Kittypower123

There is no rule that you have to work exclusively in wound care. I got my certification while working in hospice. I continued to work in hospice for a few years then decided to move into full time wound care.

Houston, TX - need I say more?

In a society that didn't even know where diseases came from. They didn't know about bacteria, viruses, etc. They had no good healthcare and terrible hygiene. Things are very different now. And over half a decade still gives time for the development of a vaccine and treatment, not to mention reproduction. As long as people are reproducing, there is hope for the continuation of the species.

But life went on after the plague. People survived. And this isn't 1333. It's 2020. Brilliant minds are working on developing a vaccine and on developing treatments. This hasn't wiped out 40 million creatures and I seriously doubt it will. Even if it does, there are over 7 Billion people on the planet. This isn't an extinction level event. Problematic, sure. Here forever, of course. Extinction level event? I just don't see it. The numbers don't add up.

First of all, we will develop a vaccine, many are working on it now. Second, in between recurrences, there will still be births. Third, those who get it and survive may be immune the next time around (obviously we don't know that yet, but it's possible). Finally, even if those who get it this time around are not immune next time, it won't be novel anymore giving us an edge. Not to mention that the 10-20% is those who are infected, not those who aren't and not everyone will be infected.

While I agree that this has the potential to be incredibly devastating to world's population, I don't quite see the extinction of mankind. Even if 20% of the population died, that still leaves 80%, many of whom can and will have children. Am I missing something?

Thank you both for sharing, I'm interested in education about COVID-19 too.

When I worked in a SNF it was 30+ patients when all the nurses showed up and more if they didn't. Med pass also included blood sugar checks and insulin administration and checking labs for PT/INR levels on 2nd shift. Plus we had to do things besides med pass. Way too much work in the time we were given. It's setting nurses up to fail.

I smell it too. It's actually kind of handy in hospice, I can let family members know their loved one is close to death. Help them prepare a little.

I've been away from this site for awhile. But I would like to clarify. I do not do my documentation after the admission visit. I do it on-site. But, I do a thorough evaluation of the patient to determine whether or not they are appropriate for hospice. By this time, I know much of their medical history as well as what is going on with them now. During the admission assessment, I am required to document on each system (cardiovascular, respiratory, etc.). When doing a thorough evaluation, I gather information such as cardiovascular disease and symptoms the patient is experiencing at that time as well as over time. So, when I get to that portion of the admission assessment, I already know that the patient has an irregular heartbeat, they require O2, experience dyspnea with exertion. All this is information I obtained during the evaluation portion of the visit. I do not need to re-assess the patient in front of me just because it's been 30 minutes or so. It's the same visit and information is still valid. I would document if the patient had taken any medication since I got there and what the effect was, or if their symptoms had changed in that short time. Typically, however, they are not in an acute care setting and are not experiencing such rapid changes to their condition. All our admissions include an evaluation as that is not done before hand.

There are a few things that help your patients and their families to have positive experience. First, don't promise anything that you can't personally deliver on. If it's not up to you, don't promise. Be honest about what you and hospice can and cannot do. Second, check meds at every visit and order any refills needed. If you wait for them to tell you, they will be calling after hours and on the weekend. Third, educate. The patient and family need to know what's coming. They need to know what changes will occur. When they don't know what's coming, they panic needlessly. That doesn't do anyone any good. They need to know which things they can and should do something about (and what to do) and which are natural and do not cause discomfort. Don't make the mistake of educating once and figuring they'll remember. They won't. Educate again, and again, and again. Finally, don't rush. Things will come more naturally and will take less time as you gain experience. That being said, don't rush a visit. Even when you feel rushed and are trying to get out as quickly as possible, take a breath and focus on what's in front of you. The patient and their family deserve your best.

Back when I was working in a SNF, I had a patient on Coumadin. The INR came back at 5-something and there was blood in the foley bag. Called the MD and he said to give the Coumadin and retest in the morning. Um...No. Sorry, not going to do that. Got him to agree to hold and retest in the morning. What the patient really needed was some Vitamin K.

I'm so sorry you're struggling with grief. It does come with the territory, as much as we try to be professional and have boundaries, some of our patients just get to us. Your hospice company should have chaplains, they can help you too. They're there for the staff as well as the families. Also, there is probably a bereavement coordinator who may be able to help. The chaplain or bereavement coordinator can help you talk through what you're feeling as you deal with the grief. If that's not enough, seek out a professional therapist. I have had a few patients that I cried over when they died. Thankfully, I can talk to the chaplains at work. I also have a wonderful husband who will hold me and let me cry it out. I hope and pray you find the right person to help you through your grief.

Time management can be difficult. You can plan your week, but it won't turn out that way! One thing I do is front-load my week. I plan to get almost all of my visits done in the first three days of the week. I know it won't happen, but if I plan for 4 visits on Friday, I know I might end up with 8. As I plan my week, I try to cluster visits geographically. I also think about which visits should be pretty straightforward (patient is stable, not much in the way of education needs, etc) and which will likely take more time. I think about which visits can be moved to later in week if something comes up and which can't. Having this information in my mind helps me change plans as I go and still be sure patient needs are being met. I'm constantly reviewing my schedule to check my progress and any changes I've had to make. If I have a CC or GIP patient, I see them first. I know they can take more time and I want get them taken care of. Most of time, if something else comes up with them after the visit, I can handle it by phone. It's tough to get time managed well in hospice, it takes time and practice. Use the frustrations with time management to learn. It will get easier. As for documentation, that takes practice too. Remember to document decline. For example, on admission patient ambulated with rolling walker, now confined to wheelchair. Also, you don't need to write a narrative for every system. Focus on what is an issue for that particular patient. For example, if you have a CHF patient, what is their b/p, hr, heart rhythm, do they have edema, is it better/worse/the same, are they on oxygen, are they compliant with meds, what education did they need, etc. For us, the assessment is mostly checking boxes and imputing certain stats like vital signs, last BM, Diet and % eaten, pain rating, that sort of thing. The narrative itself doesn't need to be long, just focus on the reason for the visit or the particular issues for that patient.

Me too. I scored 22 on that little list. As a hospice case manager, I visit patients where they live. I love being able to see one patient at a time, then spend time by myself between visits. Facilities can be a bit on the noisy side, but I don't have to stay there for an entire shift, just long enough to complete the visit(s) I have there. I also make sure to take a lunch break. I eat and read (or something) and don't think about work. When I worked in LTC I quickly learned to leave the building during my break, even though I just sat in my car. It can be challenging for us sensitive folk, but it's doable.