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goodneighbor

goodneighbor

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  1. goodneighbor

    England: Lt Col Maureen Gara Dies, saved lives during WW II

    God Bless her. What a hero and inspiration.
  2. goodneighbor

    IV tips and tricks

    Saline lock tape trick: When preparing your anchoring tape at the beginning, take a strip of tape, sticky side up, turn the two ends inward and stick it to a clean surface. So now you have a semicircle of tape, secured, at the ends underneath. When you need it, spread your index and middle fingers and place them on the tape, like one-and-a- half inches apart, palm down. Now you can slide your fingers with the tape right under the catheter and then do that little cross thing with one across and one up. Then apply the transparent dressing.
  3. goodneighbor

    Does allnurses.com make you a better nurse?

    Yes, allnurses makes me a better nurse. It is alive, it is interactive, it is an adjunct to journals, books, and lectures. We can bounce our ideas and knowledge off each other and grow. Take, for instance, the blog on "sedation before death" which deals with the dark area of end-of-life care. This is one of the most intense and distressing parts of nursing, and how many lay people can you discuss this with? I have learned how nurses perform skils in other facilities and picked up tips. I feel enlightened and proud of being a nurse when a veteran explains things to us and I am so impressed with their knowledge and professionalism. I thank you all for joining in. I also get different points of view. There seems to be about 300-400 members and we get about 2,000 "guests", indicating a great deal of interest. Thank you, staff, for running it, and thank you, fellow members, for joining!
  4. goodneighbor

    Hard Choice for a Comfortable Death: Sedation

    Yes. I would act in the patient's best interests--alleviating the pain that you can see. It is better to take the pain away than to take the mask off for God's sake!!
  5. goodneighbor

    Hard Choice for a Comfortable Death: Sedation

    Certain end of life patients, such as patients with dementia, become so agitated that they suffer because of confusion, such as the example of the pt who climbs out of bed and cannot control himself or be settled down by redirection. The pt usually forgets how to eat or drink. Cognitively, he can no longer perform the act of even drinking water. The main point is that they no longer can safely or intelligently make their own decisions or actions to prolong their very life. The root cause of stress for the family is that THEY have to make decisions for this person. It's assuming the mantle of responsibility. It is no longer trying to figure out what "Dad would want", it's "what do I do for him?". You cannot expect the pt to express his wishes, you can try but... It is not so much about palliative or terminal sedation, but "when does the patient lose autonomy?" It is similar to a situation where a patient is severely mentally ill and the family must commit the pt to medical care (depressed, delusional, hallucinating). An agitated pt must sometimes be sedated for safety and that is considered more humane than restraints generally. A screaming writhing trauma pt must be sedated, given morphine to be treated, and medical personell do this with no hesitation. I am just trying to say that it seems that the big issue is the loss of autonomy for the patient-that is the line we are all afraid to cross.
  6. goodneighbor

    Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH

    The CDC has published best practice guidelines to prevent CAUTI Cath Acquired UTI that you can look up with those keywords. They do recommend not having the collection bag on the floor, no routine bag changes unless clinically indicated (contaminated), recommend against irrigation, single unit foley and bag tubes, there is continuing research about other issues. Clinical research and scientific method are our best allies. Give it a lookup!
  7. goodneighbor

    Why is this forum so dead?

    Regarding the patient with personality changes after injury...the question was is there a component of neurology to help the family deal with changes in their loved one. Gosh, I certainly hope so! These types of changes happen in many types of disorders:renal failure, cancer, alzheimer's, dementia--many chronic conditions. In Acute Care, here is the principle of Maslow's Hierarchy of Needs that states that healthcare professionals must deal with the physical basic needs of the patient first, such as ABCs, nutrition, shelter (warmth etc) and can only address higher needs after the first level is attained. This also carries over into the beginning of Rehab as the patient may not be entirely stable. One striking aspect of, say, long term care, is the perceived absence of normal family life and relationships that people are used to. It might help to look up Maslow's Hierarchy to ground yourself in what's going on. For instance, if a child is lying in the street after being hit by a car and has a broken leg, you are not going to worry about whether he has fulfilling play relationships at first. So with someone who has lost the ability to engage in stimulating discussions, etc. I think this realization may help slightly in the long road to adjustment. Nurses, being compassionate, do consider the whole family as the patient, and try to help family members adjust and process feelings. Many hospitals have spiritual care or social service or group support to help. Self help groups are invaluable, as are internet blogs and support groups. Slowly, the spouse begins to participate in the small increments of improvement that can be attained. It is part of life's journey that makes you consider the meaning of basically everything and what you believe. My heartfelt empathy for this lady and her husband and best wishes for happiness goes out to you and all who are experiencing these problems.
  8. goodneighbor

    Why is this forum so dead?

    Hey, I'm listening! I too have just been offered a place in the exciting Neuro world and we will help each other!
  9. goodneighbor

    Are we experiencing mass burnout in healthcare?

    S. 1031: National Nursing Shortage Reform and Patient Advocacy Act Oh, it's wonderful. It's " A bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes" You can do a search under S 1031. What do we do, write to our Congresspersons? Will have to get educated about this one!
  10. goodneighbor

    Are we experiencing mass burnout in healthcare?

    Wow, Tabitha, thank you for addressing your response/challenge to me! I wish I could write as well as you! Sure, I'll be happy to stand up for the nurses in Washington State, but I am in Texas and I'll have to stand here too! I will check to see what S103 is (some activist!). We have here Senate Bill SB476 regarding Nurse Staffing. ... Nursemike, you are inspiring also and help make it all worthwhile. Well, thinking about this discussion throughout my day I kind of thought that there was a tremendous PR thing going on about "the nursing shortage" that has been picked up by NYTimes, Newsweek etc. etc. It seems that it has been promulgated by some entity that somehow benefits by it(?) I have read a lot of posts and have friends that are trying to get jobs that are not there. Especially new nurses. Schedulers say they are going crazy trying to staff but everyone has a "hiring freeze". Witness the intense interest that was just shown in the part time Mollen vaccination clinics on our boards. Another thing I thought about is that it seems that Hospital Administrators at the top level perhaps seem to think of us a "glorified clerks".[i.e."Well, they're college educated, they must be able to fill out a few forms correctly"] It's as though they are so impressed with documentation that they conceive us as sitting at a desk orchestrating care by UAPs, Techs, transport aides, housekeeping--sort of like a foreman of the floor. And we learn so little of this in Nursing School. And we, silly things, want to deal in vomit and blood and pain. I can see them saying.."What do these women want!" (OK what do these PERSONS want) Yes we want it all. We want to have hands on with the patient and we want to handle the paperwork, doctor interface, community of care thing. I read a forty two page job description of charge nurse duties that, well, no one could do well for the patient load. I'd like to see some ideas of how we ourselves define our job; what we ourselves conceive as the role of the nurse. I'm still new and learning all the unwritten, unspoken aspects of the job. Sometimes I'd like to just ask: "What is our goal here-what are we really trying to accomplish?" Many times I've been surprised to see it wasn't what I thought it was.
  11. goodneighbor

    Are we experiencing mass burnout in healthcare?

    Ok, Miss Tabitha, you appear to be the new Sister Simone Roach! And the internet is the new "book" that you should write. Ok so we all agree that something is wrong, and like politicians we can go on stating the problems that we find and we all will nod our head and say..YES! But let's do this...we must come up with a catchy phrase that will get people's attention and that will epitomize our ideals. Then we will have to find ONE THING to will ask for and then go on to find other things little by little. Brainstorm, guys...any ideas for a good movement slogan? Can we get together on this? Ideas anyone?
  12. goodneighbor

    Are we experiencing mass burnout in healthcare?

    What I am really good at is assessing the patient, listening to them, interpreting the S&S they describe and putting it into "doctorese" so they can obtain apropriate treatment. I am also a good caregiver in that I can make someone feel better with a footbath while they talk, for instance: things that make up the magic of nursing, in short. I like to research their disease and find nursing interventions that address the discomfort they are having. This is good for chronic diseases as well as acute. Once I had care of a person who had Gastroparesis, among other things. This person started spewing Tube feed out of his mouth.The LVN who came on gave him an injection of Ondansetron. However I had managed the problem before by checking the residual (350ml!) and turning off the pump as necessary to tolerate the feed, assessing for constipation, etc, and recommending a lower rate, or just actually informing the DR of the findings. The LVN was "more efficient" according to the powers that be, and was a more desirable employee as the LVN finished the paperwork and task faster, problem solved. This is a terrible risk for aspiration, and misery. It kind of demonstrates the value of an RN. How many times have we seen a DR who says "Oh, you have nausea, take this..." when the problem is something like aversion to pureed chicken, as an example. This type of nursing takes time and thought but pushing meds seems to be the priority all too often. I don't know what this has to do with activism exactly but I think I am talking about the kind of slapdash nursing that is in vogue now in some places. I suspect Florence did a lot with just observation and caring. I wish we had the gift of time.
  13. goodneighbor

    Dear preceptor

    What I am really good at is assessing the patient, listening to them, interpreting the S&S they describe and putting it into "doctorese" so they can obtain apropriate treatment. I am also a good caregiver in that I can make someone feel better with a footbath while they talk, for instance: things that make up the magic of nursing, in short. I like to research their disease and find nursing interventions that address the discomfort they are having. This is good for chronic diseases as well as acute. Once I had care of a person who had Gastroparesis, among other things. This person started spewing Tube feed out of his mouth.The LVN who came on gave him an injection of Ondansetron. However I had managed the problem before by checking the residual (350ml!) and turning off the pump as necessary to tolerate the feed, assessing for constipation, etc, and recommending a lower rate, or just actually informing the DR of the findings. The LVN was "more efficient" according to the powers that be, and was a more desirable employee as the LVN finished the paperwork and task faster, problem solved. This is a terrible risk for aspiration, and misery. It kind of demonstrates the value of an RN. How many times have we seen a DR who says "Oh, you have nausea, take this..." when the problem is something like aversion to pureed chicken, as an example. This type of nursing takes time and thought but pushing meds seems to be the priority all too often. I don't know what this has to do with activism exactly but I think I am talking about the kind of slapdash nursing that is in vogue now in some places. I suspect Florence did a lot with just observation and caring. I wish we had the gift of time.
  14. goodneighbor

    Dear preceptor

    Tabitha: [Quite] "I am one nurse in America who is looking for answers and would love to generate a thoughtful discussion to that end. There are pockets of us who are willing to stand up and fight;" Your post was amazing. I wonder how we can promote this end to the "lateral violence" we experience. Who do you suggest we fight against? I believe that there really has to be a lower nurse/pt ratio, and that corporate decisions for "productivity" are to blame for the amount of work that nurses have to do. There really is no such thing as charting by exception. So many things are done to prevent liability. We are professionals and yet are are treated as employees (lackeys) and are dictated to by...lawyers?...efficiency experts?...resource managers?. A thinking RN is not really wanted in many operations; a tech seems to be preferred. As far as your experience with the burned out nurse who was going to call the house sup, I would say we need to try and maintain professional speech. Good manners are not for when everything is fine; manners are for when everything is messed up! Doctors seem to have some kind of training in speaking well of everyone, as do members of Congress, even when they are calling each other jerks! It would be nice if we as nurses could develop this respect towards each other and then demand or command respect as professionals who can do x amount of high quality work and then state what is the natural limit of what we can do and that we need additional professionals to deliver the quality of care that is necessary. There is no nurse shortage---there is a staffing shortage. This is the source of burn out.
  15. goodneighbor

    Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH

    Thanks! I think the idea to place the bag inside one of those pink buckets is wonderful. It is true that low beds make it almost impossible to hang a bag. I also like the idea of using an alcohol wipe after emptying the bag. Tell me this.. I worked at a place that advocated "changing the bag" once a month (for those who had permanent catheters). This sounds like you are breaking a sterile field, although on the other hand it does seem like it cannot stay there forever. It was a LTC and patients had their foleys for months. My Lewis says dont break a sterile field. What is current best practice?
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