janets1

Leslie, you are precisely right. I am so sorry you did not return to the committee, you appear to be the only member with the understanding of hospice role. Unfortunately I have often thought committees murder the souls of more members than they ever help. So I certainly don't fault you for running for the door. Kudos for trying to work through committee at all. You have far more patience and endurance than I. Thanks for your condolences. I find grieving to be such a very solitary experience. Each of us have a unique relationship with the loved one, each love, each role, is unlike any other. Each of us believe our grief is more intense and poignant than anyone elses. We walk the road of grief alone. I hate this part of the journey. Having the joyful memories is all that makes it bearable. I will be ok eventually. Just not today. :-)

Was just thinking about a personal scenario very similar to the one you described. 88 yr. old male, very confused, sleeping majority of the day (and night), minimal verbal response... That is how he presented in the hospital. However the day before admit, he lived independently, drove, worked out at the gym 6 days/wk alternating aerobics & strength training, managed all ADLS independently. (Managed families ADLs as well :-) Hospital staff saw an elderly man with what appeared eol issues. When the nurse recommended hospice/palliative care to me I was appalled. This man (my beloved grandfather) was the lion of our family. Mercifully his physician knew my grandfather personally and treated his MRSA for 6 long weeks. When he was discharged it took almost a year of rehab to become a shadow of his former self. It wasn't my idea to "intervene." It was my grandfather's. He still had work to do. Granted your scenario is likely NOT the same as mine. However, just because we see the same thing everyday at work, doesn't mean it is all the same. Death and dying are taboo subjects in the "real world." I still know many nurses who refuse to prepare the body for the family because it "creeps them out." Your patient's family may not be aware of what EOL symptoms look like. The "denial" the family is in may be more related to ignorance (lack of exposure) than an inability to accept the inevitable. In reference to my grandfather he lived 4 more vital years. During those years his contributions to community, family, and my life were always meaningful. Last Tuesday when he died, we expected it, largely because as a man of medicine he was a tremendous educator. He taught us what to expect. All things being equal I prefer the theory work of grieving to the "clinical" experience.

Thank you so much for your ideas. My mind was so focused on the limited time frame, I forgot there are still several things I can do and assess.

I wear the z-coil shoe. They literally have a coil for the heal. Looks like Tigger shoes. They look different enough they are usually a conversation starter with clients or families. I don't have back or knee problems however I have been advised by the 'ol timers :-) that if I don't have problems now, I will. So take care of the merchandise. The shoes are available at "authorized dealers" who are trained to "tweak" the coil to support your walking style. If you habitually wear out one part of your sole before the other they can correct for that. It's apparently the uneven walking that causes the back and knee pain. All I can say is at the end of clinicals I have no pain, with minimal sit-down breaks. They are do exactly what I hoped. After years of listening to commercial hype, that's kind of refreshing. Zcoil.com

If you are looking for a model of how to (and not to) check you tube. They have several videos. Our instructor requires us to do all stethoscope work at the same time. She finds it inefficient for both pt and student to put on ears multiple times during the assessment.

I basically understand the ideas behind concept maps, dx, etc. (basic = 1st semester student). My frustration is choosing goals and interventions that can be completed within the 4 hour clinical experience. I am not to choose interventions that might roll into another clinical day. My interventions must be supported by the text only. (kozier & Erbs fundamentals 8th edition.). My clients are geriatric long term care residents. Majority with dementia so assessment is sometimes difficult, and education doesn't seem appropriate. We have been told not to use chronic confusion dx as there is nothing we can do. Skin care problems are also discouraged so they will not be overused. I'm looking for explanation on how to approach this. I feel as though Im hog tied before I begin and my frustration is making me blind to the possibilities. Help!