goodneighbor

I think there is a growing awareness of alternative medicine and holistic practises. For instance, we now know that ice water is not given to certain Asian people when ill or post-partum because they, like some Latin Americans, believe that hot is healing and cold is not healing. We know that for some cultures we must talk to the male HOH, also we know that traditional Chinese will nod and smile but may not agree with you but are being polite. There are people who use aura healing, and some people have a talisman at the bedside. You have to be sensitive and feel your way through sometimes to make sure you're on the same page. Some like a priest, some like a rabbi, some like a healer. And some like chicken soup! I guess you can teach medicine but you can't teach compassion.

Oh my gosh, I didn't even think about CPS. They don't still take "Indian Babies" away do they? I have a naive (perhaps) belief that CPS is there to help (with education, blankets etc) I cant imagine the fear of an NA mother taking a sick baby who might be taken away. Is there a culture of breast feeding among NA? Are there grandmotherly wise women? I know this is like trying to catagorize people, for instance I have been in inner city slums where there are many superstitions or beliefs about things, but babies do return to these slums and many thrive. You have to think about how much is just our beliefs that we try to impose upon people--when they have their own native intelligence and culture. But the universal language is kindness and respect--and there are things we know and there are things they know. We, of course, are not better. Hell, we are not even really in charge of anything, just trying to make little differences as we travel this world together!

I have been to he Wind River Reservation in Wyoming and met wonderful people there. I have since been reading about the Pine Ridge Res in South Dakota and there seems to be great need there, but it seems almost overwhelming. I imagine the hardship of detoxing ETOH dependent persons and then returning them to their home--or how difficult to deal with Diabetes management --or persons with tuberculosis. There is a dearth of basic necessities such as housing, water, lighting, sanitation. RaineyRN, I wonder how you do it. God, I wish I had the strength to do this. It is said that the infant mortality rate is extremely high and teen suicide is too common. What is it that you would say that the NA themselves want most? I imagine the worst problems are neuropathy, blindness, amputations, liver failure, renal failure from chronic disorders, dehydration. Bad treatment at a high acuity facility sounds like a nursing failure and cultural insensitivity and perhaps lack of common sense. What has happened to a sense of the dignity of the patient? Why become a nurse then? Well, I am sure you agree with me. I applaud your practice of nursing in an area of great need. How can we help?

Thank you RaineyRN, I'm afraid I had you confused with another poster (it was late at night!!) I read the article and was shocked about the conditions our fellow Americans are living in, and then did some further research, and was further shocked. Thanks for your response.

Silly question, but is bottled water, cola, ice tea, lemonade, kool aid, gatorade, watermelon, ice cream, etc. readily available on the rez? Smoothies anyone? I mean, are alternatives as available as alcohol? What did ancestral native americans drink on these hot dry plains? Some kind of root sarsparilla perhaps? Could not a native drink of some sort be developed and marketed with pride? Wouldn't that be nice? Sounds like everyone's dehydrated!

RaineyRN, that is so sad. Tell me, is there a lack of necessary supplies at clinics on Reservations? On another post I believe you mentioned that alcoholism and violence are "a way of life". This sounds like it is very dangerous to work on a Reservation, is that so? Are nurses appreciated (meaning welcome) in general, or regarded as a part of an alien lifestyle? The Lakota must be very strong tough people to thrive with such limited resources, yet this gentleman sounds so matter-of-fact about the harsh conditions. The article talked about a hospital being built by Obama's stimulus plan, but it is interesting that Mr Brings Plenty stated that what they need is water! Shows that Maslow's Heirarchy (which states that basic physiological needs must be met before...say..poetry) is not in play here! How 'bout they have water, food, and shelter so they don't get so sick! BTW is the res "safe"? This is interesting. Thanks for letting us know.

This is either the funniest or the saddest forum here! I am laughing because it is so true. Who is it that comes up with these forms?? It seems that facilities (hospitals, corporations, etc) look at us as "employees" when they should look at us as "professionals". Maybe we should join some kind of a group? Somewhere, somehow-someone is thinking-I'll just come up with a form "to help them out".

Remember, most nurses LOVE their work, but HATE their JOB. This means we love to take care of people, love to learn our craft, are excited when our patients improve and take real satisfaction in the part we take to help someone regain their health, or even, to die in comfort and peace. But mostly we like to be there for the patient, and we don't mind-and even agree with- much of the documentation and policies we must comply with. But sometimes we get kind of grouchy about the amount of paperwork that is required. Also we are usually very compassionate with our patients but sometimes nurses get edgy with each other. I don't know why. That's why we talk to each other on these posts.

What? You take breaks? What? You pee?

Good veteran CNAs usually bond with their patients and know them very well. They also tend to know the "scuttlebut" in the facility. They are invaluable help in caring for your patients. But they can also be wily and so "efficient" that they tend to disappear for extended smoke time/break time! Veterans are usually the first ones to complain about a coworker CNA not doing her job. Be respectful of them but don't be afraid to ask for their help. If you want them to do a certain task, tell them in advance and they'll work it into their well-honed schedule. They are usually very compassionate with the patients. Try to develop an easy friendly tone with them. If you must counsel someone do it privately (they are usually intimidated by being called behind the nurses station). Preserve this area as your domain! Teach but don't delegate beyond scope of practice. Praise good care. Explain a little about disease processes so they know why it's important to (be clean, peri care, turn pts, feed carefully etc.) in the course of your side by side care. Find out what they need to do their job (more wipes? more pads?) and make sure they have it. You are in charge because you have more knowledge and are the clinical decision maker as far as medicine. They do quality of life on a more basic level. Oh, and explain you need the vitals and blood glucose first thing because you have to decide on medicines (they tend to think of it as just paperwork) and that you really need to know that your patients are voiding and having BMs because if they don't its a sign of sickness-its not "just for the chart"!

Southernbeegirl, you must be beloved by your team. You exemplify what an RN supervisor should be in that you guide, educate, and provide support to your nurse! You are writing about a true example of teamwork and nursing excellence. How important it is to have more than one RN in the building! As a new nurse I had accepted a position at a SNF and then realized I was the only RN with a DON who was available by phone (nights). I believe it is imperative to have adequate staff and precepting-or at least physical presence of experienced nurses (RNs). (If you're going into LTC find out your support team!) There are so many reasons that this is unacceptable--but the root cause is lack of adequate staff. I don't think there is really a "nursing shortage" but really a staffing shortage. If you have one patient with a hypertensive crisis that was really going on on the last shift and another with blood glucose over 400 and another with insufficient urinary output you cannot delegate assessments and still fill in all your MARS and do your trach care and unfortunately you're the only one that realizes how bad this is. This is why when you call for backup you are told to send them out. Your LVNs are overwhelmed also and your CNAs are changing bedsheets (if you are lucky) and are not certified to change colostomy bags. I think corporate thinks RNs are sitting at the desk waving a baton directing staff as in a symphony, while occasionally counting and recording NOC deliveries of meds, and that patients sleep all night. You learn to prioritize quickly, but the things that we think are important are not necessarily the things the family thinks are important. So, again, the root cause of ED transfers are not enough hands. I would love to see how a top notch SNF is supposed to work. I love the work and patients but the load is heavy. Perhaps there is a book (fantasy) of exemplary care. I suppose a private pay/ insurance facility would be better than a Medicaid only floor. This must be the reality shock they talk about. I would like to get past this! And get really good!

This has been a very interesting discussion, and I appreciate the input from Cape Cod Mermaid who shared that she has to send an "Unplanned Discharge" form to Corporate that gives me another level of understanding of SNF management. I am thinking that, yes, it is good that we can get stat labs and have the E-box and all that, but in the real world I have had 45 pts and 2 CNAs and the real issue is nurse-to-patient ratio. When the acuity level goes up the nurse cannot safely treat and monitor all. Actually, it's tough on a quiet night. No longer are nursing homes filled with just Grandma or Grandpa who needs a little help in dressing-the patients are only somewhat stable (in a chronic way!) It might be more cost-effective to staff more nurses, do you think?, than to incur hospital expenses, but I am just dreaming. There is a proper I guess you call it scope of practice to hospitals and another to SNFs. Thank you, Heron, for the info on hypodermoclysis, which I've only seen done on a postpartum cat!

Oh, and I forgot to add that PAIN itself is not necessarily a priority in triage, but the patient in pain can take up a lot of time. The person on a drip needs your attention more. Jeesh.

There are patients who take a great many pain meds and demand amounts that can scare you. These patients usually demand pain meds by TIME not by pain score, ostensibly so they can AVOID the pain that they say is coming. Pre-emptively. You have to assess them frequently if not constantly. I would recommend a pain consult with the hospital's Pain Management Team. Although a patient's pain is what they say it is and where they say it is you need some guidelines/orders, particularly when they start "stacking" their meds: Q4 Q6 PCA IM, HS. For instance, you have a patient on frequent morphine who is developing twitches (toxicity) and yet demanding more. When you are worried and don't know what to do-yes-that is a sign that you need more resources and more expert advice or direction, i.e pain consult, well-written DR orders (not to exceed x in 24 hrs, not w/in 6hrs of x, etc). You also have to use the FACES score for pain sometimes rather than self reported 1-10 scale. This is a very difficult ethical decision and it may just be discussed by a team in the hospital. You have to use diversion of attention and guided imagery and provide other activities to get he patient away from their pain. Pillow fluffing and snacks and let them talk. Chronic pain can lead to terrible social skills and a person who just is difficult to be around. Well, this is just one reason that Nurses are exhausted at the end of their shift!

When a pt has AMS and any other S&S, particularly on Noc, you have to call the physician to advise. At night, you get the on-call who frequently is an intern whose safest bet is to "send them out". So now you have a Dr's order to ED. Also anything reported at night usually results in a "send them" order. As an RN you can suggest/request labs, fluids, Abt, etc. but you run the risk of being accused of "practising medicine" by administration. The order to ED originates with the DR or on-call most of the time, not necessarily the RN. Also the ADON is usually an LVN/LPN and not able to make clinical judgments but able to make administrative judgments. The DON is beholden to the Corporation that is deciding in fear of litigation. I have seen pts sent out to change a Foley catheter, and usually the reason is a SNFs "policy" to change out the cath once a month. Nursing home policies do not always follow CDC guidelines or best practices but vigorously enforce their own guidelines. So, in short, the reason for ED visits is physician-led or corporation-led, I believe. Does anyone have any opinions on this?