tewdles RN

PICU, NICU, L&D, Public Health, Hospice

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All Content by tewdles

  1. tewdles

    Patient refusing Hospice

    tewdles replied to jammycakesRN's topic in Hospice, Palliative

    you are misunderstanding how hospice bills and is paid. Hospice is paid a flat rate daily...a per diem benefit...regardless of who visits or how long they stay. If the aide visits 5 times per week...
  2. tewdles

    What can I do or say???

    tewdles replied to loveanurse777's topic in Hospice, Palliative

    Be compassionate. Be persistent in your education. Model behavior for them. Document your teaching and their responses. We cannot force people to accept the terminal decline of the loved ones, we...
  3. tewdles

    No dnr

    tewdles replied to aphillipi's topic in Hospice, Palliative

    In Ohio, Michigan, and Alaska there is no "presumed" DNR. They either have legal DNR documentation or they do not. DNR status is not required for hospice services. Hospice does not force people to...
  4. tewdles

    Patient refusing Hospice

    tewdles replied to jammycakesRN's topic in Hospice, Palliative

    Talk to the patients medical provider and report your assessment and concerns. Request a referral for hospice information visit and possibly for a hospice consult if that is available in your area....
  5. tewdles

    No dnr

    tewdles replied to aphillipi's topic in Hospice, Palliative

    If the patient does not have a valid DNR (called Comfort One in Alaska), you are required to perform CPR...just like EMS would have to when you call them. Your license requires this. In some states...
  6. tewdles

    Computer charting in hospice

    tewdles replied to coogabooga's topic in Hospice, Palliative

    I also have used Suncoast and it is much easier to complete point of service documentation in that software than in Horizon, which is what we are using in my current
  7. tewdles

    Anyone used music as an intervention?

    tewdles replied to mamatara's topic in Critical Care

    In hospice we actually use live musicians rather than recorded
  8. tewdles

    What would you say to this shocking patient statement?

    tewdles replied to aboucherrn's topic in Patient, Colleague Relations

    I, personally, don't believe this requires any response...so you did fine. Bigotry rarely justifies a response, in my view. What I would caution is your view of these "professional patients". It...
  9. tewdles

    Kussmaul Respirations

    tewdles replied to ajitamamasita's topic in Hospice, Palliative

    The respiratory changes you observed were part of the natural process. All of the opioids have a very very similar affect on our respiratory effort and SOB so the use of the liquid oxy rather than...
  10. tewdles

    how to ask patient for pain scale score correctly?

    tewdles replied to 7feetunder's topic in Emergency

    As one who has been conducting comprehensive pain assessments for some time now...coupled with personal experience of pain and need to report in a measurable way...would lead me to disagree that a...
  11. tewdles

    how to ask patient for pain scale score correctly?

    tewdles replied to 7feetunder's topic in Emergency

    And of course, my comment was reflecting the fact that you were identifying what a pain of 10/10 is to YOU, with a "sigh" relative to their (the patient's) interpretation. The reality is that when it...
  12. tewdles

    Work in Alaska?

    tewdles replied to thatchergirl's topic in General Nursing

    I came to AK without an AK nursing license, started my job and got my license within one month of my move. Some areas of AK do not have adequate access to health professionals who are educated and...
  13. tewdles

    Rectal use of opiates???!!!

    tewdles replied to RNOTODAY's topic in Patient Medications

    Rectal use of opioids is not uncommon in hospice care. Notify the MD and reconcile the
  14. tewdles

    Really worried and need some advice from my fellow nurses

    tewdles replied to Fd_rn2009's topic in Hospice, Palliative

    on call time can be brutal... If you are on call you have to expect to make visits...some times multiple visits... Sometimes we visit because the family expects it... sometimes we visit because we...
  15. tewdles

    Need advice about what to say to pt family

    tewdles replied to ellie23's topic in Hospice, Palliative

    I would plan a time to meet solo with the family member to discover if they actually believe that the patient is going to get better. It is important to help family members understand that hospice is...
  16. tewdles

    What is and isn't allowed on Hospice?

    tewdles replied to RachelRN25's topic in Hospice, Palliative

    The contracted hospice must pay for care related to the terminal diagnosis as outlined within the hospice plan of care (POC). Because hospice is paid on a "per diem" basis rather than a fee for...
  17. tewdles

    how to ask patient for pain scale score correctly?

    tewdles replied to 7feetunder's topic in Emergency

    Of course, it is their (the patient's) pain experience that we are trying to assess, not
  18. tewdles

    how to ask patient for pain scale score correctly?

    tewdles replied to 7feetunder's topic in Emergency

    If the patient is cognitively able you assess for a numeric level of pain...1/10. If they are not able to quantify using a number you may use the faces or you may use other verbage; like quantifying...
  19. tewdles

    "working" when you're off...

    tewdles replied to blamejoe's topic in General Nursing

    Yep...boundaries!
  20. tewdles

    Have you ever lost it with a patient?

    tewdles replied to notjustanurse's topic in Patient, Colleague Relations

    I would have to say that I have not "lost it" with a patient or family member, in more than 30 years of nursing. That is not to say that I have not been furious, etc, it simply means that I maintain...
  21. tewdles

    No bm in over a week and half??

    tewdles replied to coogabooga's topic in Hospice, Palliative

    Unless this woman is nearing death I would be concerned about her absence of stool. The poor po intake will certainly impact the quality and quantity of feces, but people typically pass some waste...
  22. tewdles

    No bm in over a week and half??

    tewdles replied to coogabooga's topic in Hospice, Palliative

    Do you have her on any bowel meds? We would presume that she might experience constipation secondary to any opiates, changes in activity, changes in diet, and secondary to her disease
  23. tewdles

    Is my license at risk working at a hospice office?

    tewdles replied to LV_Scrubs's topic in Hospice, Palliative

    Your liability will be determined by what they are asking you to augment within the record. Know you nurse practice act and the scope of practice for your state. Fall back on your education regarding...
  24. tewdles

    Has Anyone Here worked for Evangelical Homes in Saline?

    tewdles replied to westieluv's topic in Michigan Nursing

    I have not worked for Evangelical homes but have worked with them and with their staff a great deal. EVH purchased their home care business from a hospice in the area, and I am not much familiar with...
  25. tewdles

    Worried about tomorrow

    tewdles replied to AtlantaRN's topic in Hospice, Palliative

    Good luck. Competitive hospice is a tough