hcan

Our hospice is a member of the state organization, and some of us get to go to the conferences and we do sometimes take advantage of the web conferences that are offered. I am also a CHPN, but have not enjoyed any recognition or financial benefits from it. I was thinking more in terms of an individual membership.

Do any of you who are members of a national or state hospice organizations want to share the benefits of membership? What educational opportunities have you taken advantage of? Has it helped you in your understanding of symptom relief or patient care? Has it benefitted anyone to have their chpn? Thanks.

I worked at a small hospice that used haldol very successfully for control of opioid induced nausea. We would start it at 0.5 mg bid, a very low dose, and if need be, we could increase it to 1 mg bid. We could also add benadryl if there were any signs of eps. Look at the haldol results on this study. http://www.mywhatever.com/cifwriter/library/70/4938.html frompalliative care perspectives. My condolences on the loss of your mother. Coming from a total stranger it may be meaningless, but it is heartfelt.

I believe the year bereavement follow up is pretty is pretty standard. We also have it, but it must be pretty impersonal when it comes from a bunch of strangers. It seems that it would be much less meaningful than if the family had actually had some bonding experience with the hospice staff as their loved one went through the dying process.

Aimee, of course you are right. It would most definitely be in the hospital's financial interests to delay hospice admission as long as possible. Sucks for us!

We hardly ever use IV access at our hospice. With all the other routes of medication admin, we seldom need to.

I am the on call nurse for a hospital owned hospice, and we have run into a situation where the hospital is using the hospice for last minute "emergency admissions", very often after hours. The patient is admitted to hospice, sometimes even in the last minutes of their life, in order to protect the hospital's mortality rate. Apparently, the hospital benefits when the mortality rate is lower, and patients who die as hospice inpatients don't figure in to the rate. So we are doing the long admission process, and the floor nurses are having to change out charts to reflect a different billing process, which is time consuming and confusing for them, the patient is being disturbed by the transfer to a designated "hospice ward", which has no benefits for the family as far as creature comforts or additional room or chairs etc., and we as hospice nurses are frustrated by not being able to assist the family or the patient in the process that leads to a peaceful death. Has anyone else any suggestions to help this situation? I try to bear in mind that ultimately improving the bottom line for the hospital is good for us, but on the other hand, we are a separate entity, and our staffing is not adequate to cope with the admission/death flood we have been getting.

Does anyone use a good algorithm for wound care that could help our hospice set up some definitive treatment plans (allowing ,of course, for individual quirks)? I respect your thoughts and advice. Thanks.

Hey be ex. You have my sympathetic understanding. It is a bitter bread to eat when you have a patient in pain that could have been prevented. Its all good though. A learning experience for you as well as for all of us that share your pain. We're not perfect. Our hearts are so eager to comfort and relieve, but sometimes we find mistakes. God bless you, and don't forget all the patients who are so grateful that you were there to ease their pain.

I guess all the results were sent out this week. I got my results from the Nashville test too. I passed, and did well in everything except patient and family care, which I bombed for some reason. What kinds of questions were those?

When I first started hospice, we had to work during the day, and then take call for a full 7 days at a time, with a 3 week rotation. I lasted 6 months before I switched to another hospice. Now I find myself at a 3rd hospice as the on call nurse Mon- Thurs. 5p-8a and off every Fri-Sun. I have call for 60 hours per week, whatever may come, including admissions. Some weeks are sweet, and some are, uh, otherwise. It's a salaried position with all the benefits of a full time job. On the sweet weeks I feel kinda guilty, but I've had enough busy weeks that justify the position and salary. It's a dangerous job, what with the night driving and going who knows where into who knows what environment and being expected to make everything alright. We also have a weekend call nurse, so the case managers only need to do backup call, and I know in the 7 months I've been doing this, I haven't had to call one yet.

I went to a patient's home this week at 5 am bc the pcg said the foley wasn't draining. I picked up the tubing from the mattress and 300 ml flowed out immediately. The pcg apologized and was deeply embarrassed that he had called me out, and vital signs were just not necessary. I wondered though, bc I've been told that vs need to be gotten with each visit. I personally don't agree--that visit being a case in point.

When an on call nurse goes to a home, is it essential that she get all the vital signs each visit, even if they do not apply to the present situation? Is this something that varies state to state?

I've worked at hospices where the md's took whatever came down the pike, and were great with orders for symptom mgmt. It is really nice to have a med director who knows hospice and can direct care. Most MD's don't havae the understanding of symptom mgmt, and most doctors don't mind turning their patient's over, unless they have had a bonding relationship with them. At the hospice I work with now, we try to stay with the referring doctor because our med director is reluctant to take many patients, and it's not as easy on the nurses.

Holy shmoley! I thought I knew a lot about hospice, and I studied whatever I knew to study, but even so, it was an uncomfortable exam! There is a whole buttload of stuff I don't know! It's like I brought my little microcosm of hospice knowledge and needed to know about the macrocosm! Even so, it was a good experience. I love working with the dying, and everything I can learn about easing their symptoms and helping the families cope with the care puts me a step ahead. Even if I didn't pass the exam, it opened my eyes to what hospice can do. Although...a mighty expensive lesson!!!