RNSUEIA

You do not need to be religious to be a hospice nurse. You have to be a caring person. Religion is not always important to our patients.

Maybe we should remember to look for the good in our coworkers. Some people spend too much time worrying about looks and clothes. Nursing spawns a lot of petty criticisms of one another. I am just not down with that. Lets be nice. : )

I have a patient with pancreatic cancer that I have managed for approx 2 weeks now. It seems like nothing I say gets through to the wife in regard to pain management. I believe this is due to her own fears of pain. She told me one day that she doesnt think her husbands pain is "that bad". She did then say "but its not my pain". She definitly wont give morphine. "makes him too sleepy and glassy eyed, like he's over medicated" The vicodin she gives maybe twice a day and then only one pill. I have encouraged her to give the vicodin at scheduled intervals and have discussed with her about preventing pain. OMG...........any pointers????????

No she is'nt allergic to Morphine, but she really resists my doing alot of changing of her meds so I am trying to ease her along. I did start her on Trilasate 750 mg BID today, trust me she wasnt that pleased. I hope it makes some inprovement i told her to start tonite and take another dose in the morning then I plane to see her tomorrow afternoon. My next plan is to get rid of the hydrocodone and replace with the oxycodone. I will see what tomorrow brings. thanks for all your advice SUE

I have a new patient that I am seeing who is having a hard time adjusting to any new pain meds being added to her current dosages. I have her on oxycontin 120 mg bid and hydrocodone 7.5\325 2 every 4 hours and oxycodone 5 mg 2 every 2 hours for breakthrough (tho its difficult to get her to take it). She continues to have breakthrough hip pain due to bone mets. Seems like every time I do|try to change something it really gets her anxious. I tried a medi planner she did not like that at all. now I have made a written list of everything she is to take and at what time. My main trouble is getting this bone pain managed. Any suggestions? By the way if you couldnt tell. I have case managed exactly 1 week and I really want to do my very best for this patient. Welcome all suggestions. Thank you

I have never had to start an IV in the home, we do however use piccs and ports. Mostly for pain control or nausea. We dont do a lot of blood draws either. I think that if you feel like hospice might be your calling, you should go for it. It is a GREAT job!!

At my hospice, the nurse does all of the paperwork, signs consents, fill out emergency contacts sheet with md, pharmacy numbers, calls for equipment etc. The social worker only gave out some printed info.{on this particular visit} I do see the importance of our s.w. you bet, I personally dont care to have them accomp. me on admissions. Plus it throws off my whole routine. I dont think our chaplains have ever gone on admissions. Thank you all for your imput.

I have been doing hospice for a couple of years and mostly on the weekends. Two days ago the social worker asked if she could go along on my admission as we were going to admit this pt in Jan. but she was scared and refused the admission then. The sw reasoning was....she thought she might not get to make contact if she didnt go to the initial meeting. The pt has two young children in the home and the sw wanted to get some info to her. Heres the question........imo this was far to much for the pt too soon. Do your sw go on admissions with you?? I am not sure if i can refuse to take them with me or not, that is something i will have to check out if the occasion arrives. I know the sw is a very important part of our team, but I really feel badly about subjecting the pt to such an overwhelming visit. I dont always bring up death and funerals on an initial visit, I like to kinda feel out the situation first, and I dont case manage so I may or may not see this person again. Sometimes I think it is helpful to build a relationship with someone before getting right down to it (if there is a probability of the pt lasting at least a month) Please give me some feedback on this and how you might handle it. Thanks much!!

I know of a very good brain injury rehab facility and they do work with title 19 as well as having done some hardship cases. Its called On With Life in ankeny iowa. They do miracles there. Another suggestion, how about a Vail Bed. This is a bed that is fully enclosed by netting the pt can see out, the nurse can see in. Pt is safe. These beds can be rented by the hospital... Hope this helps:nurse:

I made the switch to hospice 2 years ago and I love it. I work part time for them and part time on a med surg floor so I have lots of variety. I find that in hospice I have much more respect from the MDs. When my pt has a need I call the Doc and tell them what I want to have ordered and 99% of the time they tell me to get my pt what ever they need. My greatest job satisfaction comes from taking a pt who is in pain and stressed and the family is stressed to the max and making a huge difference. Try that on a med surg floor.............

TIGRESS; I lost my 12 year old daughter 3 months ago and I can tell you with great conviction that the family has suffered a terrible tragedy and can use all of the kind words and deeds you can give them. Having people whisper and speculate is not what is needed here. Also their need for kindness will be there long after the funerals are over.

After reading the product information, long ago. I always give Lovenox in the love handles. I have found that typically pt have less discomfort with this area as well.

How about teaching the wife to do the dressing change? Giving her some hands on training during your visit would be comforting for her. That would at least eliminate this daily dressing change. If you've been doing it for a while, she probably already knows how to do it. Now, take a deep breath. Your going through a tough spell in your job. Utilize your on call nurses to do routine visits. Then see the patients who are declining the most. Things will get better! Good luck to you

we typically use atropine gtts orally to dry secretions. 2-3 gtts per hour usually works well, and is less invasive than suctioning.

Pt was just diagnosied 2 weeks ago. Thought he had a sinus infection and turned out to have a tumor behind the eye with mets everywhere. I suppose there could be sometime of involvement close to a nerve that is causing the hiccups. I just dont know and I just dislike not knowing how to explain to the pt and loved ones what is causing this. Thank you for your reply.