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leslie :-D

leslie :-D

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  1. leslie :-D

    Question for atheist nurses

    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
  2. leslie :-D

    Desperate for help with Gastroparesis pain mgmt

    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
  3. leslie :-D

    Can a nurse refuse to participate in a code?

    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
  4. leslie :-D

    Is a slow code ethical?

    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
  5. leslie :-D

    The right to refuse has so many interpretations

    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
  6. leslie :-D

    The right to refuse has so many interpretations

    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
  7. leslie :-D

    Question on swallowing precautions

    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
  8. leslie :-D

    Question on swallowing precautions

    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
  9. leslie :-D

    The right to refuse has so many interpretations

    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
  10. leslie :-D

    Childhood Obesity

    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
  11. leslie :-D

    Cry for help: I don't think I can do this.

    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
  12. leslie :-D

    I think I might be a scary nurse

    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
  13. leslie :-D

    What do you call this respiratory pattern?

    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
  14. 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
  15. leslie :-D

    Life and Death

    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
  16. oh gosh, i so agree. i too believe it is crossing a professional boundary when nurses do this... and seriously wish there were penalties for those who do. or, that the BON would consider that professional misconduct. the only exception might be working in a faith-based hospital and their p&p encouraged such interchange. even then i still feel uncomfortable with a nurse disclosing that type of info to a pt. it is just not professional. yet, people are going to do what they want to do. in some cases it'll be because they don't see anything wrong with it; and others, do so out of defiance...sheer defiance. this isn't specific to religion, i am saying this in the most general sense. aky, great point about everything that is dumped on us nurses. leslie
  17. at this point, this is semantics as anyone could defensively assert that they only are conversing. i have been privy to many bedside confessions. when a pt has shared with me that they are not sure if they are going anywhere (after death), a few have asked me what i believe. keep in mind that i had developed very intimate relationships with these folks. i worked inpatient hospice so we were together, during the most vulnerable of conditions, for weeks...sometimes months at a time. these bedside conversations were a reflection of a cumulative bonding experience that only deepened over time. and so, at those moments (when they asked me my beliefs), i kept it as brief, succinct and conceptual as possible. for example: from the time i was a child, i understood that energy never dies. and so because man is comprised of energy, it made perfect sense that while our physical body dies, our soul does not.... because our soul and spirit are energy forms. my patients found comfort with that, because "it made sense" to them. there was nothing religious about it, and i tried to be as analytical and logical about it to extent possible. even if i didn't believe that? i believe i would have still answered the same way as these pts were terror-stricken about dying and the thought of nothingness or hell afterwards... again, absolutely nothing religious about our conversations. fwiw, while you also deny that you would proselytize... anything cited from the bible, could be construed as just that. leslie
  18. leslie :-D

    Why are people uncomfortable talking about mental health?

    the above (my meds) is one of the major reasons i haven't returned to nsg... don't trust myself because a lot of my memory is shot and my mind is often discombobulated. be careful, sweetie. leslie
  19. ok, we are clearly not communicating, or, i am thick as poop... because for the life of me, i am not understanding how you can definitively deny a contradiction. again, a pt is in spiritual crisis, i.e., they are UNSURE if they are truly Christian or not. and so, the aforementioned would fit your first criteria of "the dying patient was a non-believer"... because even if they had been a practicing Christian their entire lives, lots of beliefs can and do change when dying. to quote 2 thessalonians 1:7-10 to a distressed, dying pt would be devastating. if you cannot understand that, there is nothing more i can say. and yes, you are probably correct in that majority of Christians believe Jesus is son of God. i'm not sure what your point is, but i will concede to that. i have cared for several Christians who were at peace. they talked about going home to Jesus, they had the 'glow' and were clearly firm in their faith. it is when there is absolutely no spiritual confusion and when the pt openly talks about their religion with joy, then that would be the only time when a nurse could respond in same. but even then, i personally do not believe in that. i feel it crosses professional boundaries but everyone feels differently. i do believe i've said all i can on this matter. if you still believe there is nothing wrong with sharing thessalonian's passage to a pt in spiritual crisis, then i will pray you don't devastate them. it is out of my hands. take care. leslie
  20. leslie :-D

    End stage Alzheimer's

    how does anyone live 6+ months without eating and without a feeding tube? leslie
  21. leslie :-D

    Why are people uncomfortable talking about mental health?

    i *think* those well-meaning friends (who suggested ssdi) weren't/aren't aware of your capabilties at the time you spoke about it. that maybe (and only YOU could answer that) you wouldn't be able to return to nursing. speaking for myself, that is the only reason i suggested ssdi...in hopes of its thought bringing you a piece of comfort, knowing that you didn't have to try and return to the very environment that has created incredible stress for you. iow, i suggested it only as a consideration...and not as an absolute and only option. :) leslie
  22. how come you're quoting "motives", inferring that i must have used this word? (i didn't.) to answer your question, i believe in God...a divine source, supreme spirit, all that is...however one chooses to address this being. i don't believe in Jesus as the son of Him. my therapist seems to think that perhaps Jesus was created as a more credible and accessible source, since realistically, many would struggle in believing in someone/something they couldn't see. *shrugs*...i don't know. i do believe there was a Jesus...maybe a prophetic sage. whatever His role, it is just not resonating with me that He was the Son of God. and it further raises my hackles when i am told i MUST believe that or i'm going to hell. nah. God doesn't work like that. He gave us free will. it is up to us to decide and trust in a divine, supreme energy that has indirect but total control over our lives. IF there is some sort of ramification for not believing, i believe it is inflicted by ourselves, not God. and only when we see the 'light', will be ascend in our spirituality. i could write a book on this, lol, but these are my most basic of beliefs. i don't know paul or anyone else in the bible. so to reference different scripture to me, falls on deaf ears. nothing personal...and God understands. leslie
  23. before i continue, why do you presume we may get "mad" at your selected scripture? i ask that most sincerely. speaking for myself, i do not get the least bit upset because the words are meaningless to me. i am quite secure in my beliefs, so there is absolutely no reason for me to get "mad". as you can see, you indeed contradicted yourself... between the words you initially stated you would share with a dying pt and your subsequent post, citing its insensitivity. do you not remember what you wrote? leslie
  24. leslie :-D

    Why are people uncomfortable talking about mental health?

    i believe people fear what they don't know or understand. and so, mental illness and death are 2 concepts that remain intimidating to most people. of course there are resultant offsprings of such a basic theory, but at its core, we fear what we do not understand. a lot more education and support would do wonders in ameliorating the stigma that frequently accompanies the aversions that we create in ignorance. leslie
  25. i would guesstimate that 99.9% of your posts have included scripture. and so respectfully, i remain skeptical of the bolded (by me). i *think* it's an exclusive type of language that devout Christians share amongst each other, re the light of the holy spirit or Jesus. still, i fully agree with your perspective...that religion has nothing to do with the glow...the light. rather, i've seen so many people that are joyous... that they have the glow/light of love, of peace, of contentment within their souls. this is why that type of Christian banter doesn't offend me... as i replace the religious concept with a more universal one, and they are one and the same. it is important to me, not to get hung up on labels. :) leslie eta: fwiw, i DESPISE that smiley face. he just looks so darned smug.
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