CompleteUnknown

I actually like the more difficult ones, love it when I can turn them around, even if it's only a slight turn around. I think there's way too many patients that become difficult because of what we do or don't do, and often we don't even see our part in it. I understand how and why it happens and I understand that sometimes it can't be helped but I think it's such a shame. A wise old nurse told me many years ago 'Anyone can look after the easy patient'. That's a bit simplistic I guess, but I came to understand and appreciate what she meant.

That's absolutely horrible abbaking. Awful. No other way to describe it. Give yourself some time before you decide 'that's it' though. I wonder if, as horrible as it was, it was more that it was just the last straw that particular shift? Maybe you normally would have been outraged, furious, whatever, but been able to handle it? I sometimes secretly wish that I was able to have a meltdown at work, it's so tempting and oh, to be able to scream and shout and say what I really think! It's just not me though. I either keep it inside or take it out on my family or friends. Neither of those options is good either - maybe we all need a kick boxing session after work. A friend of mine works in an office and they have a 'quiet room' with a sofa, soft drinks and snacks. Anyone can go there for a break when they feel it's all getting to be a bit too much. I don't know, when the paperwork starts getting abusive or something. I'm kidding!!!! No disrespect to people who work in offices - I've done it myself and I know it can be extremely stressful. It's a different kind of stress though even when dealing with the public and even if we DID have a quiet room, we would never have time to go and sit in it! Hope you start to feel a bit better soon. :hug:

If the catheter is occluded but urine is leaking around it and there's no distension, you have to wonder if it really is necessary. If it is, I'd try the side-lying idea first. For the resident, it's generally not a confronting position to be in while the traditional lying on the back with legs apart definitely is. Either way, undo the bedding from the bottom of the bed and double it over towards the top rather than pulling everything down, it feels much less exposing for the resident to have the bedding around the top of their body as normal when you're doing something 'down there'. We do this for all pad changes and incontinence clean-ups where I work and it makes such a difference with the ones who tend to resist or fight - works like magic. If you think about it from the point of the view of the person with dementia, someone is coming in, ripping their bedding off and then doing things to them, no wonder some of them fight.

I've seen this several times too. It's really not that unusual. I voided over 2 litres about six hours after I had my first child (lady partsl delivery). I didn't feel I even needed to go; it's only that they said 'if you don't go soon we're going to have to put in a catheter' and it sounded like they meant it. Lol.

This is a great post and I think that most nurses feel the same, that 'it is huge' to be present when someone dies. It's easier when it's an expected death (no matter what the age of the patient) because things are usually relatively calm. Codes and unexpected deaths are harder because there isn't that sense that something profound is happening, it's too 'busy', if that is the right word. It sounds ridiculous to say you will get used to it but there's not really another way to describe it. There will always be deaths that upset you far more than others and often it's hard to even know why this death in particular affected you so much more than that one. Back in the dark ages when I first became a nurse, most of us were very young and had little or no experience with death. We all learned to cope in our own way and in our own time and it's okay, I think you will too.

Many years ago, I was told by my boss that I always looked like I had the weight of the world on my shoulders and that I needed to lighten up a bit. Honestly, I was pretty hurt. I mean, I was new and there was so much to worry about and what if this happened and what if I didn't know enough and what if I forgot something and what if this and what if that and I DID feel like I had the weight of the world on my shoulders! Anyway, after I thought about it for a bit I realised she was right. Nurses don't have to swashbuckle around the ward with a devil-may-care attitude but not everything is an emergency, not everyone is going to die right this minute, and it won't be the end of the world if I don't know every single thing there is to know. I made a conscious effort to try to relax and smile a bit more and it really did help. It was an act at first but soon I was feeling more relaxed as well as looking more relaxed and I found I actually started to enjoy work and even sometimes have a bit of fun. There's plenty of terrifying moments to go around, it's good if you can smile and joke with your patients and colleagues when it's appropriate. You may not be thinking that you're too proud to ask for help but is it at least possible that you are giving that impression? If what you've said are the only things they found to criticise, I'd let it sink in for a day or so, think about it again without feeling that you're being judged, and then take it on board. It doesn't sound like bad advice to me, and it doesn't sound like a reason for resigning either. :)

We only chart behaviours if there is an increase in frequency or severity of existing behaviour, if there is a new behaviour observed or noticed, during an assessment period, or during a review period such as when there's a trial of reduction in medication. Otherwise we'd have pages and pages of notes or charts on each resident each shift. However, we can't chart 'no behaviours this shift' (as that is rarely that the case) although we could chart something like 'current interventions for challenging behaviours remain effective' with a more detailed description once a week/month or as required by facility policy. Agree that behaviours need to be documented so that successful interventions can be developed. Our main problem seems to be people documenting behaviours but not what was tried to manage it. It's also true that staff get used to the way residents are, and work around this (use interventions) without even realising what they are doing. That's where you get the 'oh she's always like this' and in a way it's a good thing because it means that staff are meeting the resident's needs. The behaviour does need to be documented though; I think that sometimes some staff feel that it reflects badly on the resident if they write some of this down and will only document a behaviour if they find it personally upsetting. Maybe some staff education is needed at OP's facility?

That's great news CabanaDay, hope the Abena pads do the trick! :) Totally agree that the more expensive pads are worth it, and probably cheaper in the long run.

I don't want to sound harsh either, but I agree with this post. If I'm looking after a patient with a tracheostomy, I need to know how to manage it. If I don't know, or don't feel confident, it's my responsibility to make sure I do find out, become confident with the changing procedure, and make certain I can handle any complications that may occur, especially in a situation like this where there is no back-up. If that's not possible for some reason (not enough time, no-one to teach me, whatever), it's up to me to turn down the assignment until I do have the skills.

Unbelievable. And to then snap a pic of the BP reading because she didn't have a pen??? I have never sent (or received) a text to another staff member about an administration or patient issue, it wouldn't even occur to me! Besides, I don't even have my phone on me when I'm working, it stays in my bag and I might check it occasionally if I'm expecting a message about something important. Most days I don't even look at it until I get home.

I'd be willing to bet that, one day, a resident fell and someone wrote an unsatisfactory note that happened to include the words 'found on floor'. Then, a surveyor came along and saw that note (we all know they have an uncanny ability to choose to review exactly the chart you wish could be lost in a fire or swept away in a flood or something ) and those in charge, instead of explaining why the note was unsatisfactory, made a rule that you must not say 'found on floor'. Or maybe they did explain why the note was unsatisfactory and maybe 'found on floor' was a bad choice of words in that particular situation but all that has been lost in the mists of time and all anyone remembers now is that the world will end if you write found on floor. Such is life in LTC!

Off topic I know, but has anyone ever actually developed an ear infection from sharing stethoscopes? We all tend to use the facility stethoscopes where I work and I've never had an ear infection in my life. Most of the doctors who round bring their own but if they hear something interesting, they'll likely grab anyone who is walking past and hand over their stethoscope saying 'hey, listen to this'. No-one seems to think twice about sharing. If a doc doesn't have their own with them, they'll just grab one of the communal ones. Every now and then someone will replace all the ear buds. It all sounds a bit disgusting now that I write it down but I've never really thought too much about it. We all must have ears of steel.

I would add that when the assessors are in the facility, while they may not actually stand next to someone and observe every medication round that happens during the survey period, they DO have eyes in the backs of their heads and will notice errors in procedure or poor practice from seemingly the other end of the facility. You think they are safely reviewing falls documentation but they will still hear and see everything unless you are able to somehow lock them in a soundproof windowless room! They will also suddenly appear around corners and have the magic ability to overhear exactly the conversation you desperately don't want them to hear. I'm not trying to scare you, just saying follow all your procedures and don't try to get away with cutting any corners when they are in the facility. :)

I don't know, I've heard it before (on here) that saying 'found on floor' can lead to confusion and questions about the patient being lost but really...... who would imagine that 'found on floor' might actually mean 'Unable to locate patient at 1600 hours. Conducted search of facility and eventually found patient sitting on the floor next to his bed'? If he'd been 'found on pathway outside facility' or 'found behind boxes in storeroom' I can see that perhaps there would be a question about how he got there, but if he's found in his room why on earth would anyone feel there might be a chance he'd been lost? PS. I love your proposed entry in the notes and the way you included the bit about the housekeeper being late because of the sausages on the road. I've never seen such a wonderful analysis of the causes of a fall - the satin socks, the strand of hair falling across the eye, the puzzlement and distraction caused by wondering how the slippers could have hopped across the room, the legs that went like wet noodles and the shifting continence aid all came together into a perfect storm of causative factors!!! I can SEE him sitting there grinning at you with his sparkling eyes 'yep, I'm on the floor again!'

I've been following this thread with interest but haven't commented so far because I'm not in the US. However I think Nicurn001 has a really good point. Even supposing a charity/community hospital could adequately treat everyone who is 'deserving' (and you then need a way of determining who really is deserving), what do you do with those who choose not to buy health insurance? Really truly absolutely deny them care?? What about any children they may have? As an outsider looking in, it seems to me that the US already has a form of universal cover (as everyone actually does get at least emergency treatment), it's just that it's one without any of the advantages of those types of systems. I can't imagine a voluntary system where everyone actually does contribute and everyone one actually does the right thing. That's just not human nature. I understand that some have a philosophical objection to 'forcing' people to buy insurance, but if so, does that hold in all circumstances? It's against the law here for a car to be unregistered and part of the registration fee is a mandatory third-party insurance. Is that the same in the US? It's not essential to have a car but if you don't there's nothing to drive anywhere so you don't need the mandatory insurance. We don't tell people 'oh you really should get that car registered', we make it a legal requirement. I'd probably be tempted to go without car registration myself if that was an option. After all, I'm a careful driver, I'm never going to be involved in an accident. Unless the society is truly willing to deny treatment to those who could have afforded insurance but chose not to buy it, I don't see that a voluntary system can work. It seems that a system of deciding which patients can afford insurance (and they don't get treated) and which patients can't (they do get treated) would also be needed. I think it was in this thread that someone said the US would face unique challenges if it introduced a system of universal coverage. I've been wondering what people see as some of the difficulties, and whether it's a logistical problem or something else?

If the doctor identifies him/herself when they answer, and I think he or she will at least have a vague idea of who I am, I generally say 'Hi, it's Complete from X, I'm ringing about Mr Jones'. If it's a doctor who may not know who I am, I'll say 'Hi, it's Complete, one of the nurses at X, I'm ringing about a patient'. If someone other than the doctor answers, or I'm not sure who is answering, I add 'Can I speak to Dr Smith please?' It occurs to me that in the days before caller ID and mobile phones, I did this whether I was ringing my best friend or the bank manager. 'Hi Gertrude, it's Complete, how are you?' for best friend and 'Good morning, my name is Complete Unknown, could I speak to the manager please?' for the bank. It's courteous and I think it actually saves time to say who you are when ringing a doctor, even if it's a mobile number, even if the doctor is going to know the number, even if the doctor is expecting a call from me. It never crossed my mind either that a wife or husband might be suspicious if I don't. I am conscious, though, that doctors are like anyone else and get phone calls about all about all sorts of things, some of which they may not want to deal with at that particular time. Why make whoever answers do the work of finding out who is calling and why?

It's a bit like age - a patient's age is objective data even if we don't have the proof there in front of us. The patient may not be telling the truth about his smoking or where he lives but it's still the case that both of those things are facts that could be checked or measured or verified by someone else. Whether or not anyone does actually check that the patient lives in New York or has given up smoking doesn't really matter, it's still objective data.

I'm more likely to forget something if it has to be done 'some time today' than if it has to be done, say, every 30 minutes. I think you'll find this will just fall into place - getting the time to actually be able to do the thing every 30 minutes is another matter altogether!

Ah, it's not so bad RN in training, it's just a discussion on a message board. Everyone has an opinion, it's hard to convey tone of voice with the printed word so every word used can get over-analysed, people get side-tracked and bring up side issues, and that's okay too. I think we're all happy. :)

Have you ever seen what a vet nurse does? The jobs might not be interchangeable, but the principles are the same and I think the similarities are greater than the differences.

We use plastic G clamps specially designed for catheters, there are no sharp ends or pointy bits. You have to be a bit careful because if you use a clamp with teeth or one that clamps too tight you can damage the catheter so I'd never use something from the hardware store. If things are grim and there are no clamps available, you can kink the tubing of the catheter bag a few inches below the join and put an elastic band around it to keep it kinked for 20 minutes or so. It doesn't matter if a bit of urine gets through as long as you can get enough for your sample.

I've been doing this for a long time, and I still tend to go over and over things in my head unless I make a determined effort to put the work day behind me. I think some of it is a personality thing; some people are better than others at letting it all go when they walk out the door. The other thing I still do is wake up in the middle of the night thinking 'oh no! I forgot to document such-and-such'. It's all pretty normal, and it does get better. :)

I have ALWAYS wanted to be an astronaut. Seriously. Either than or an astronomer. Might just head on over to allastrounauts.com because, you know, maybe it's not too late for me.

Veterinary nurse is the official term here in Australia and even if it wasn't, I wouldn't have a problem with it. The original post with the comment about the OP's notes on cardiac conditions seemed to be suggesting that a vet tech/vet nurse has less knowledge than an RN/LPN which is a bit condescending and I doubt it's true anyway. Imagine having to know your disease processes, common problems, interventions, usual medication dosages, reactions to anaesthesia, and a million other things, not just for one species, but for the cat, the dog, the horse, the cow, the guinea pig, the bird, the goat, the rabbit, the lizard, the bat, the kangaroo, yikes it never ends. This was a casual conversation in a shop.... I'm finding it hard to see the problem.

Yes, you need the 'flow-through' liners/boosters otherwise it's a waste of time, as you say. I think the Abri-Let booster pads would probably be okay with the pull ups, but perhaps they'd be too bulky. Good luck, hope the high absorbency pull-ups work for them. It sounds like the family is doing a great job, all things considered! :)