milly

I have continued to follow this thread, lack of technology has prevented me from commenting further. I have recently started a new role, and there is small proportion of my work is Palliative care. I know that I am good at my job, and I have a good raport with my patients, and in my previous role my manager in an appraisal did remark that I had an exemplary bedside manner. I know I can be good in this job, but I also realise that this means I have to face my issues in respect of Palliative care. I am very keen to work through these issues. Hence why I have asked for help. It would never be my intention to allow people to suffer needlessly. I just want to be safe and be sure that I am not causing harm. Isnt that what we are suppost to do? When I hear about a patient Iv cared for dying, I do take it very personally, and spend allot of time reflecting about the care Iv given to them.. I have read the thread, and I have issues and queries... * I note that some of you have spoken about a PCA. I have wondered why patient controlled analgesia devices are not used in Palliative Care, as they are in post surgery care. why is this so? Is this because of the monitoring that would be required? * Terminology such as 'dying anyway' suggest that we are giving up on our patient, is there any more proactive language used in palliative care. Oddly when people refer to 'stat doses' that sounds more negative, however when refered to as 'PRN medications' sounds more positive. * I have had lengthy discussions with my piers over the years, some very senior nursing sisters who have, added fuel to my thoughts about the link between these medications and the nearness they are to euthanaisa, I may very well be paraphrasing but they have said that. * Blase, yes I have witnessed that, one former colleague, once actually said she thought that the morphine she gave must have caused her patients demise as they didnt survive longer than an hour.. and that is only one example of such. * Someone mentioned sublingual Morphine, is this something used often in Palliative Care, Iv not heard of it? *What exactly is the dying phase? what things should I look for, I know I dont recognise the symptoms. I am the eternal optomist in these matters. *It was suggested that giving these PRN doses have peaks and troughs in terms of effectiveness, but syringe drivers are a constant steady flow... Does this suggest that they are safer for the patient? The people in my new team that Im working with seem to be very kind, and I have even heard one of my Nursing Sisters say that it can take years to adjust and to feel confident with Palliaitve care. I will be having some formal training in due course. I have approached a colleague and asked her to be my buddy interms of having someone to mentor me through this issue. I hope to spend time with specialist nurses and the hospices. I have infact spent time on my holidays reading palliative care text books. Although I have of late learnt that these patients are managed and treated for reversable causes, and there are homepathic pathways to comfort patients, all of which i didnt know. milly

Thank you for your understanding.. Your first paragraph summed it all up.. Patients dying has always been viewed negatively..and if it happened on my watch I did something wrong .. And I let them down.. Both of which I don't want. I have very rarely come across death.. Iv never seen a loved one die.. It's always been out of the blue when someone I cared about died.. I went through all my training seeing very few extremely poorly people.. On more than one placement i was referred to as the Angel of calm... Even when I worked for a palliative care service I still managed to avoid being involved in symptom management side of things mostly.. I did care for people in terms of basic cares and always took great pride in knowing is done a good job and they were clean and comfortable when I left them.. I'm in a new role now which does involve palliative care, but it's only a small percentage of my work. I will be having some training and mentoring throughout this. I know that I am being thought of as cruel that is not my intention. I'm just scared and I want to understand and develop. Thank you

How do you achieve that mindset? Without being terrified of killing someone?

I don't suppose it's the machine itself that scares me, iv used them in different ways like sliding scale insulin and heparin infusions, with not an ounce of worry. The problem comes when it is mixed up with palliative care. Thing being is the vast majority of people who end up with them for that purpose dies. I know there is a school of thought that stat doses and syringe drivers are so very close to euthanasia. That is something that totally adds up when I think about it logically. It's not about ego. Or a lack of empathy. I want to be able to sleep at night knowing if do e the best for my patient's i can. And for the record I strongly believe that these patients are the people who we need to advocate for more so than any other. But I also want to be safe and protect both them and my own registration. I don't understand how the rules change so much. For instance morphine in a surgical scenario, if respiration rate is below 12 it is contraindicated as it suppresses the breathing further and that is dangerous.. Yet in a palliative scenario it doesnt seem to matter because they are dying any way... How do I know that these medications which are very potent and quite a cocktail doesn't play a part in the poor souls demise... I don't know how to wrestle with my conscience on this point. I do indeed plague myself torturing myself wondering if my so called caring act isn't some how killing someone under another guise. And that terrifies me ..I just want to have peace with it. There are hundreds who are incredibly blasea I want to be like that too..

I had hoped for some encouragement.. Iv hardly slept. Can hardly breathe and I just want to cry.. Hoping beyond all hope that I manage to survive today without a panic attack.

Hello I know that there will be allot of people disagree with me here Am I only nurse that is quite simply terrified of syringe drivers? I just feel like I'm helping someone die. I didn't want to be a nurse to help someone die.. I wanted to be able to provide comfort and health.. Are they really agents of death? How can you make peace with it all ? Please help me.. If got to get involved with it all tomorrow and I can't sleep..and I'm on the verge of a panic attack already.. Milly

cant help really but whats a PICC?

we have to report our illness to the senior nurse on duty at that time, and you have specific times we have to call in by and it differs in length. for instance we have to call before 6am for our early shift before 10am for our late shift and before 4pm for a night shift. and we have to tell tehm the nature of our illness and if we are suffering from Dand V then we are suppost to provide occupational health with a sample.....

dont know if its much good, but i had two ex fixes myself, and i had them in for 13 months, i was taught to shower ever day with it, cleanse each pinsite with a cotton wool swab with normal boiled water allow to dry. and part of my physio was to swim with my fixator, and in the13 months i only got 2 very mild infections which cleared up in a few days.............

hi all, i am going out of my mind i really am at this present moment, i am a newly qualified nurse and i am having a real hard time getting my prioritising and time management right. i seem to keep making little mistakes and things get left. not only that i have no one in the world to talk to about it and get some peice of mind to stop feeling sick to the stomach because i have missed something, is there any forum or group that you can go to to de breif and relect positively. i really need some help i am torturing myself and letting my team down, milly

hi all, i am going out of my mind i really am at this present moment, i am a newly qualified nurse and i am having a real hard time getting my prioritising and time management right. i seem to keep making little mistakes and things get left. not only that i have no one in the world to talk to about it and get some peice of mind to stop feeling sick to the stomach because i have missed something, is there any forum or group that you can go to to de breif and relect positively. i really need some help i am torturing myself and letting my team down, milly