling towards me as a professional. It is not that black and white. I would appreciate if the entire context of my comments were taken into full consideration. In this I mean that
In fact, I already stated that I could see that there was a shift in my therapuetic technique into emotional attachment. Now that I've seen this, I simply asked if I could retrain myself or I should search for a new career path as an lpn. The other stuff in your reply was a bit excessive and unnecessary. That is just my opinion.
The way I expressed my opinion of the mother might have seemed harsh, but I do not resent her. I am not sure what you mean by nurses being concerned with being BFFs with the family. When you spend 5 to 6 days a week with a family for over a year and have accompanied them to special occasions such as birthdays, etc. as the pts caregiver of course. I guess then this brings up another question.
How do i act like i care, but not get attached?
What makes a good 1:1 caregiver?
I understand now going back and reading my comments about the pts mother were unprofessional. I regret that. I have gotten to know very well and that might be true about the resentment.
A few things i need to address is that I DO NOT use the pts family approval and love for me as validation for being a qualified professional. In any case. Perhaps you've had some experiences yourself with 1:1 care that have tainted your view on home health nurses? That is a genuine question, not a snotty remark.
I would also like to put it out there that i readily communicate and enjoy problem solving with my fellow coworkers and have never thrown a nurse under the bus to gain brownie points or lied to cover up an error, etc. I strongly believe in there existing an entire team to care for a complex home care case such as this. I am not comfortable with being the "sole" caregiver, and have never witnessed any patient benefit from it. Hence my feelings of concern and reason for reaching out.
I accept constructive criticism. My only concern here is that the point of us all being here is to listen with open hearts and minds, and use our experience and education to help those in need of guidance. I think that there are times when all of us jump to the conclusion that it needs to be assumed as the person in need of guidance is the worst case scenario and there is a need to come hard right out of the gate.
I hope all individuals involved in this thread understand that their replies are all appreciated and taken into consideration. But I am not comfortable with certain assumptions.
Im sorry you assumed that I meant you needed their adoration to build your own self worth. There are people that build their own self worth by standing on others to gain favor. The difference between them and you is that you see the lines that have become blurred and that you might a bit too involved emotionally. They do not. They are so intent on being the favorite they are blinded to everything else even when the world around them recognizes there is an issue.
Ways to not cross the line:
Dont give out your personal contact info all clinical concerns need to go through the clinical manager. All scheduling requests and changes need to go through the office. Even changes between nurses. I've seen this happen quite a few times. Parent gets so dependent on a nurse they are so clouded they call the nurse instead of the physician or 911. (Not likely, at least for clinical issues in your case as you stated the mom tries to minimize medical contact. But the clinical manager needs to be aware not just the field nurses)
Don't be Facebook friends. If you are already, place the parent/family on "restricted" so they only can see items you tag them in or make public. That way you don't have to deal with the drama of I un-friending.
Dont refer to the child as my patient. Refer to the child by name when speaking to other professionals. Try to not see your family in the child, see the child for the individual that they are, try focusing on what makes the child special/unique not what characteristics remind you of your loved one.
Ive seen some excellent PDN cross the boundary of professionalism and it's not pretty. They are so clouded in their judgement someone always gets hurt, whether another nurse, too familiar with the child subtle changes are missed, they cross into fantasy seeing progress that not one other person in the universe other than a parent can see. Parents need to have hope even if they are delusional. It's their child but the professionals don't need to feed into the delusion. There are nurses that convince themselves. They start arguing with therapists to re-initiate unrealistic treatments and equipment trials when the cognitive and motor function is objectively non-existent. Such as putting a near-comatose child that can't even hold up their own head never mind torso, never ever voluntarily move their legs even in withdrawal to pain in a gait trainer because "I believe (child) will walk if we just cram their body in there with four staff members to hold the child up and move the legs ". Parents should have hope for miracles and recovery. We don't need to crush their last strings of hope but we don't need to be delusional. Suggest having a PT consult for new range of motion exercises to prevent contractures . Don't ask the PT to order unnecessary equipment as a favor to the parent. If the parent declines a medication or therapy or medical recommendation after hearing the risks and benefits don't interfere and try to change their mind. The provider is capable of documenting a refusal. If it's an order document objectively and let the clinical manager know.
Be be knowledgable about the primary condition and if there is a progression to the disease to watch for subtle changes and help prepare for the inevitable. Such as the progression of SMA. Or if the CP is the result of a brain bleed at birth know the signs of increased ICP or VP shunt malfunction.
You don't need to refer the the parent as Ms/Mr/Mrs but you don't need to refer the them as "Mom" either. If you start a new case ask what they want to be called.
Dont give treatments, medications or therapies that require a provider order. Using lotion on dry skin is one thing but don't put triple steroid cream without an order. Parent can give medications/creams if they want and you know it's safe such as Desitin for a reddened peri area if you don't have a standing order. Or a new case and the manager forgot to get Tylenol standing orders and it's 3AM, child is miserable with a temp of 102, parent can give Tylenol based upon package instructions (and you document parent did so) and you have the manager get a SO in the AM.
Whle you may be fond of a family working so often consider backing off and adding another client. Kids are good until they are not. If your primary gets admitted for pneumonia you will be the one that has an empty schedule. By adding or filling in on other cases you will get a little distance and can more easily maintain perspective and professionalism. Plus the parent will know other nurses are caring and competent should you need a shift off.
Even if you are aware of an egregious error by a colleague that you caught follow company reporting protocols and documentation rules. Don't do what happened recently nurses shared third hand knowledge. And a nurse two shifts removed started her notes with details regarding the incident that were inaccurate and the nurse didn't have first hand knowledge of, all this nurse needed to do was state that she reviewed new order to hold a medication. Not a two paragraph documentary as what she thought happened that lead up to holding the medication. Parents will read the chart.
Never bad mouth a parent no matter what and never ever in writing. If you have concerns regarding care or access to needed care involve the agency. Not do like one nurse did and write in the communication book (that is a legal document) that kids teeth are filthy (they weren't it was a drug side effect and this nurse was new to the case) and how the parents never come to the clients room
to play or hang out. Not that you would but I've seen some of the most ridiculous statements in communication books. Nurses now just sent the manager an email to come check out the notebook rather than respond in kind. The clinical manager handles the issue per agency protocol.
Most important and often hardest...leave work at work. Don't think about your client and seek things that remind you of your client. You have your own child. Leave work and turn your focus to your own family. Much easier if the family does not have your personal contact info. The client will be ready for you to focus all of you attention on at your next shift.
Specializes in Complex pedi to LTC/SA & now a manager.
I didn't mean you ever lied about an error or talked about other nurses to gain favor but just gave examples of the path that getting too involved and crossing the professional line in 1:1 PDN can happen. Not everyone is predisposed to crush others to make themselves look good or feel better. The fact that you realize that the lines of personal v professional may have been crossed shows good insight.
Consider not taking certain "gifts" from families. Pay your own way if you accompany out to eat or bring your own food. Don't accept gifts like $50 gift cards especially if against agency policy.
Several nurses got very close to a family when the case was transferred to another branch. The nurses that overlapped were taken out to a fancy meal by the parents at family expense while other nurses were either not invited or didn't have another shift. The not included nurses were insulted when the nurses that went happily discussed the fancy meal (not realizing that the family could not afford to treat all of the nurses). The office manager was not happy as the cost exceeded company policy. Sadly this occurred within a week or mandated corporate compliance training that included why staff could not give or accept gifts over a certain amount per federal guidelines. The nurses did not want to hurt the family's feelings....it became a big deal
Specializes in Home Health, Mental/Behavioral Health.
Im sorry you assumed that I meant you needed their adoration to build your own self worth. There are people that build their own self worth by standing on others to gain favor. The difference between them and you is that you see the lines that have become blurred and that you might a bit too involved emotionally. They do not. They are so intent on being the favorite they are blinded to everything else even when the world around them recognizes there is an issue.
Ways to not cross the line:
Dont give out your personal contact info all clinical concerns need to go through the clinical manager. All scheduling requests and changes need to go through the office. Even changes between nurses. I've seen this happen quite a few times. Parent gets so dependent on a nurse they are so clouded they call the nurse instead of the physician or 911. (Not likely, at least for clinical issues in your case as you stated the mom tries to minimize medical contact. But the clinical manager needs to be aware not just the field nurses)
Don't be Facebook friends. If you are already, place the parent/family on "restricted" so they only can see items you tag them in or make public. That way you don't have to deal with the drama of I un-friending.
Dont refer to the child as my patient. Refer to the child by name when speaking to other professionals. Try to not see your family in the child, see the child for the individual that they are, try focusing on what makes the child special/unique not what characteristics remind you of your loved one.
Ive seen some excellent PDN cross the boundary of professionalism and it's not pretty. They are so clouded in their judgement someone always gets hurt, whether another nurse, too familiar with the child subtle changes are missed, they cross into fantasy seeing progress that not one other person in the universe other than a parent can see. Parents need to have hope even if they are delusional. It's their child but the professionals don't need to feed into the delusion. There are nurses that convince themselves. They start arguing with therapists to re-initiate unrealistic treatments and equipment trials when the cognitive and motor function is objectively non-existent. Such as putting a near-comatose child that can't even hold up their own head never mind torso, never ever voluntarily move their legs even in withdrawal to pain in a gait trainer because "I believe (child) will walk if we just cram their body in there with four staff members to hold the child up and move the legs ". Parents should have hope for miracles and recovery. We don't need to crush their last strings of hope but we don't need to be delusional. Suggest having a PT consult for new range of motion exercises to prevent contractures . Don't ask the PT to order unnecessary equipment as a favor to the parent. If the parent declines a medication or therapy or medical recommendation after hearing the risks and benefits don't interfere and try to change their mind. The provider is capable of documenting a refusal. If it's an order document objectively and let the clinical manager know.
Be be knowledgable about the primary condition and if there is a progression to the disease to watch for subtle changes and help prepare for the inevitable. Such as the progression of SMA. Or if the CP is the result of a brain bleed at birth know the signs of increased ICP or VP shunt malfunction.
You don't need to refer the the parent as Ms/Mr/Mrs but you don't need to refer the them as "Mom" either. If you start a new case ask what they want to be called.
Dont give treatments, medications or therapies that require a provider order. Using lotion on dry skin is one thing but don't put triple steroid cream without an order. Parent can give medications/creams if they want and you know it's safe such as Desitin for a reddened peri area if you don't have a standing order. Or a new case and the manager forgot to get Tylenol standing orders and it's 3AM, child is miserable with a temp of 102, parent can give Tylenol based upon package instructions (and you document parent did so) and you have the manager get a SO in the AM.
Whle you may be fond of a family working so often consider backing off and adding another client. Kids are good until they are not. If your primary gets admitted for pneumonia you will be the one that has an empty schedule. By adding or filling in on other cases you will get a little distance and can more easily maintain perspective and professionalism. Plus the parent will know other nurses are caring and competent should you need a shift off.
Even if you are aware of an egregious error by a colleague that you caught follow company reporting protocols and documentation rules. Don't do what happened recently nurses shared third hand knowledge. And a nurse two shifts removed started her notes with details regarding the incident that were inaccurate and the nurse didn't have first hand knowledge of, all this nurse needed to do was state that she reviewed new order to hold a medication. Not a two paragraph documentary as what she thought happened that lead up to holding the medication. Parents will read the chart.
Never bad mouth a parent no matter what and never ever in writing. If you have concerns regarding care or access to needed care involve the agency. Not do like one nurse did and write in the communication book (that is a legal document) that kids teeth are filthy (they weren't it was a drug side effect and this nurse was new to the case) and how the parents never come to the clients room
to play or hang out. Not that you would but I've seen some of the most ridiculous statements in communication books. Nurses now just sent the manager an email to come check out the notebook rather than respond in kind. The clinical manager handles the issue per agency protocol.
Most important and often hardest...leave work at work. Don't think about your client and seek things that remind you of your client. You have your own child. Leave work and turn your focus to your own family. Much easier if the family does not have your personal contact info. The client will be ready for you to focus all of you attention on at your next shift.
This was the most helpful advice I've gotten thus far. While I appreciate everyone's participation and suggestions I really needed this.
Specializes in Complex pedi to LTC/SA & now a manager.
This was the most helpful advice I've gotten thus far. While I appreciate everyone's participation and suggestions I really needed this.
Thank you very much!!!
Im glad in my insomniac delerium I made sense. the other option is to work overnights much less drama aside from some not-exactly-stable kids that like to crap out or party at 3AM.
Specializes in Home Health, Mental/Behavioral Health.
Im glad in my insomniac delerium I made sense. the other option is to work overnights much less drama aside from some not-exactly-stable kids that like to crap out or party at 3AM.
That is hilarious that you mentioned the 3am thing, my very first ped case was a "complex/no so stable" pt, and I did overnights, and this is exactly what happened! Lol. It kept me on my toes though that's for sure.
the other option is to work overnights much less drama aside from some not-exactly-stable kids that like to crap out or party at 3AM.
JustBeachyNurse, LPN
13,957 Posts
Im sorry you assumed that I meant you needed their adoration to build your own self worth. There are people that build their own self worth by standing on others to gain favor. The difference between them and you is that you see the lines that have become blurred and that you might a bit too involved emotionally. They do not. They are so intent on being the favorite they are blinded to everything else even when the world around them recognizes there is an issue.
Ways to not cross the line:
Dont give out your personal contact info all clinical concerns need to go through the clinical manager. All scheduling requests and changes need to go through the office. Even changes between nurses. I've seen this happen quite a few times. Parent gets so dependent on a nurse they are so clouded they call the nurse instead of the physician or 911. (Not likely, at least for clinical issues in your case as you stated the mom tries to minimize medical contact. But the clinical manager needs to be aware not just the field nurses)
Don't be Facebook friends. If you are already, place the parent/family on "restricted" so they only can see items you tag them in or make public. That way you don't have to deal with the drama of I un-friending.
Dont refer to the child as my patient. Refer to the child by name when speaking to other professionals. Try to not see your family in the child, see the child for the individual that they are, try focusing on what makes the child special/unique not what characteristics remind you of your loved one.
Ive seen some excellent PDN cross the boundary of professionalism and it's not pretty. They are so clouded in their judgement someone always gets hurt, whether another nurse, too familiar with the child subtle changes are missed, they cross into fantasy seeing progress that not one other person in the universe other than a parent can see. Parents need to have hope even if they are delusional. It's their child but the professionals don't need to feed into the delusion. There are nurses that convince themselves. They start arguing with therapists to re-initiate unrealistic treatments and equipment trials when the cognitive and motor function is objectively non-existent. Such as putting a near-comatose child that can't even hold up their own head never mind torso, never ever voluntarily move their legs even in withdrawal to pain in a gait trainer because "I believe (child) will walk if we just cram their body in there with four staff members to hold the child up and move the legs ". Parents should have hope for miracles and recovery. We don't need to crush their last strings of hope but we don't need to be delusional. Suggest having a PT consult for new range of motion exercises to prevent contractures . Don't ask the PT to order unnecessary equipment as a favor to the parent. If the parent declines a medication or therapy or medical recommendation after hearing the risks and benefits don't interfere and try to change their mind. The provider is capable of documenting a refusal. If it's an order document objectively and let the clinical manager know.
Be be knowledgable about the primary condition and if there is a progression to the disease to watch for subtle changes and help prepare for the inevitable. Such as the progression of SMA. Or if the CP is the result of a brain bleed at birth know the signs of increased ICP or VP shunt malfunction.
You don't need to refer the the parent as Ms/Mr/Mrs but you don't need to refer the them as "Mom" either. If you start a new case ask what they want to be called.
Dont give treatments, medications or therapies that require a provider order. Using lotion on dry skin is one thing but don't put triple steroid cream without an order. Parent can give medications/creams if they want and you know it's safe such as Desitin for a reddened peri area if you don't have a standing order. Or a new case and the manager forgot to get Tylenol standing orders and it's 3AM, child is miserable with a temp of 102, parent can give Tylenol based upon package instructions (and you document parent did so) and you have the manager get a SO in the AM.
Whle you may be fond of a family working so often consider backing off and adding another client. Kids are good until they are not. If your primary gets admitted for pneumonia you will be the one that has an empty schedule. By adding or filling in on other cases you will get a little distance and can more easily maintain perspective and professionalism. Plus the parent will know other nurses are caring and competent should you need a shift off.
Even if you are aware of an egregious error by a colleague that you caught follow company reporting protocols and documentation rules. Don't do what happened recently nurses shared third hand knowledge. And a nurse two shifts removed started her notes with details regarding the incident that were inaccurate and the nurse didn't have first hand knowledge of, all this nurse needed to do was state that she reviewed new order to hold a medication. Not a two paragraph documentary as what she thought happened that lead up to holding the medication. Parents will read the chart.
Never bad mouth a parent no matter what and never ever in writing. If you have concerns regarding care or access to needed care involve the agency. Not do like one nurse did and write in the communication book (that is a legal document) that kids teeth are filthy (they weren't it was a drug side effect and this nurse was new to the case) and how the parents never come to the clients room
to play or hang out. Not that you would but I've seen some of the most ridiculous statements in communication books. Nurses now just sent the manager an email to come check out the notebook rather than respond in kind. The clinical manager handles the issue per agency protocol.
Most important and often hardest...leave work at work. Don't think about your client and seek things that remind you of your client. You have your own child. Leave work and turn your focus to your own family. Much easier if the family does not have your personal contact info. The client will be ready for you to focus all of you attention on at your next shift.