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Content by tewdles

  1. Hospitals should be part of a larger health care system for a community. The continuum of care and health within that community is both a shared endeavor and responsibility. Poor communities with few resources to assist the disadvantaged will have poorer health outcomes for patients mentioned by Marisette. How do we fix these problems??
  2. tewdles

    Bending and Breaking the Rules in Nursing

    Thank you for breaking a stupid rule...
  3. tewdles

    Dear Family Members

    Unfortunately, not all of the family members have good social or coping skills...stress increases the likelihood that people will behave badly...
  4. tewdles

    Do Nurses Earn Big Money? You Decide.

    My bold and italic. I had a family member like that. The family spoke to her...let her know that it was NOT OKAY. Some of us helped her with job skills, resumes, transportation, etc. She got off her arse and got productive. The system is there for people who need it. Some people will always abuse it. In my thinking, that does not mean that we should treat all persons receiving aid as cheats and consider cutting the safety net for many because of the bad actions of the few.
  5. tewdles

    Do Nurses Earn Big Money? You Decide.

    Sounds to me that a CNA going to school to improve her circumstance is not getting a handout but rather a handup. It is sad for me the number of otherwise well meaning Americans who despise people for needing help. I think that very few of us do well in life when we are truly on our own. Not everyone comes from a family or social situation that can provide assistance for financial needs...they can't afford to subsidize college, or rent, or food, or transportation for their children. That doesn't make them less American or less valuable than the child born with the silver spoon. Mitt Romney, for example, is no more valuable to the USA because he was born wealthy and has never received welfare as compared to the young man or woman who receives support while getting an education or working toward personal goals which will improve their social status. In my view, this "class warfare" is destructive to our society.
  6. tewdles

    Is Your Name Important?

    I haven't read all of the posts, sorry. As a hiring manager the name itself on the resume has had zero influence in my decision making. I don't expect that it will in the future.
  7. tewdles

    Dear Nurses: Please Forgive Me

    Your essay is my professional life...from the other perspective. All of my patients die and all of the family members are somewhere in their grief. Many of the families have a nurse or other health professional in the midst because of the employment mix of the region. Go gently, live each day with the goal of no regrets...not today, not tomorrow, not 6 months from now. Be "in the moment" with your loved one. Breathe.
  8. tewdles

    Nurses: Oppression Can Stop With You

    High paid CEO's do not improve patient outcomes in the acute care setting, adequate numbers of professional nurses properly trained and supported in providing nursing care to patients improves outcomes. Until hospital systems acknowledge and embrace this fact there will continue to be struggles to maintain the bottom line of the facility at the expense of nurses. And when the outcomes suffer the nurses will still be blamed and asked to do more with less and the CEO will collect a bonus for continuing to put bandaids on the problems.
  9. tewdles

    Nurses: Oppression Can Stop With You

    I wish I felt as confident about this as you do. Frankly, the Ryan plan for the budget and treatment of Medicare scares me spitless and I cannot support it.
  10. tewdles

    Our Death-Defying, Death-Denying Society

    As a hospice professional I have observed the "death denial" behavior of health care professionals for some time now. In my opinion, families and patients often accept the terminal prognosis sooner than the physician does. It is not at all uncommon for a family member or the patient themselves to request hospice services only to have the PCP or medical specialist balk at identifying the patient as "terminal". I will also simply refer folks to the stats that indicate the average length of stay in the USA for a hospice patient...the late referral of terminal patients speaks more to the inability of the managing medical provider to even acknowledge evidence of decline toward death of their patients than it does of death denial in the families. Most families and patients trust their doctors and respect their opinions and recommendations. Families will demand fewer futile interventions when the medical community is honest with them and does not offer them futile options. MDs should not be surprised when their patients with CHF, Diabetes, COPD, etc begin the process of decline! These are chronic debilitating diseases that will contribute to or result in their death at some point. The traditional medical community is very well educated in diagnosing and treating disease states. They are not so well educated in identifying chronic terminal disease states and then educating the patient toward a "good outcome" that does not include cure but rather focuses on palliation of symptoms. I am accustomed to having medical residents rotate through our hospice program to learn about end of life issues. Among other things, they learn how to speak to people about death, and dying, and end of life goals. I wish I could say that my initiation of these discussions during hospice informational visits was not the first time that these people have heard such language...but it OFTEN is. Too many people have commented to me that I was the first health professional to actually use words such as death and dying. Generally those folks are relieved (not all, but many). The removal of nurses from the primary care setting has reduced the amount of ongoing education people get about their health status and the goals associated with their needs. WE are the professionals trained to educate and advocate for the patient. IMHO, the education of the patient and family relative to their disease state should be ongoing in the primary care setting...NOT in just the acute care setting (although it should occur there also). There certainly are cultural and religious foundations to the decisions that people make relative to their end of life or that of a loved one. It is important that we discover what the perspective of the patient and family are and then attempt to reconcile that with excellent, compassionate, ethical care. I find that many times family are making decisions based in fear and misunderstanding. When a patient daughter recently expressed to me her goals for her mother's end of life care I listened intently and then asked her what she thought her mother would want. I followed that by asking her if she was developing this goal to improve her mother's quality of life or to diminish her fears and anxieties about losing her mom. Granted it was a very blunt question, but it made her think, and over the next couple of weeks her opinion evolved as she continued interaction with her mom and the hospice team. She was not offended by my question and actually expressed to the MSW that she appreciated my honesty. Having said that, I have one family who will want a feeding tube and IVs for their father because the priest advised them that to do otherwise would be counter to their religion. Another who refuses all opiates for a similar reason. Another family doesn't get to make the choices at all, the spiritual leader or eldest male in the religious group makes the decisions. These, however, are the minority of cases in my view. In terms of miracles, most folks who are hoping for a miracle at end of life are not encouraged to abandon that hope. Miracles do not require intensive intervention on the part of health care staff, they require intervention by God and can occur at anytime...even post mortem.
  11. tewdles

    Wage Deflation In Nursing

    Nothing will change r/t nursing wages and work load as long as profit drives our health care system...nothing.
  12. tewdles

    The Purpose Of Pain Clinics

    Of course, the comprehensive pain assessment is integral to determining the best treatment options. However, we often use things like acetaminophen or ibuprofen in combination with other meds. Often a steroid will help, or addition of something like gabapentin. Sometimes addition of adjuvant meds like elavil will help. Some bone pain responds better to methadone. Good luck.
  13. tewdles

    The Purpose Of Pain Clinics

    Opiates are not the best treatment for bone pain...at least they are not most effective for bone pain in hospice...
  14. tewdles

    Managing Fungating (Malignant) Wounds

    We see these too often in hospice. Very traumatic wounds typically for the patient, family, and nurses. I love the info about gold dust, this is not something I am familiar with and will read with interest. These are the wounds that sometimes erode an adjacent blood vessel causing the patient to exsanguinate in the home.
  15. tewdles

    Hospice Care Versus Palliative Care

    There are many misconceptions and misunderstandings of what "hospice care" means. Palliative care is the portion of hospice care that can be shared with patients no matter their life expectancy. No matter where the patient lives, the hospice care will only be as good as the people running it expect and plan for it to be.
  16. tewdles

    Thickened Liquids With Dysphagia (Part I)

    Thanks for the article. As one might imagine, dysphagia is a recurring issue in hospice and we provide thickeners for patient use in the home. Of course, our goals for care are a bit different than they are in the "curative" arena of health care, but we still don't want our patients to suffer through choking, paroxysmal coughing, and aspiration pneumonitis.
  17. tewdles

    4th Nursing Caption Contest - Win $100

    But...my name really is Dr Dick, I'm new in town and I really am going to work with you!
  18. tewdles

    And He Will Die...

    I am, as we read this thread, endeavoring to start and build a hospice that DOES pay attention and take care of the cummulative grief of the staff. Thank you for your insight and wise words.
  19. tewdles

    2011 grads..jobs?

    in Michigan the pay at LTC is better than no pay...just sayin...
  20. tewdles


    nuthin like having the buckwads hijack a Michigan thread...
  21. tewdles

    Offensive Nursing Behavior

    I agree that this is abuse. This is not appropriate age specific nursing care. The nurse described is likely not uneducated about relevant nursing care, she is a bully. Report her in every way you are required by your workplace policies and by your license.
  22. tewdles

    Peg Feeding Complication

    If it were my grandma I would have scooted her up in bed first and spoken to the staff later. Would it be possible for grandma to get into a chair for her feedings? If she routinely "burps" the feeding into her mouth I might question the volume of the feeding, or the time over which it is given. You are correct to wonder about this. Your grandma could aspirate and I would consider her to be at risk for that complication based upon the scenario you described.
  23. tewdles

    Nurse burnout/Moral distress/Compassion fatigue

    depression would be a medical diagnosis, which most of us are not qualified to make...
  24. tewdles

    Transplant error, nurse and doctor disciplined.

    wow...just wow.