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I make a mean chocolate cake!

Jewelrmn's Latest Activity

  1. Jewelrmn

    i have a question about su

    Within my trust, seclusion rooms do not have camera's and this practice, as far as I know, is not usual in the UK. In fact, the use of locked rooms is now deterred, especially since we adopted the civil rights act in the uk, as this can be seen as an infringement. Special obs are completed within the ward area, and it has been known to nurse people who are violent or at risk on 2, 3, or even 4 to 1 obs within my own trust. It is important to remember, that people who suffer from mental illness are still people and should be treated with the same respect you or I receive. It is unfortunate however, that through illness, they are unable to exercise the same amount of control that we do. N.B. they may still use camera's in special hospitals such as Broadmoor :) :) , but I cannot attest to this.
  2. Jewelrmn

    wound question

    In reply to all who have written on this subject: The taking down of dressings does prolong healing rate. Those who have posted that this is due to a drop in temperature are correct. Those who claim that the new type dressings are designed to require less changes are right. Heres a few tips for you. When changing a dressing, ensure that all equipment is ready so that speed in dressing change is facilitated. Ensure that the wound cleansing solution is warmed to wound temperature. Try to encourage doctors not to take down dressings just for the sake of it. Empower yourself, docs generally know less about wounds than nurses do, so whats the point. If you need to take down a dressing and are unable to replace it immediately, cover it with something whilst you wait, either a piece of non adhesive dressing or even plastic wrap will do the job of keeping the wound warm. Good luck
  3. Jewelrmn

    Prevention in pressure ulcers

    Hi Tam910 Your right about one thing, the key to preventing pressure ulcers is education, all involved in care processes from care assistants to managers need to be well versed in this subject. Throughout your research you will have ascertained that pressure ulcers are 95% preventable. With adequate pressure relieving surfaces, frequent repositioning, good nutrition and hydration, hygiene and generally good nursing care, they can be prevented. However, you must also think of that 5% that are not preventable. The skin is the body's largest organ and also one of its most active. In terminal care, we accept that patients could go into renal failure or heart failure etc. If these organs can 'fail', why can't the skin? You also need to acknowledge the presence of existing co-pathologies. In a healthcare setting, the patients are ill, otherwise they would not be in hospital! These co-pathologies, whether they are the ones which brought the patient into hospital or not, may make the patients more susceptible to tissue damage, and acknowledgement must be given to these. It is worthwhile for nurses to know what effects the patients disease process has on the patient and correlate these with their risk of developing pressure ulcers as a result. I find that in many instances that these are not taken into consideration. Also, think about pre-admission care. If a person is to be hospitalised for surgery, they generally know in advance of the admission date and many undergo a pre-op assessment clinic. Why can't info be disseminated to them of the risk of tissue breakdown due to surgery. Giving them this type of advice may help them 'build' themselves up a little, to help them tolerate the malnutrition experienced due to pre and post op fasting and catabolic states? You are right, much more should be and can be done. It is worth the while for trusts to look into these ideas. Research has shown, that across the NHS hospitals, that pressure ulcers can cost up to £30M per annum, and that is not counting litigation costs! Good luck with your research.
  4. Jewelrmn

    i have a question about su

    You are right, these sorts of things should not happen, but unfortunately do. Keeing people on special obs is designed to prevent them commiting self harm or suicide, or from hurting others. The difficulty is in choosing which level of special obs is required. The easiest way would be to nurse everyone on a one to one basis (at the very least), however this is very intrusive nursing, and not always therapeutic. We look to our risk management strategies to help ascertain which level of special obs we need to apply. Unfortunately you cannot eliminate all risk, and sometimes things go wrong. 15 minute obs are designed to give patients some degree of privacy, the nurses must ascertain the whereabouts of the patient every 15 minutes and ensure their wellbeing. It is very possible for someone to take their life, or the life of others in this time. A higher obs level would have been appropriate in this instance, but we are all wise after the event, and though I do not know about this situation other than what you write, I expect that the risk management system in place did not highlight the need for them. I'm so sorry for your loss, my thoughts go out to you and everyone else affected by this tragedy.
  5. Jewelrmn

    Tips for Dressing to Scrotum??

    Hi This is a tricky one. I think I would pack the wound with an absorbant foam dressing. You can get ones from Allevyn which are little pieces of foam contained in a tea bag type 'pocket'. You just pop these into the cavity, they come in all different sizes. Cover with a sterile dressing and then hold all in place with a stockinette dressing - something like tubifast or tubinet. I would cover the whole of the scrotum with this, cutting a hole in it to feed the penis through hole so it can be fixed above the pubes, therefore no tape would be required peri wound. Sorry about my poor descriptive abilities, but I hope you get my meaning.
  6. Jewelrmn

    OUCH! Bet he'll never go without undies again!

    Answer: Very Carefully :chuckle
  7. Jewelrmn

    Help c wound care and dressing choices

    I know how you feel, this is an age old problem! The solution is to train all nurses in the art of wound care, so that we are all singing from the same song sheet. However, we do not live in an ideal world do we? Assessment processes which are designed to guide nurses through wound management will help continuity of care. Having a well formulated assessment form takes some of the subjectivity out of the assessment process. Formulating review dates to the care plan also helps, as any dressing needs time to work as we all know. My theory is though, that you treat the patient not the wound, and if you can get all your team to take this philosophy on board, you may get somewhere. Hopefully. Good luck
  8. Jewelrmn

    "Regular" psych vs. geriatric psych?

    Thank you to both Sanakrz and StuPer In my 20 years or so in older age psychiatry, I have come across many sad and many funny situations. All these go to enrich the work involved in looking after this client group. Before regulation and controls, many people were put in institutions for inappropriate reasons. When I was training, I came across one old dear who was put in hospital for getting pregnant out of wedlock, she had been in in hospital for 60+ years. There are many such stories as this. Not that long ago, I looked after a gentleman suffering from Lewy Body / Parkinsons Disease. His mobility was shocking and he fell umpteen times a day despite all efforts. One day, after a series of falls, he fell, went to get up and then shrugged his shoulders and just crawled to a wall, sat there. He then asked me to get him a plate and a sign to say "wife and kids to support". :kiss
  9. Jewelrmn

    "Regular" psych vs. geriatric psych?

    Working with older people with mental health problems is not just diaper patrol. Shame on those who think of it as such. I have worked in this field for 20 yrs and have loved it. My professional knowledge and skill base has benefitted tremendously. In how many other fields of psychiatry do you need to have as much knowledge on caring for physical illnesses as you do mental illnesses. My role includes IV therapy, catheterisation, wound care, Dysphagia, stroke management etc etc etc. I am also involved in ethical problems such as resuscitation in Dementia and the with holding and with drawing of medical treatments. Do not think of older age psychiatry as burden and toil, think more in terms of dedication, skill and love.