leslie :-D

i love this part of your post... as i find it pertinent for each person to define their version of spirituality. more often than not, religion and spirituality are used interchangeably and for me, they are most certainly not synonymous. as i read elsewhere, religion is an account of someone else's experience whereas spirituality is your own, unique experience. that spirituality is one's personal journey... no teachings, no dogma, no conditions or commands from external sources. it is discovering, acknowledging, and feeling the wonder and perplexity of the universe and all it contains... whether it is nature, music/arts, meditation... or whatever it is that stirs your soul, often sensing phenomena that feels bigger than oneself. you really need to experience it before one can appreciate it, as my words are meaningless until one has experienced and reveled in the awe of "it". :) and so op, in attempting to answer your question, one's personal beliefs have absolutely nothing to do with your role as a nurse. we are trained in treating our pts holistically. whatever the pt's needs are, we refer/consult/deliberate/contemplate accordingly. being a considerably sensitive and intelligent person, i take pride in being able to competently address my pts needs. absolutely nothing to do with religion, spirituality, or otherwise. leslie

seriously, i suspect the opioids are worsening his symptoms, as they further delay gastric emptying, delay gi motility, and can/do induce increased pain, n& v. we've used erythromycin with decent/improved results... along with neurontin and/or ultram and/or nortriptyline. these meds were initiated after dc'ing the narcs and pts reported improved effect. need to avoid or minimize anything narcotic and anticholinergic, as they appear to do more damage than good. IF he needs to stay on narcs, i would try methadone as it is the only narc i know that responds favorably to neuro pain (which the gut is rich with neural networks)... and PREVENT CONSTIPATION...which always, always, always worsens any situation. i hope you are being aggressive with bowel mgmt. gastroparesis IS a tough one. if all his symptoms are refractory, perhaps ketamine may be the way to go... but you need to be inpatient with experienced staff to administer. wishing him and his family, comfort and resolution. leslie

yes, it'd be highly unethical to disregard a pt's wishes, even if the nurse personally/morally disagrees with it. afterall, we ARE supposed to be their advocates. but it becomes much grayer if you know the pt doesn't want to be rescusitated, and a code is called anyways. this happens all too often as well. and so, should the nurse have to participate in a code knowing his/her pt didn't want it? i don't know the answer, and i could see the nurse being terminated because of it. but at the end of the day, i could also see the nurse being vindicated in a court of law... since the nurse was acting beneficently. we need to choose our battles wisely... and be prepared for undesired consequences as well. leslie

thanks for this. i too, have completely disregarded family wishes when i knew the pt's wishes, which were contrary. more often than not however, i have seen pts defer to what their family wants... putting their own personal desires aside. it is at those times that i have been their voice, and have acted accordingly. again, working inpt hospice for many years, i've had palliative care pts who remained full codes because of what family wanted. i have also witnessed head-butting between drs - one who wanted to pursue aggressive (but futile and invasive) tx, vs the other dr who just wanted them to die with dignity. i'm relieved to read that you have seen an improvement, because at the time, i certainly hadn't. and "slow codes" have indeed, been the saving grace for a few of my pts. for that, i and they, are most grateful. leslie

it is evident (to me) that you are struggling... and hope you can forgive yourself, as that is when true healing will begin. in the meantime, i am confident your mom knows how much you loved her... and pray you will find the much-needed peace in acknowledging that. only then, will your burdens be lifted and you can move forward freely and painlessly. leslie

i wish families understood this. that yes, even with a low bed, floor mats, bed alarms and continual supervision... that the self-determined pt IS going to walk, whether s/he is able to or not. and these pts are going to fall, be hospitalized, return only to fall again. personally, i think there are many family members who suffer a lot of guilt after their parent dies... and much of their angst is displaced. yes, there are substandard nursing homes and i wish all families did their research before selecting a ltc facility for their loved one. medicare has the public results of all state surveys that are done at ltc... and one can plainly see the results/standing of any particular facility. still, we nurses are blamed for everything - some, rightly so. as long as each and every one of us can sleep at night, knowing we gave ea pt our personal and professional best, then all is right in the world. i wish healing and peace for all who are grieving a loss of a loved one. leslie

i can assure you there are many pts on fdg tubes who are not eligible to eat foods by mouth... unless one's intent was to cause serious harm or death. also, fdg tubes do not prevent thirst, and so, a fdg tube would not address that particular problem with your pt. continue on giving good mouth care, that is helpful. and there is a reason that only skilled personnel can feed this pt...as it is too easy in causing a pt to aspirate. i appreciate your compassion, but i do believe you will understand so much more when you advance in your studies. good luck to you. leslie

the bottom line is food is still considered a pleasure of life.... and is always preferable to a fdg tube. the pt still gets to satisfy this most basic need by tasting and swallowing her food. you don't get any of those sensations with a fdg tube. speech needs to stay involved, to ensure pt is tolerating these fdgs and isn't microaspirating. fdg tubes should always be a very last resort, and not used as a means of convenience. leslie

i think several posts may be overlapping, because of 2 separate continuums that we're referring to: nsg continuum - when residents refuse care, on one end of the spectrum are nurses who shrug shoulders and say "ok" and chart accordingly...to the other end of the spectrum, with some nurses wracking their brains (after hours) trying to come up with ideas in getting their pts to comply/cooperate. resident continuum - those who are alert & oriented at one end, and those with total cognitive dsyfunction at the other. reading through all these posts, you just don't know what type of nurse is talking about what type of resident. i'm certain there are nurses who chart "refused care" with absolutely no effort on their parts. just as i'm certain there are residents who retain a notable amt of cognizance, yet dementia is prominent in other aspects of brain function. my experience has been that the most resistant of pts, will/do inevitably find that one person (title irrelevant) who they trust won't harm them, or who they trust to make the dreaded experience, as pleasant and timely as possible. it may not be every week, sometimes showering once a month is the best you will get. and finally, to me, honoring one's dignity entails NOT allowing a resident's condition to deterioriate to the point where they languish to the point where their physical and mental health are affected. i have never, ever encountered a pt/resident where they refused care throughout their stay at the ltc facility. eventually there was always at least one person they entrusted enough with care. as nurses, we have to pick our battles wisely. and i'll tell you quite frankly - if i had a resident that was known to refuse any/all care consistently, i for one had no problem dropping some lactulose in their drink and watched them swallow every drop. same concept with mom. again, this isn't for every pt but if it works for that particular pt, i'm good with that. every pt and situation is unique, and you need to customize ea intervention that reflects the pts known strengths and weaknesses. as long as we do everything humanly possible in honoring the pts needs of body, mind, and spirit, i do believe that's what counts. we as nurses walk many fine lines. in the end, it's finding that balance that dictates the desired outcome. leslie

i agree with all that carolinapooh has suggested. the biggest barrier i see however, is getting the parent(s) on board with this. more often than not, the parents themselves are obese and aren't going to be proactive in getting their children to a healthy weight. i reiterate, not all but "more often than not". this really needs to be a family effort as it entails a major lifestyle change. anything less is setting everyone up for failure, imo. leslie

i seriously believe your state of mind is the culmination of nsg school stressors. i felt as you do, right towards the very end when i wanted to walk away from it all. a loved one gave me a dopeslap that knocked me across the room, but also reoriented me back to my good senses. (thanks, i needed that.) you'll feel differently once you're a nurse, i can promise you that. it likely won't happen overnight, but you will grow into your own unique role of the professional nurse. you will exercise your nsg judgment appropriate to ea pt situation... and will apply your 'mature adult' judgment to those who may try and undermine you. in other words, you do not have to take anyone's ****...please always remember that. like the pp who brought in goodies and had a "talk" with his/her instructors... i too, had the same type talk with mine, less the goodies. i totally rejected their attempts in trying to disparage me, and communicated that calmly, articulately, and succinctly. i made myself quite clear and after that discussion, there were no more issues. you (or anyone) do not have to accept victim status, as you are in control. i'm not saying you're feeling victimized; i'm saying that your perceptions of any given event, are what will define its acuity or not. take your power back; give yourself a much-needed dopeslap; and move forward. you can do this...as you've been doing it all along. it's your time to shine. leslie

i was fine after graduating, i.e., a healthy dose of anxiety but certainly not crippling. i *think* the "scary" ones are those who are completely cocky (vs confident). i wouldn't read too much into your lack of enthusiasm now... and agree it likely has to do with where you are in your job search and feeling discouraged. let us know when you do get a job. i'd be willing to bet you'll feel much differently. leslie

long time ago i noticed a similar pattern with a pt... and the dr seemed to think it had to do with the splitting of the s2 heart sounds. i don't understand it, just repeating what was told me. leslie

well yes...the specialty of parish nursing is the only specialty of our profession that would be conducive to addressing faith-based needs of a patient. here are a couple of links for the readers, to learn the connection betw community and church. Functions of the Parish Nurse Role Functions of the Parish Nurse Role Starting a Parish Nurse Program (yes, the info contained herein is relevant, lol) www.indianaparishnurses.org/starting.html so yes, i can see why it'd be obvious that a parish nurse would be the exception to religious interaction with the pt. fsu, this might be the perfect specialty for you to work in. thanks tnbutterfly, for the reminder. leslie

it has been commonly expressed for a long time, that suicide is "selfish". i never, ever agreed or saw it that way. to call it selfish because the person does not think how their suicide will affect others, is secondary to me. all i see are tortured souls that are acting desperately or stupidly. my dtr's bff hung herself in 2009 and succeeded. she had broken up with her boyfriend - the boyfriend killed himself as a result but left this girl a note, blaming the suicide all on her. 'heather' decided she couldn't live with the condemnation and guilt, and killed herself. (she was a teen.) a few yrs later, her brother threw himself in front of an oncoming train when he was inebriated, and died. rumors said it was because of a breakup with his gf - it was later discovered that he missed his sister. bottom line, whether it seems petty/insignificant or not, these people were tortured or drunk/high enough to make poor decisions. suicide is always so very tragic but i am always relieved for them as i believe they are now in a realm where enlightenment will occur. jadelpn, you have experienced so much loss and i am sorry for that. we truly need to all be proactive in getting mentally unwell people, the help they so desperately need. we don't need "snap out of it", or "well, you don't know what I'VE been through", or any type of dismissive, superficial responses. mental health is tragically low on the priority list in this country... and it should be addressed as any other healthcare need. in the meantime, jadelpn is right - we need to take care of ourselves. unfortunately that will not happen until we learn to value and respect ourselves... and only then, will we be able to effectively and compassionately reach out to others. leslie