Second

Hello! I am a home care nurse wanting advice from all you wound care pros. I have a patient who has HIV and Hep c. He is almost 80 and has lived long in spite of these long term infections. He now has a wound to the dorsal foot that started as a trauma injury but has become infected with MRSA. the caregive says this wound has slowly grown in size over the last 6 months. It is is now 4x3 centimeters approximately and has a red beefy appearance, no foul odor and moderate serosanguinous drainage. Our orders are to cleanse with wound cleanser, apply a debriding agent cover with gauze moistened with 1/4 strength Dakins solutions and cover with kerlix. What do you think? The order is different from what I am used to and I am not an expert. I want to make sure we are doing the best for this very sweet gentleman. Previously the caregiver was soaking the foot in water and epsom salts per physican order and this only made things worse. This doctor likes to give orders but admits to a knowledge deficit in the wound care department and would be open to suggestions. Any one have ideas?

Hi does anyone use a single page cheat sheet to make sure you have all the info required for SOC. I hate to add another paper to the pile, but I thought I might be helped by trying to get everything on one page while in the home. It feels awkward paging through mountains of paper work while interviewing and assessing. If anyone has such a thing I would love to have it!

hi all- I started this thread feeling rather desperate about the paper work and I am now finishing week four on my new job. I have been realizing this week that I absolutely love my job. Yes, the paperwork is awful and sometimes even silly. This is the approach I took. I followed the advice of one writer on this thread and organized my SOC visits differently starting with the med list and using a cheat sheet to make sure I didn't miss important elements. I'm trying to write as much in the home as I can. I am also really preparing for the visits writing anything that can be written in advance. The most important thing I did was I told my supervisor that the best way for me to learn the process would be to do a lot of SOCs and ROCs and Recerts until I get the hang of it. I've been doing one a day or sometimes 4 revisits. I figure the best way is not to avoide the hard stuff but just to do it over and over. As you can imagine my supervisor is only too glad to have me do her intakes and recerts! And it really is a good way. The first few days felt like hell, but suddenly I see the light. If you take too long between doing the big paperwork items like SOC you keep having to relearn the same thing. A lot of repetition really helps. I am so excited to be learning this part better so I can focus on patients. I have to thank all who encouraged me on this thread. You helped me hang in there and get creative. I am interested in anything and everything anyone has to say about what helped them learn this job.

Hi Enursl, I want to say that after 3 weeks, I am hopefull that I can master the paperwork. It is the hard part and I am taking the attitude that I want to learn it as quickly as I can so that it does not become a constant bother. I have also resolved not to waste time talking about how bad the paperwork its because it only makes me feel worse and really, all jobs have something negative. In this job, I am already loving the intimacy one has with patients at home and the freedom to schedule things as I like. In my agency we are all busy, but it helps to be able to set one's own schedule. I too like the idea that I can take paperwork home and do it on the couch in sweats! Being able to go home keeps you out of office politics and negativity. I have much to learn and I do think it will be months before I am truly comfortable with this job, but I think I will love it.

Thank You all for great suggestions and encouragement! The past few days I haven't been able to use my computer and I was so happy to have your notes. This week I seemed to have one good day followed by another in which I felt at sea. But this is progress. Today I had an all day OASIS seminar. Surely a bunch of sadists gathered in a room to figure out how to torture hard working nurses and came up with this! But I tried mightily not to be bored and to understand the forms. There is so much to it. Is there anyone out there willing for me to ask questions about paperwork if I'm stumped? I think my plan (0nce I'm out on my own) will be to see patients early doing as much paperwork in the home as possible and then actually going home to finish the rest. The office is full of interuptions and it's distracting. Does that sound right?

Hi! I am new to home care and I am overwhelmed by he quantity of paper work. My preceptor is extremey quick at it which is good for her, but it is hard for me to follow and I keep forgetting things. Does any one have a system to help keep paper work organized, for speeding up paper work? My agency is still on the pen and paper system. Today I was out on my own for the first time on my second week on he job and had a recert with a foley catheter change,wound care and PT INR and a revisit with someone quite confused with COPD. There were MD. calls to make and urine to take to the lab. It's the eveing and I still haven't finished the recert documentation! I love being with the patient at home-- it's wonderful. But I need tips, little tricks to keep the paperwork as simple as possible. I worked in an inpatient hosice setting in the past and my paper work was always good and fairly efficient there. Here, I feel like I've been knowcked upside the head. I feel terrible that it looks like it will take me months and months to learn this and be quick at it. Ideas, encouragement, experience? HelP!

I passed with 75 questions and relied heavilly on Saunders. It's a great tool because it is organized by body systems and that was a nice way for me to study and learn. I also read some elsewhere on test taking strategies and that helped to. Good luck!

I have found it helpful to let hospice work remind me of the preciousness (if that's a word) of lifel as well as the fragility of life. Working in hospice helps you see that every day counts and that it is up to you to make yourself a good day each day. Working in hopice you will meet people who really grasp that-- they are fun loving adventurous people who know what to do with their free time and who are able to really enjoy their patients. There are many people who aren't meant for this work and they find out quickly If you have worked in Hospice already you know what the work is. DOn't be afraid of it if it's your calling.

I will be coming to the Bay area in AUgust for 2-weeks to look for a job. Then I go back to Ohio with the plan of moving to CA in September. I want to make the best of my AUgust visit-- set up interviews meet potential employers and figure out where I want to work-- ideally even lay the ground work for getting a job. I have a free place to stay in Berkley until I get settled in, but I want to find a job quickly. I am open to living just about anywhere in the Bay area that is safe and affordable for a nurse. In the workplace I look for a congenial atmosphere, team work and really good patient care. My question is-- how can I make the most of my August visit? Who should I see, who should I call before hand? I have 18 months experience as a nurse in inpatient hospice and by the time I get to California I will have had about two years. I also have 25 years as a clinical social worker, which may help me with some jobs. (But I want a nursing job. )I lwould enjoy doing home hospice. In the much more congenial workplace (I refer to patient ratios!) of California, I would also consider doing oncology or med surg. or other jobs in the hospital setting. Should I talk with a recruiter? My problem is that I live in Ohio and it is hard to job search from here, so I want to make each day count when I come for my visit. Does it seem possible that I could actually find a job during that time? Are there any hospitals that I should be applying for already? :spin:

I am interested in moving to California and am currently browsing jobs on line. Some Kaiser jobs have numerical designators, eg., RN II. Does this designation refer to a salary. How can one know how much a job pays at Kaiser. I assume that because of the union there that this information should be public? In any case I need to know about Salaries before making a decision to move to the SF Bay area. Can any one help me?

Yes this is a clear HIPPA violation. If you do not have parents consent, preferably written consent, it is not okay to divuldge the family's personal story. The parent must be in control of this information. SOme teachers are notorious gossips, so you may be spreading news far beyond where you intend. While health professionals have rules about sharing private information, teachers observe very few such rules. IF the parents are suffering and unable to talk about things you might offer to help by sharing information, but as nurses we can't determine which part of a family's private life we should or should not divuldge no matter how helpful we think it might be. SO if you share make sure you have permission to share and know what the parents want shared. There is a big difference between- "the parents are experiencing some marital problems right now" and "the dad is a drunk and a womanizer and the marriage is over" But be ever so careful about HIPPA as I believe your colleague has violated it and has put her carreer at risk.

Whatever area of nursing you decide upon, you must make sure you have a good orientation to regain skills that we just don't use in hospice. I have known other nurses who have gone from Hospice to OBGYN. I think it must be wonderful to provide care both at the beginning and end of life.. The care you give to your hospice patients is holistic and emotionally supportive. Laboring moms need just the same thing. Something to think about. S

I have been working in an inpatient hospice setting for a year and a half. I love the work, and as a new nurse, I felt the inpatient setting was a better place to learn. Now that I have seen and learned so much, I am considering doing home care. What I would like is advice on how to prepare for the change. What do you carry with you? HOw do you prioritize your visits, make your schedule. Do you end up documenting at home in the evenings or is there time to do the job within the hours given? What are the more difficult challenges of working within the home setting? For me, what I would treasure is seeing one patient and family at a time.:)

We have had two patients with this type of wound in the last month or so. While superficial bleeding can be stopped in a variety of ways, it seems that nothing can prevent a bleed out if the tumor reaches a major vessel. I agree that it is helpful to prepare the patient and family for this possibilty. It is in fact quick and painless and the one's who suffer most are people caring for the patient who are unprepared for this. For bleeding from superficial vessels we sometimes spray Afrin directly on the bleeding areas with very good results. THis is something the patient can have at bedside. My patient also had a large deep wound which she prefered to keep open to air, partly because dressing changes were painful and the dressings she was using were sticking. Also wrapping the wound was awkward. WE ended up cleansing the wound with saline, spraying with Afrin, applying calcium alginate and ABD's. The patient came up with the idea of wearing a sleevless men's tee shirt instead of wrapping, THis held the dressing in place. The difficult aspect of these wounds is that they really don't seem to heal, just grow worse with the tumor's growth. We also administered morphine prior to dressing changes, and this helped the patient very much.

I would like to hear more about the aerosolized lasix. THis is new to me. How does it work. DOes it come pre-packaged. Any evidenced based articles? I am asking only because we use everything else mentioned here but sometimes we are still stuck with heavy secretions that don't want to move and sound awful -- I'd love to introduce the idea to our docs who are usually open to new ideas, but I need more info. Thanks.