FranNHRN

Funny that you should ask this question because it has been an issue of debate on my rehab unit recently. I've been working on this particular unit for about 1 year. We have never followed a bathing schedule for showers, but patients were showered upon request. Patients are usually bathed by sponge baths, or set up in the bathroom. The first and second shift do this. Recently, we had a family member complain that a patient had been with us for a month, but did not recieve a shower the whole time. Our manager made a shower with weighing schedule that has both being done on first and second shift. So, basically each patient is suppose to get a shower at least once a week. More often is they request. We recently met with the vp of nursing because we are having difficulty with our staffing guidline....which is another story...and she said showers should be done in the evening. The day shift has to get patients through breakfast and lunch and ready for therapy by 9:00. We are still working on the schedule. OT doesn't get involved with showering people that often. You would think they would, but I don't see it happen.

Ahhh, Dermerol. I've had two experiences with Demerol as a patient. The first time was 17 years ago when I had my gallbladder removed the old fashioned way. I had a large abdominal incision and was given Dermerol IM Q 3 hours round the clock. It was totally inefective and I deveoped swelling and erythema on both injections sites on my butt. One of my nurses was completely unempathetic and acted as though I was bothering her because I was crying in pain. My next experience was 12 years ago when I had a c-section. I was on a pca with demerol. When I was still in recovery I told the nurse I was in a lot of pain and was told I had the pump, so I shouldn't be in pain. Yeah...shouldn't. Demerol did nothing to control my pain. I cried for 8 long hours until the nurse on the second shift told my obgyn that demerol was not cutting it for me. They switched me to morphine and I finally recieved relief. I was tempted to add demerol as a allergy so they don't attempt to give it to me again....but as a lot of you have said, it's not used as commonly. As a nurse, I remember quite vividly how I felt I was not being listened to about my pain management and I try to address pain and push the issue with the doc if the patient feels the pain is unrelievedl I was always thankful to the nurse who finally told my doctor that demerol was ineffective. but, it took a long time.

I work on an acute rehab unit. To me, it's different from med/surg because patients are expected to get dressed and out of bed daily for rehab. they are encouraged to do as much for themselves. We do get sick patients that need blood transfusions or IV antibiotics. We sometimes get TPN. Frequently, we have people of tube feeds. It's very hectic in the am because you have to get your meds passed by 0900 to get done before therapy starts. From what people have told me that have worked there for a long time, the type of patients have changed due to medicare reimbursement. We get sicker patients that often don't do well on rehab. People that are too good are not qualified. It's sad when we get these cases that just don't belong there. It happens.

When I worked in home care, shadowing was very popular because many nurses don't know if home care is something they want to go into. Our agency used to have a policy for students and anyone shadowing that they were to sign a "confidentiality agreement" that states they agree not to share the info that they learned with anyone. It wasn't a big deal. I think shadowing is a great idea and wished I had thought of doing it before I did some of the positions I have done. Good luck!!!

If I were you, I would continue to complain in writing and cc a copy to HR. I would totally stop during her work, as you said. Eventually her errors are going to catch up to her. I think it's okay to close your eyes on break, but to sleep at the desk??? PLEASE!!! Our hospital has computerized documentation. One day I was looking at some documentation on a patient of mine from the night before. The 3-11 nurse checked off that a patient had a "lactation consultant ordered". What????? I asked her about it when she came in. She giggled and said she was falling asleep while checking off boxes...and OOPS!!. I don't think it was funny and told our manager about it. Who knows how she took care of it. We're not suppose to be privy to another person's disciplinary action, but in your case that person should no longer be there!!!!!!

I agree with everyone that said you must have a ethics commitee that you can consult as well as risk management. I think the family has a right to know, I just don't think it's your responsibility to give that info out.

I have always found myself wondering how patients are doing if I've had a particularly sick patient. I left for vacation and thought about a patient that I knew was having a back sacral ulcer debrided while I was laying on the beach. I had a brief experience taking care of a hospice patient while I was working home care, and decided I could not do that job. My agency lost all of it's hopice nurses at once and I cared for a 100 year old woman who was dying of end stage CHF. She died on Christmas Eve and I found it very difficult to leave the thoughts of her at work. Also, my husband works at the same hospital as I do, so we often talk about the place. That can be difficult, but it's nice to have lunch with him every day!!!:loveya:

I also agree with Smokey. Deep tissue injury would present as purple...more like a fresh bruise. The presence of eschar makes it older and unstageable.

I worked home health for several years, and although I am not an introvert I could see how an introvert may enjoy it. You work alone most of the time and are 1:1 with the patient. We used to only meet once a week with our coworkers for team meetings or to meet with our manager. Otherwise, you are pretty much on your own. I liked the comment about forensic nursing, though. That was funny. It's probably not as much alone time as one might think.

That's funny!!!

Just a couple of thoughts....does your dad have insurance? If he does, the insurance could be paying for his bandages. Also, I would recommend that he see a wound specialist. If he is draining that much he possibly could be a candidate for a wound vac. His wound would heal so much faster. As far as dealing with someone so noncompliant....it can be very difficult, but sometimes you have to be very blunt and state what his effects of his noncompliance will be. He is an adult and can make the decision not to take care of himself, but he should know what the consequences of his noncompliance will be i.e. getting his foot, or let amputated, or sepsis and death.

We get different groups on students at a time in the fall and spring. I hate to say it, but I find that how the students behave can be a reflection on the instructor. One of the instructors I work with will have her students help out with answering lights when their assignment is done or will find things for them to watch or get in on. I did a vac dressing with 8 students watching at one time. The instructor needs to keep the students busy. On the other hand, one of the other instructors was sitting at the nurses station chit-chatting with the nurses while her students were wondering aimlessly. She got reported by the charge nurse and we haven't seen her again. If we have any problems with students or instructors, we inform out education department who deals with the issues. (if we can't work them out on our own.) Thanks. Fran

A wound vac would be perfect for this wound. Hopefully the wound clinic will recommend it. How can your facility refuse? It should be covered by Medicare and continue when she goes home.

Patients need to have their circulation checked in their lower extremities prior to applying unna boots. Applying unna boots on someone with poor circulation could be dangerous.

I have seen the Blue Sky system once in home care. I like KCI's system better. I only had the one patient on it, but it seemed as though his wound did not heal as fast. I think KCI's system is easier to use, too.