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miracleluke

miracleluke

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miracleluke's Latest Activity

  1. miracleluke

    Physical Assessments: Do Any Nurses Do Them

    That's funny Jomonurse! I was just wondering,because it is possible to still be working and 94! There are a handful of those people still out there! I was just going to be so amazed and awed by that fact! Age is just a number! How you take care of yourself and live your life tells the real story, right? I am 49 and look and feel more like 100! LOL! Take care! All my best!
  2. miracleluke

    To aspirate or not to aspirate?!

    Again, What I have been reading holds true then, "That in Nursing we never stop learning and the day we do, should be the day we consider getting out of the profession! Always keep your ears and eyes open Nurses to everything that comes down the pike towards you to offer you a new way of doing it if it improves the situation, but question it if you are not sure and make sure you research it to back it up!" Good Luck Nurses!
  3. miracleluke

    I witnessed the most horrible death last night at a LTC facility.

    saintplatypus! Sometimes there is nothing you can do with families that are that way, Either they have other motives for a quick death or they are grieving in a way you cannot get through to them. I am sorry you had such a terrible experience in your facility. When something like this happens the only thing you can do as a professional is Document, Document, Document!!!!!!!! Make sure everything you do is in writing so if some family does decide to go to court the LTCF has a leg to stand on! Good Luck!
  4. miracleluke

    I witnessed the most horrible death last night at a LTC facility.

    You are so right cxg174! And doesnt that make it that much harder for all of us who work for reputable companies to get in there and prove to them that not all are the same? I agree whole-heartedley! So back to Topic: Kelly, we are so sorry you had such a bad experience with this death, but please believe us that not all Hospices are alike! We did want to impart to you however that you did do the best you could under the circumstances. We believe as Hospice Nurses that having a TF going is only going to make the death more difficult on the patient. What we all as Hospice Nurses want you all to know is that having IV fluids for dehydration and TF for nourishment is highly discouraged in Hospice patients that are at the end of life because they would have a much more peaceful death having less fluids aboard without these. The body just does not require that much when the systems are shutting down. So please in the future we just want you to understand that is why we are telling you this, not to be mean or to try to starve someone to death it is just easier on them during this process. As I have read from other Hospice nurses in this thread all of what we are telling you is true. We have all seen it both ways and can stand by what we are saying! Take care and research the Hospice Companies you are letting into your LTCF's and know who are the best at providing you with the information and the care your Residents deserve! Now as cxg174 stated it is illegal for you to suggest a certain one Hospice program, but you can educate yourself to the ones that are more reputable. Take Care.
  5. miracleluke

    Physical Assessments: Do Any Nurses Do Them

    Jomonurse! Are you really 94 years old and still working as a nurse? Kudos to you!
  6. miracleluke

    To aspirate or not to aspirate?!

    Plus, it depends on the medication you are injecting and the recommended ways to deliver it based on how fast it acts that you need to be aware of as well as if you are in a vein or not? Again, why take the chance? I say Aspirate! and be safest!
  7. miracleluke

    Physical Assessments: Do Any Nurses Do Them

    To RNandsoccermom: It is very scary to be a patient these days! As an RN I have seen this from both sides of the fence so to speak. I always advise my family and friends to not go in the hospital alone. Take someone you trust to be there with you as your advocate. Hospitals are so understaffed and Nurses are overloaded so many times in an unsafe way that the only way the needs of a patient are heard or seen are when a family member chases you down the hall to tell you what they need. I hated this part of my job in the hospital! Like I said before, I worked the noc shift 8 hrs shifts and I had 14-16 patients sometimes. You can do the math: that is 30 minutes roughly per patient! How can you give safe and effective care when you have that kind of load to carry? You can't! My unit was a surgical/oncology unit. I was admitting people that came from the EMR, recieving new post ops from recovery and hanging Chemo and monitoring those patients. When will our Health Care System wake up and see this cannot go on! And Nurses it is our licenses on the line! The hospital is not there to back you up when something happens that will jeopordize your license. I say just be very careful, pay attention and don't put yourselves in that type of situation! To all the New Grads! We need you! As a new grad I was told by a very wise professor to work a year in Med/Surg first because there you can get your time management and Assessment skills down to where you have a routine that works and then be ready to move into a more acute area. That was the best advice because on Med/Surg you see alot of different types of patients and can learn a boat-load of good stuff to prepare you to move on into the more Critical Care areas. I learned I never wanted to do EMR, OR or ICU's! That was not my cup of tea! I loved the medical/surgical setting and Oncology was fun too which helped prepare me for my Hospice choice of nursing! Be sponges and ask to learn anything new, to take part in any new procedure a doctor may be doing and never be afraid to ask questions. That is how we learn! And as Nurses we never stop learning in this profession! It is on-going! RNandsoccermom, I didnt mean to pick on you, but you brought up a very valid point in being a hospital patient today! It is not because they do not want to give you the best of care , it is because of the way these medical centers are staffing! Its all about numbers not acuity anymore. Bring a family member to be with you so you know you have someone to speak up for you! Take Care all! And for heaven sake, New Grads reap what you learned in school and continue to follow what you were taught! PA's are a very vital part of your shift and the way you care for someone! It is imperative you establish a baseline for your shift! This is safe Nursing Practice! Take care and good luck to all the New Grads!
  8. miracleluke

    I witnessed the most horrible death last night at a LTC facility.

    I dont know what part of the country you work in cxg174, but I work in the midwest and I have worked for 3 different Hospice organizations(for profit and not for profit) here and they all provide supportive care to the LTC Resident as well as support to the staff in those facilities. This is part of our model here and I can only speak for here. I am glad to see we are doing so well here at our jobs as our Social Workers and Chaplains are on top of this aspect of Hospice services and hold regular grief meetings around town here as well as in the LTC facilities themselves for LTC staff. We also provide this support to families at home and direct caregivers in the home whether related to or not to the Hospice Client. I know things are different in different parts of the country and I am sorry about this as Hospice is a wonderful service and I think everyone that needs it deserves the entire service, not just the nursing component. Our Hospice team is comprised of a Medical Director(MD),RN, LPN, CNA(HHA), Social Worker, and Chaplain as well as Volunteers. We all work together and communicate together regarding our Hospice patient and Caregivers(Family, LTC staff or just hired caregivers). My sisters MIL just passed away a few weeks ago on the West Coast and I was surprised how different their Hospice Services are compared to what we offer here. In a way, we are so much more ahead in the Midwest than what they offer on the West Coast which was so surprising to me! I am glad that you enjoy Hospice and I am sorry that, that LTC place you were in was missing the true benefits of what Hospice can offer them. You know, I have also worked in LTC with nurses that were too busy to call with questions or ask for Hospice to come in to help. There was a huge learning curve once Hospice went into the LTCF. They are now reaping the benefits now that they know we are not coming in to replace their care but to enhance what they can do to keep their Residents the most comfortable during their transition in end of life. Sorry, I really did not write what I did to offend you or anyone else for that matter. Take care.
  9. miracleluke

    I witnessed the most horrible death last night at a LTC facility.

    cxg174, I am sorry you did not have a good experience being a hospice nurse. It really is not an area for everyone. I believe Hospice in LTCF is a good thing. They are there to support the staff just like they are in the home situation supporting the family. I have seen more good come from having Hospice employed in a LTCF patient than when it wasn't. I too have worked in both areas and I believe that Hospice is a God-send for anyone regardless of where they are living! I am not lectureing you, I just want other nurses to know that it is a good thing and if you are in LTC then please utilize the services provided you by Hospice to ensure that the Resident gets all the benefits at the end of life! They really deserve that and Hospice is available to LTC staff for counseling just like they are available to family members up to a year after the death. So Kelly, look into this in your facility with the Hospice provider you had working with your resident! They can be very helpful to you too and maybe just talking with someone once can help you find some closure to the whole event! Gods Blessings to you all!
  10. miracleluke

    I witnessed the most horrible death last night at a LTC facility.

    Well, I guess I am the first Hospice Nurse to reply?! Kelly, it sounds like this man turned for the worse very quickly and as a hospice nurse you did everything right! You stopped the TF right away! You gave Roxanol, Atropine gtts, Ativan all as prescribed. All of these meds are indicated in helping open the airways and help the patient to breathe a little bit easier. But, Kelly the damage was done. His body obviously was shutting down and couldnt handle the fluid overload of the TF he was getting. This all can happen very quickly. Now as far as suctioning, at Hospice we will suction with a yankur(oral) suction when indicated but that is something we too have to have an order for. We will initiate if needed and then call and get the order if we have the equipment there and available. But in the meantime we have to employ what we have available. The Atropine gtts generally takes 3-4 doses before the gurgling is quieted. I agree that sound is very hard to listen to. The gurgling is usually deep and not in the back of the throat like it sounds and suctioning in that situation would be more uncomfortable to the patient. So in Hospice we evaluate what will make the patient the most comfortable the quickest and at that point it is the Morphine and Ativan. Both help each other and can potentiate the effects of the other in this situation. We would crank up the HOB and employ oxygen if it is not already being used. All of this is to make the patient more comfortable. In Hospice we treat the symptoms as they show themselves and we don't look at it in a curative sense because we know that this patient is terminal and all the efforts to get them well have already been tried. This sounds evil a bit, but I want you to know that TF are not indicated with Hospice and are usually done only because the family in not willing to stop them. This is when we as Hospice nurses need to step in and start doing some education on what is happening to their bodies. When a person is actively dying or in the dying process their need for nutrition or fluids is not in high demand. They actually are more comfortable with less on board than having the IV's for hydration and TF's for nourishment. I have seen patients go for days without food or fluids to drink. We aren't there to hasten their deaths we are there to offer them comfort and quality during what is going to be inevitable. We all will make this transition in our lives just like we were born and we all will face a certain amount of fear during this process because we don't know what is happening or where we are going. To be a good Hospice nurse one really needs to be in touch with their own mortality and spirituality. You don't need to be spiritual but it helps! I have seen so many positive beautiful deaths in my time as a Hospice nurse that outweigh the more tragic ones. Please remember you did all you could for this man and you did the best! He is in a better place now and is pain free! I too, take to heart my patients when they pass because they impacted my life in a way I will never forget them, but I learn from each one. Please trust in your local Hospice nurse and also trust in your own gut feelings like you did! Hospice did not tell you we don't suction, but that is probably what you heard because there is so much more we can do that is more comforting for that patient than sticking a tube down their throat at that time. Maybe that particular Hospice Nurse didnt say what she really meant to say so you could understand that. She sensed your angst on the phone and was trying to get there as soon as she could to help you. It is very hard to talk , drive and give instructions without sounding sometimes abrupt! I try to always put myself in the person I am talking to shoes and hear what she is hearing when I tell them what I am trying to explain. Some people don't do that, I know. Please, don't remember this situation as a nightmare you care not to repeat any time soon, but learn from this and next time you will know exactly what you need to do. Take care and all my best!:wink2:
  11. miracleluke

    Physical Assessments: Do Any Nurses Do Them

    What??? I think that many nurses are lazy, not just older ones as I have seen younger new grads do the same thing! I worked on a Surgical/Oncology Unit a few years ago and we all had 14-16 patients each on the noc shift! It always took me longer to get done with my initial rounds and pass meds than the rest of them! They were always finding time to run around and visit each other or go to other floors or just sit and talk at the nurses station. I was floored by this practice. All I could think of was, "One day it would come back and bite them in the butt big time!" I knew I was responsible for my own work and documentation and if I didnt do it, it did not get done! That was my feeling. I made notes on my "brain(report paper)" I carried around all shift and most noc's would not get done and be ready to start my charting until I reported off to the next shift! I was that busy! I rarely took a lunch break! We had cows(computers on wheels) that we took with us into the room to chart and scan meds when meds were given and when I had the chance to sit down it was usually a quick note here and there but my major charting was saved until I could do it uninterupted in a corner after I gave report and no longer had to run every time someone called and needed something. I don't know about anyone else in the nursing field but I worked damn hard for my license and I am not going to jeopordize it by cutting corners! Besides it is a human life we are dealing with, and I think if I was in that bed I would expect my nurse to be on top of things so that my recovery period is not extended due to an unobserved complication! Put yourself in each one of your patients places and think of how you would feel if someone neglected to make any necessary observations early enough to fix the problem or nip it in the bud! Good Luck and I hope you continue to operate as a nurse on the floor with a conscience and not worry about who gets done first or gets the most credit! Our jobs are not ones meant to be competitive! We are working with human lives here people! This just angers me when I see it! I can not work among people who are careless and also put my license on the line because we are part of a team! This makes no sense. I now work with Hospice patients and believe me I am still making the thorough assessment with each patient I see! They arent dead yet and deserve the right to have all their symptoms addressed as they pop up!:wink2:
  12. miracleluke

    To aspirate or not to aspirate?!

    Ultimately, who is responsible for that person you are giving the injection to? You are! So my advice is to remember what you learned and why you learned to do it that way and continue the procedure of giving an injection the way it was taught to you in school! That is the safest and surest practice! The other nurses you are observing not doing this are only responsible for themselves and if something should happen to that little patient they gave an injection to, they would be the ones responsible, right? Protect yourself and instead of following the leader, do what you think is appropriate based on your knowledge and nursing practice that was taught to you and what you know is correct procedure.:wink2: Good Luck!
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