madwife2002
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Nutella a great insight-In 2000 my mother was diagnosed with a stage 4 uterine ca. The specialist said nothing they could do-too far gone and was not operable. My mother and I had talked for years about end of life care. I lived 5 hours away and would visit at the weekend. I missed a weekend and while I was gone my mother was offered radiotherapy, when I arrived at the hospital she was screaming in agony, was red raw between her legs and was in a horrible condition. The hospital had stopped pain meds because they said her mind was befuddled. I talked with my mother, we agreed enough was enough and it was time for hospice-to control pain and move her down to where I lived. The RN on duty informed me that I was a cruel wicked daughter for asking for treatment to be stopped, that my mother had lots of life in her. We moved her to hospice and my mother died peacefully 3 days later!!!!!!
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Death came to visit Friday, it was not kind, and it was not peaceful for my friend's mom-it was hard, she struggled so much, her mind was ready, but her body fought her to the bitter end; causing trauma to her loved ones who stayed by her side so she did not die alone. The family had discussed end of life choices, and treatment was stopped on Tuesday, with the only intervention being pain medication. Death is still a taboo subject that many of us prefer not to discuss. Why is this? Unless you work as a healthcare professional, the clergy and funeral directors, many people are not able to talk about it freely. As a nurse who has been with many patients as the end of their life, I know you cannot prepare their loved ones for the final end. You cannot say that it will be peaceful, you cannot give a timeline and you cannot promise how it will be because you really don't know. There are relatives who have no clue about what their loved one wanted. There is often no discussion about end of live choices. I have been fortunate to be with my sister and my mom when they breathed their last breath and it was peaceful, calm and a relief that their struggle was over. I have been with patients who have passed away peacefully without pain, without struggle and without suffering. I have also been with patients who have fought to the bitter end, every last breath being a struggle for them. It was like something from a horror movie only it was real life. My question is why? Why do some people have horrible deaths and some people go quietly. It certainly doesn't pertain to how they lived their life; I can vouch for that with my own eyes, experience and knowledge. My mother was a feisty firecracker of a woman who fought for everything in life, never gave in to anybody and would never hold her tongue. Yet her death was one of the most calm, peaceful I have ever experienced. When somebody passes what determines if it is peaceful? What would determine if death is going to be horrible? Is planning important, should patients and relatives make known what they want near the end of life? You still cannot guarantee that death will be peaceful, however everybody involved knows what their loved ones want. Is it the environment they pass in? Can we choose where to die? Hospice is a wonderful environment, where the nurses, aides and doctors are amazing. I have never seen such caring individuals. When my mom passed many years ago they were amazing, I will never ever forget the kindness my mom received and how supportive they were to my husband and myself. The atmosphere was incredible in a hospice where everything is available for support. Nothing was too much trouble; nobody seemed rushed or didn't have the time to spend with her. Hospital can be a frightening place for many people, yet many will die in the hospital this year. Some expected deaths and some unexpected deaths. Relatives can add peace or trauma when their loved one is dying. The circumstances of impending death play a huge role for end of life decisions. Is the hospital environment a good one for a peaceful death? Yes it can be. It can also be a very traumatic experience. How many things can contribute to peaceful versus traumatic-who or what determines the definition? Hands up! How many of us nurses have witnessed needless interventions, pain and suffering? How many of us have experienced relatives prolonging life as long as they possibly can? Does this add to the trauma of their dying? End of life discussions can be very difficult; but it shouldn't be; as it is something we are all going to experience as our only guarantee in life. Many people do not have a living will. Many people do not even understand the terminology 'Living Will'. It makes no sense to them, although we as healthcare professionals are much better at promoting living wills. Even with a living will there can be struggles to make sure your wishes are followed, but without one relatives can fight and disagree with each other about what they want. Clear precise instructions can at least highlight your choices helping relatives to make better decisions on your behalf. In 2007 only 41% of the population in the United States had a living will. In 2009 President Obama made it more popular by publically talking about his living will, saying it is a sensible choice. In 2013 only 1 in 3 people had a living will, 32%, Findlaw.com In March 2016 "American College of Emergency Physicians' stated that two thirds of Americans don't have a living will! Question of the day-Do you have a living will? Or are you part of the 2/3rd's that don't have one? Less Than One in Three Americans Have a Living Will, Says New FindLaw.com Survey http://newsroom.acep.org/2016-03-21-Nearly-Two-Thirds-of-Americans-Dont-Have-Living-Wills-Do- The living will needs resuscitation For young and old, it's wise to have a living will to state health-care wishes - The Washington Post
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Cowboyardee-it is indeed a good read It does say that EQ can be used for both good and bad, I am an advocate for EQ because my emotions can be detrimental to me in my position. I need to be able to function more effectively. Since using EQ in my work life, I am identifying where I need to moderate in order to get what my team needs. Sometimes we have to play the game.
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Emotional Intelligence or EQ Emotional Intelligence (EQ or EI) is a term created by two researchers - Peter Salavoy and John Mayer - and popularized by Dan Goleman in his 1996 book of the same name. In the recent past it was always considered that IQ was what got you employed in most jobs especially healthcare. Today Emotional Intelligence or otherwise known as EQ is considered far more important than your IQ. Years ago IQ was the focus and tended to be what employees looked for when employing a RN, when interviewed a lot of questions revolved round responses which may have required you to be an expert on the subject matter and your ability to perform the job. Today it is believed whilst IQ is important it really only counts for 25% with the other 75% being your emotional intelligence. Interview questions will ask you how you respond in certain situations, they can include question about relations with co-workers and previous managers. Interviewers want to know how do you work under pressure, with emphasis on conflict management. EQ is not measurable in the same way that IQ can be measured because EQ is subjective, it is emotions and emotions can depend on the moment, the situation, your stability in life, to name a few. EQ is your ability to handle stressful situations, your emotions, and your responses to a trigger in your everyday life. So what it a trigger? A trigger maybe somebody who you do not have a great working relationship with, suddenly pushing your button and you respond in an emotional way. They may be late on a report, they may be late or don't complete a certain task. Triggers could cause you to be very negative towards a certain situation or a certain person. An example of a trigger in my life-My boss questions me on every single cent on my expense report, every month without exception. Every month I wait for her to question and I am fired up, angry, indignant, upset and ready for a disagreement with her. I am immediately on the defensive, even if there is nothing to defend. This leaves me feeling stressed, upset, negative and feeling of inadequacy. It has an impact on physical health and well-being. I have included co-workers in my rants, which has caused them to feel miserable. A better way to handle this situation would be to just answer her questions and move on. Not telling myself a story about how she is out to get me, or how she only picks on me. The higher your EQ the better you are able to put things into perspective and manage your emotions. Disagreements with co-workers, patients, and family members can always be handled in a different way. The big question is how do you plan to change your behavior and your response in situations. The most important step you can make in your journey is to identify your triggers, this could be something that always makes you angry, it could be something out of the blue and you respond immediately. For example you are in a line and somebody pushes in front of you or you may be cut off in your car-your immediate response is anger and indignation. You may or may not respond verbally, body language and facial expressions will be evident. Your BP may rise, your fight or flight responses will be initiated you whole body will respond in a negative way. Do you always make the right decision when 'confronting' this sort of situation? At work a patient is rude to you and you respond inappropriately then this situation doesn't rest easy with you for the rest of the day, so you seek affirmation from your co-workers, which then has the ongoing effect of dragging down the mood of the team. You may have conflict with Doctor, I am sure most of you can identify with this situation-This can quickly affect your mood, your indignation and affect the mood of the floor and day. EQ is learning how to manage that situation so there is a positive outcome, managing your own responses to the situation, managing the outcome and managing the Dr. You have to review how you behave when you are triggered; you need to evaluate how you are making other people around you feel when you are triggered. Could you have handled the situation differently? Then you make an action plan of how to respond better to triggers, do you have any indication that you are triggered? Role-play conversations with somebody who you consider 'safe' a mentor or a life coach. Mentors do not cost anything apart from time and investment from both of you. There is a commitment that you talk weekly; it can be formal or informal, in person or via the phone. You have to trust this person, make ground rules especially the 'Vegas" rule! Life coaches can be expensive but a great alternative if you want somebody outside work who is not tied to your company. There are literally 1000's out there you will need to do research as with everything there are good and bad life coaches. Do reflection, start noticing your responses to certain people in your life, this doesn't just apply to work, it could be in your family or any outside activity. Start a journal initially twice a week, or when you have identified that you have been in a situation you could have handled differently. Reflect on what you could have done differently, thinking about how the situation made you feel, the person who you were dealing with felt and also the people around you. Once you start evaluating your behaviors, triggers, your responses to situations and start changing. You will start to recognize when you acted or spoke appropriately and can alter how you manage certain situations. On occasions you even recognize that the way you behaved which you thought was positive could be improved. EQ is going to be life long learning, are you going to always handle situations appropriately-No of course not life is unpredictable and can change in an instant. You cannot predict how somebody else is going to behave; you can only change how you respond and how you manage others especially when under pressure. You can however learn to manage your EQ so unlike IQ, which is, pretty fixed-EQ can be modified. Further study is recommended-there are literally 1000's books out there devoted to EQ. Live courses, WebEx's, journaling and life coaches are the way forward. Recommended reading 'Emotional Intelligence 2.0' by Travis Bradbury and Jean Greaves-includes a EQ test to give you a base line to start from.
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Wear business clothes, closed toe shoes Shake hands with your interviewers-even if they don't offer their hands walk over and offer yours Take several resumes and hand to each interviewer If you do not know the answer to the question do not waffle on-stop, think, ask them to rephrase the question and if you still don't know be honest. Write down a list of questions and ask them
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No nursing shortage just a shortage of good nurses
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Moved to Private Duty Nursing forum at the request of the OP
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First of all thank you for caring so much that you are asking for advice on the renal diet, two things you need to know are your patients on dialysis or are they on a renal diet to slow down their kidney deterioration? By this i mean are they stage 3 or 4 pre dialysis patients? The reason I ask this is because the Renal Diet is different for pre dialysis patients-my suggestion is call or send a note to the dietitian at the renal centre where they get their dialysis. Each patient has their own specific diet prescribed for them and the dietitian at the dialysis facility would be more than happy to send you information on each of your patients. Dietitian love it when nursing home staff contact them about this as they have a deep frustration when it appears NH patients eat just what ever they want, plus drink what ever they want and their lab results suffer as a consequence. Call the facility before you leave-staff in renal units start very early and leave a message on the dietitians voice mail or speak with an RN who can get you all the information you would ever need. If the pt is in end stage renal failure but not yet requiring dialysis then you need to speak with a dietitian at the doctors office or you can fax the dietitian and ask for them to provide you with a diet for that specific patient I hope this helps
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Welcome to allnurses I have moved your thread to this forum as you will get more responses
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Do you have any Renal experience? A lot of dialysis centers are cross training their home nurses these days, the RN's will do the PD and HHD training. It takes about 3 months to train/orientate a RN to PD and the same for HHD. You can be expected to train 2 PD patients a day-their training and it should be individualized can take 8-10 days. Currently if you use baxter products patients are experiencing a delay in going to IPD using the NXstage peritoneal dialysis machine, so patients may go home on CAPD. They will need to return to the clinic to retrain onto Nxstage. You will be expected to be once for home patients, should there be an emergency overnight you would troubleshoot issues and problems via the phone. Monthly labs and follow up Nephrologists will see puts monthly, normally at the home therapy center. Home visits for new patients and home visits to assess conditions post peritonitis A lot of IDT work Education for family and patients
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Moved to NCLEX forum
