jornac

It seems to me that there are a great number of people in this world that seek narcotic pain medication for whatever ails them. Anyone every heard of an "addictive personality". There are also a great number of us with actual pain that try everything we can to avoid those narcotics! Fibromyalgia is real!! Do some studying about the symptoms, and then consider someone with chronic pain that has to have evereything else ruled out prior to actually getting a diagnosis. I have been diagnosed with FM after many years of chronic back and neck pain, having joints injected to help with the pain (without relief). RA was ruled out as the cause (my sister has RA). I had decided I would just have to live with the fact that I hurt all the time. When I was finally diagnosed I had all but 1 of the pressure points positive for pressure pain. What a relief to have a diagnosis and find out that what I was suffering was real and I wasn't losing my mind!!! The best help I have found is to get a good night's sleep, (lessening the early morning pain) keeping active, taking anti-inflammatories, and staying busy with something else that keeps my focus. I personally believe that the fact that I was diagnosed with Celiac Disease (after years of malabsorption) is then underlying factor to my development of FM. I tried a support group. What a joke!!! The people in the group were way more interested in talking about how disabled they were, what narcotic pain medications they were on, and how "foggy" their minds were, than giving positive support to each other. They all seemed amazed that I actually get up in the moring and work more that 40 hours a week at a job that requires a clear mind. Yes, there are days when I hurt worse that others and actually do have trouble focusing on things. Those are the days after I have had difficulty sleeping the night before. I cannot even consider laying around all day and then trying to sleep! The members of the support group frankly depressed me. They were all very sad and I found myself feeling sorry for them related to the fact that they had taken the path they were on, taking debilitating medications, feeling sorry for themselves, and letting their disease control them. What a sad way to go through life. Sorry this post was so lengthy, but there isn't one of us that can ever know how much pain and distress some one else is in without first experiencing the same thing.

In our facility, we have a very specific DNR policy. It is discussed with residents ans families on admission and is included in our admission packet. To make a long story short, we only do CPR on resident if we witness the arrest. Which means, if we see them go down, we do something. We do not do CPR unless it is SUDDEN and UNEXPECTED. We work closely with our families as soon as we notice the impending demise of a resident and explain carefully that their loved one may not make it through this one and invite them to notify relatives and close friends that my want to see their loved one prior to their passing. Our physicians are great at talking to families and recommending "Comfort Measures Only". We talk a lot about Quality of Life with the residents, families, and staff members. We have frank, open discussions with families and our residents and find by the time it is necessary, everone is willing to let go. I have worked for this facility for 14 years and remember only 2 times we actually performed CPR on one of our residents. We do everything we can to keep them comfortable, address choking episodes as we would with anyone, and have actually had not negative issues.

I have had this very experience. It was 4 or 5 years ago by now. I will always remember it as my "Worst Infection Control Nightmare!!" We developed a strange rash with itch. As Infection Control Nurse (at that time), I contacted our County Health Officer to discuss what he thought I should do. His recommendation was to have various physicians look at the rash that their residents had to see what they felt it was. Out of 6 physicians I had 1 that initially thought that it was the Scabies. A couple of them did punctures for evaluation. In the mean time, while waiting for the results, I contacted my Infection Control Physician, administration, and the Consulting Physician for the facility (One of the docs that didn't think it was scabies). We decided to contact the state epidemologist. The State Epidemologist set up an appointment with me for Sunday evening when he was going through town on his way to a Monday meeting. This physician was wonderful!!! He took at look at three residents in various stages of the disease process and informed me that we had scabies (by this time we had 55 of our 75 residents symptomatic). His recommendation was to treat ALL 75 of our residents, all direct care staff, and all of the facility day care staff and children AT THE SAME TIME. What we learned was that Scabies are spread by direct contact. The Isolation gowns we were using were of NO HELP. It seems that the litter bugger actually burrows under the skin in a matter of 2 to 3 seconds after contact. Our employees were being infected every time they helped a person treanfer, reposition, etc. and then carrying the scabies to the other residents in the facility. Our consulting physician wrote the order to cover every one that needed treated, we ordered the medication, and set up our schedule for treatment. The day before the treatment was to begin, the evening and night staff were sent home with treatment. The day shift staff were to come to work untreated. We treated every resident in our facility during the morning. Stripped every bed, sent all clothing to the laundry, housekeepers did terminal-type cleaning of every room including removing the divider curtains and window dressings which were sent to be laundered and shampooed all of the hallway carpeting. When the evening shift reported to work - already treated and they had the distinct honor of showering every resident in the facility (all 75) to remove the lotion that had been applied. From that time on, al staff had to have been treated (symptomatic or not) prior to reporting to work. We treated Nursing, activities, social services, housekeeping, , laundry and day care personel as well as all of the children in the day care and some of their families, at the expense of the facility. Cost of treatment exceeded $3,000. We had about 15 residents that needed a second treatment and 2 that needed a third. We have not seen scabies in the facility since that time!!! Thank God! I no longer serve as the IC Nurse which I requested to give up due to my MDS and management work load. But, even this long after the epidemic, I still get questions about rashes that develop as to whether or not they are scabies. Our long term resident and employee population still has not forgotten. I have finally quit having dreams about epidemic outbreaks. I am sharing this information with you so that you know that this mite can be erradecated and life can return to normal (whatever that is) in the facility. Please try to see what you can do to eliminate this problem from your facility. It can be done!!!I can be done!!! My good wishes and prayers are with you.

I have an idea!!! I work in a 75 bed facility in Wyoming. Our State has a minimum staffing requirement of 1 nurse (RN or LPN) for every 50 residents. Therefore, we are required to have 2 nurses in house at all times. at all times. It is my understanding that there us also a facility minimum requirement for staffing that is related to the number of employees it would require to safely see that an evacuation of the residents could occur in an emergency (i.e. Fire). Does anyone remember a recent news report about a nursing home having a fire at night and residents that didn't live due to not being able to evacuate them? Ever think of the risk that the facility is taking in this situation? Do the powers that be care about risk and safety issues. Risk and safety could also include an injury producing fall and need for CPR on another resident at the same time. I would look for another place to work rather than put myself through the stress and concern about the safety of everyone that is depending on the facility (me as their representative) to meet their needs and keep them safe. Has anyone from administration been in the facility during the night shift? Do they realize that these people that we care for do not all sleep at the same time? The big question that I would ask myself is "Does this facility CARE about the residents, or am I the only one who does?" You are in a horrible situation! The best thing that could happen for the people you CARE FOR is that the entire facility would CARE ABOUT them. If it is not possible for you to make them understand the risks they are taking, they will never understand the risks you are taking. Take care of yourself as well as the residents. As nurses, we often forget to take care of ourselves, and no one else will do it for us. I commend you for taking the stand you have taken and wish you the best of outcomes. jornac