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marachne

marachne

Hospice, Palliative Care, Gero, dementia
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marachne specializes in Hospice, Palliative Care, Gero, dementia.

marachne's Latest Activity

  1. Hopefully it's not bad form to post here about another forum. The Hartford Institute for Geriatric Nursing has launched a new forum. Some of the top names in the field (Mathy Mezy for example) are running the place, and it is focused on substantive discussions. You may want to check it out: http://forums.hartfordign.org/
  2. I often get the "that must be hard, I could never do it," but don't necessarily see a wince or a shudder, more often appreciation and/or admiration." I usually say how I love it, how it feels like such a prividedge and humbling to be with people at a most vulnerable and intimate time. If they are a nurse or a nursing student, I'll often add something about how that's one of the wonderful things about nursing -- there are so many different things one can do and so many different kinds of people to fill those niches -- I doubt I'd ever be a good ED nurse, and my exposure to ICU made it clear to me that that was not the kind of nursing that I enjoy -- and I'm so grateful that there are others for whom it's a perfect fit.
  3. marachne

    Hospice Opportunities in Arkansas?

    I don't know anything about the Arkansas VAMC, but across the US the VA system is doing a really good job with palliative care. And the VA is a great system to work in.
  4. marachne

    Public health nursing in Oregon

    Glad it worked for you -- really encourage checking out Outside In. They are set up to work w/students and HC professionals.
  5. marachne

    Public health nursing in Oregon

    Two places that come to mind are Outside In, which provides services to homeless youth and has a huge volunteer program specifically for people w/a medical background, http://www.outsidein.org/volunteer.htm and Virginia Garcia Memorial Medical Center -- I don't know about volunteers and you probably need to have pretty good Spanish language skills. Also, Our House of Portland may be able to use you -- they work w/people with HIV/AIDs Finally, I just put into google health care volunteering in Portland and got a listing through Business Week, plus this one via Reed College: http://www.reed.edu/seeds/volunteer/volunteer_health_care.html It's amazing what one can find w/just using a search engine!
  6. marachne

    How do you use the FAST Scale?

    So what, exactly do you think is meant by "CNS aging?" I would also refer back to the article I cited in my earlier post -- the reliability of the FAST has studied and validated with AD, but I'm not so sure about its reliability or validity for other conditions. For example, we know that vascular dementia has a different presentation, and therefore may not progress in the same way. Lewy Body Dementia is even more of a different course, and we're still talking dementias. (the line in the abstract I'm referring to is: "This system has been studied extensively and proven to be reliable and valid for staging dementia in Alzheimer's disease (AD)" I guess the caveat/point I'm trying to make is just because a scale/instrument exists, doesn't mean it's the best thing to use. Now if funding is based on using it, then you're stuck until something changes. But my understanding is that even w/CMS no one expects agencies to use the FAST for anything other than dementia.
  7. marachne

    Hospice question from a new-ish LTC nurse

    My thought is that someone needs to talk to you board of nursing about the behavior of the DON and NM. I would call them and ask about annonymous reporting, explaining, if necessary your concerns about your job/work relationships. Have you spoken to anyone in the hospice agency you worked with? They may be able to do an in-service on symptom management, that includes a discussion of the kinds of uncomfortable side effects that people can experience with opioids (and morphine often has the most uncomfortable effects, whether it is itching, or nausea, or just a feeling of vauge, general, discomfort), as well as a strong emphasis on patient-centered care, and how sometimes when we are medicating for (percieved) discomfort we are medicating the caregivers (paid or unpaid) as much as the patient! Good luck with this. I understand you being in a difficult situation regarding the work relationships, particularly in this economy, but you also need to be comfortable with your co-workers/superiors, and you do have an obligation both to future patients and the profession to report unethical/illegal behavior. One other thought, if going through channels does you no good -- contact a local television station and tell them you might have a story for them. Health care issues are allways good stories, and if you make it clear that you need to protect your annonymity, they will. I'm not saying this should be your first course of action, but if nothing else helps, bad publicity can be a very stong motivator to change bad practices!
  8. marachne

    Questions and a Request

    Bumping this up in hopes of a reply.
  9. marachne

    How Much Autonomy Do Hospice Nurses Have?

    I can't speak specifically for in-patient hospice, as you are still going to be w/i whatever is the culture of the institution -- after all, ICU RNs have a lot more autonomy, than the average med/surg RN, but that is going to vary from hospital to hospital, as well as the relationships between physicians/NPs and RNs. If she/he is a good one, having a certified hospice/palliative care physician will make a big difference, because the traning includes an emphasis on working cross- inter- disciplinary, and recognizing that that the folks that are at the bedside have the best picture of the current situation. Ideally, the RNs who are going to be working w/the doc would get to be part of the hiring process, but that's probably asking a bit much.
  10. Without getting into a "AD vs. BS" fight, I would argue that there ARE advantages, in terms of learning things at another level in getting a BS. In addition, even if base pay is the same, somepositions are often only open to those with a BS. Sometimes it is stated with the caveat "or equivalent experience," but that's a very subjective term and you are at the mercy of the person doing the hiring.
  11. marachne

    scheduled meds and PRN dose orders in nursing home

    Abosolutely agree w/what everyone has said, and here's a few other things to think about: besides dose, what is the action (as in time to effect/half-life) of the med? For example, po tab morphine is going to take longer and stay in the system longer than IV morphine, so dosing timing will vary. Also, where is the patient in terms of their needs? If pain/anxiety/SOB, what ever is being tx is labile, you may be using the PRN more frequently. If there is a clear escalation of symptom, or tolerance, you're going to want to do whatever you need to keep on top of it (boney mets?) If we're talking incident pain (pain with movement, like when cleaning up or changing position or dressing change), you want to plan those PRNs to coincide with need. Another thing that hopefully is being looked at is the PRN useage -- if there is a consistent pattern of high PRN useage, it's time to adjust the scheduled dose to more frequent and/or higher dose (or other agent/route!)
  12. marachne

    Questions and a Request

    Hi all, I have an interview a week from Tuesday with Kaiser Hospice, and I have a few questions, and a request. First of all, as those of you who've hung around here know, I have a background in both hospice and palliative care, but it's a bit different from the norm. My hospice (and some of my palliative care) background is in the VA, in patient. So the biggest difference is that I'm not dealing with Medicare at all -- no COPS, no (traditional) certification/recertification, little dealing w/outside primary docs (and they all tend to be w/i the VA system). Our palliative care pts are often folks are sometimes people who need their symptoms controlled, but often they are admitted into the unit b/c they are getting a radiation series, often for head and neck cancer so they need supportive care, either because they are from other parts of the state, or they have no support system while they are going to get debilitiated and likely need support in terms of tube feedings and the like. Sometimes tx doesn't allow for discharge and they just seamlessly move over to hospice care. Also, while we try and limit the time that our hospice patients are with us (after having the first few be with us for over a year) we're not talking GIP where the requirements are very strict. LOS sometimes IS hours (when they get sent over from the hospital at the last minute), but it can be months. The other, large part of my palliative care expierience was in a role that is usually more an NP role where we do hospital consults for symptom management, goals clarification, care planning, etc. What is of course the same is that I've dealt with all the stuff around EOL -- symptom manaagement, dying trajectory, pyschosocial & spiritual issues, family support / conflict resolution, supportive presence, education, etc. The other thing that is different for me is that I was never hired specifically as a hospice nurse. The unit is part of the skilled/LTC facility, and really, my interview was kind of a formality anyway, because my mentor (who worked for quite a while as a CNS in the facility) and is close to the DON basically said "she's a good one, hire her." So: I've never worked community based hospice (although I have some knowledge/experience w/it) I've never interviewed for a hospice position I've never worked community palliative care (and while I know that Kaiser does have community-based palliative care, I'm not sure if the same folks do both). I'm interviewing for two positions really, one is a per diem, one is part time (benefited). I have been told that the job requires working one weekend a month, and being backup on-call once a month. I can't work full-time right now anyway, because I'm still finishing up my PhD dissertation. I have read through some of the prior posts here about interviewing for hospice positions, but I'd appreciate any words of advice and wisdom y'all can give me. The other reality is that I haven't worked outside of the VA, and have only done a few nursing interiviews of any kind before. So, anything about interviewing for a nursing position in general, for a hospice position (not full-time) specifcially, and for the Kaiser system in particular would be appreciated. And the other request? Think good thoughts for me on 7/28! miriam
  13. marachne

    Capella PhD in nursing education

    As others have noted, many, if not most universities that have PhD programs will have faculty pages that list current, or most salient publications/active funded research. Looking at this information will give you info regarding what their research focus areas are. As was mentioned, it is also good to do a lit search on the research area in CINAHL and see what names come up, and then what unis they are at. One caveat about that -- if you depend on the listing on the article, they may no longer be at the institution listed on the manuscript. If you think you are iterested in a particular institution, I would contact their graduate department, tell them where your interest lies, and ask what faculty are engaged in research in that area. I just went and looked at the Capella site. I would be very cautious about getting an EdD from a generic institution like this. While there is certainly aspects of education that is cross-discipline and profession, there are also aspects of nursing education that are much more specific to the profession. I would wonder about the quality/appropriateness of the education you recieved, as well as your marketability as nursing faculty w/o some connection to nursing education. When I did a search on PhD in nursing education distance programs, I see that Capella came up, but the fact that when you go to their site you don't get any kind of listing of the specific faculty to me is not encouraging. Not saying you shouldn't explore it as an option, but I'd say look at other options that might serve you better. Ask to be able to interview faculty. Ask for names/contact info of graduates from the program who you can talk with. Really do your homework, as it's too much of an investment of time and energy to not get what you want or need.
  14. If you want to go for a PhD, another thing to look for are programs that have recieved GAANN funding, which is often specifically aimed at people who plan to teach. I don't know where you are located, but I googled "Nursing PhD programs with GAANN funding" and found several programs that have recieved these grants. If you get into a school and get a GAANN fellowship, it can be renewable for up to 5 years. It covers tuition and a stipend -- I believe the funding is somewhat based on need. Below is the statement from AACN about GAANN funding for SONs New Funding Opportunity for PhD-Level Nursing Education AACN is pleased to announce that nursing has now been designated by the U.S. Secretary of Education as an "area of national need" under the Graduate Assistance in Areas of National Need (GAANN) program within the Higher Education Act. As a result, new funding is now available to nursing schools offering PhD programs. GAANN provides funding for fellowships to attract students into graduate programs in specific disciplines. Nursing has now been added to the list of national need areas that also includes biology, chemistry, computer and information sciences, engineering, geological sciences, mathematics, and physics. This important addition resulted from a three-year legislative and regulatory lobbying effort led by AACN. AACN is grateful to Representatives Jon Porter (R-NV), Carolyn McCarthy (D-NY), and their colleagues for their ongoing efforts in the House to make this important amendment to the GAANN program. Advocates in the Senate have also addressed this need with their legislative efforts. On August 29, the Office of Post Secondary Education within the U.S. Department of Education issued a call for applications to schools seeking GAANN funding in FY 2006. Schools of nursing are invited to apply for funding to offer fellowships to graduate students with excellent academic records who demonstrate financial need and plan to pursue a PhD program. The Secretary is "particularly interested" in applications from nursing programs that focus on the preparation of nurse scholars at the PhD level for educational leadership roles. Graduates of this type of program will become the teachers preparing students for careers in nursing and will disseminate to the public new knowledge gained from disciplined inquiry related to nursing and nursing education. Fellowship monies will cover the costs of tuition and fees as well as student expenses. The Department of Education estimates awarding to schools of nursing approximately 96 grants averaging $211,000 each.
  15. marachne

    Who is Responsible for Discussing End-of-Life Treatment Options?

    This is why a palliative care team is a team, and the good ones include physicians, rn's APNs, SWs, chaplains (specially trained in EOL), and when they're really lucky, a psych person. It's about exploring values and goals as well as prognosis and options. That said, nurses are the ones who spend the most time with patients, who often are the best known and trusted by pts & families. We are often, in many ways, good generalists, and approach care from a holistic perspective -- mind, body, and spirit. I feel it is a nurse's duty to share her/his knowledge, wisdom, and experience with a pt or family if the physician is doing a disservice to the patient in not sharing full information about what the options are, and what the (likely) consequences/outcomes of certain decision paths. The problem is that the system often leaves nurses feeling intimidated and afraid to speak up.
  16. marachne

    Nonverbal symptoms of pain

    There is a well tested and recognized means of assessing pain in persons with dementia called the PainAD. (It is also appropriate for other non-verbal patients) There is a wonderful website called "How to Try This" that has a number of Assessments and Best Practices in Care of Older Adults. There is both written information and video individuals using the different tools. Pain Assessment in People with Dementia is here: http://tinyurl.com/dhvz8x and the video is here: http://links.lww.com/A251 good luck w/the family and the medical director And yes, grimacing, moaning, guarding are all signs of pain! So are less subtle things, so maybe bringing some information from experts will help your case
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