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  1. ktwlpn

    Bending and Breaking the Rules in Nursing

    After hospice came on board why in the world were her diet restrictions continued?????
  2. ktwlpn

    ESRD Patients in the PCP Office

    One of our PCP's in our LTC informed one of our staff nurses last week that "anyone on dialysis has to be 'full code'.....
  3. ktwlpn

    ESRD Patients in the PCP Office

    We do have a palliative care program ,first in this area.
  4. ktwlpn

    ESRD Patients in the PCP Office

    My experience has been a total lack of advance life care planning with every ESRD resident I have encountered in LTC.It is NEVER addressed outside the nursing home and we end up with a family in crisis,a resident CTD and rolling out to dialysis as a full code with end stage dementia.This may just be a characteristic of our local unit...If your experience is something g different please share it.
  5. ktwlpn

    The Devil and Delta Webster

    "You ain't the best nurse on the (expletive deleted) planet, but thanks for the Popsicles." No higher compliment has ever been paid to a nurse....I love that.
  6. ktwlpn

    Bending and Breaking the Rules in Nursing

    In my LTC even though the resident is on hospice they are still under the care of the physician in the nursing home and he can concur or not with any hospice recomendations. As far as dietary restrictions we,too have gotten much more liberal however we have (and continue to admit) more and more younger residents with multiple co-morbidities and diet continues to be a focus for their docs.These residents are all full codes and as non-compliant as they can be. I don't get it-all we can do is educate,provide the appropriate diet and walk away.I get a kick out of seeing what some of the folks fill their plates with in the independent dining room.And then I always see them later at the snack machine for the salt licks and sugar highs.
  7. ktwlpn

    Bending and Breaking the Rules in Nursing

    HPNA.org EPERC The National Hospice and Palliative Care Organization Here are some links to get you started with your proposal.
  8. ktwlpn

    Bending and Breaking the Rules in Nursing

    We are very liberal with diet and our hospice and palliative care residents.Maybe it's time for your facility to update it's policy and procedures (in her honor) Do some research,write up a proposal,bring it to the admin
  9. ktwlpn

    Out, Out, Damned Spot!

    OMG! Whose savy business idea was that??!!! They deserve a Delbert Award,imho I'll admit that over the years I have stayed in a few "screw and skidoo" type places and they all smelled like urinals-maybe the back halls were long term care units....
  10. The thread is a "sticky" in the Geriatric Nurses and LTC Nursing specialty forum and it's the second thread-"redirecting tips for Alzheimer's/dementia pts"
  11. My advice for facilitating teamwork ( which you are already doing) is to listen to the cna's and then go and assess the resident as soon as you can. You will decide to give the med or not. After you have been there for awhile you will get to know your residents, their triggers and which interventions are effective for each particular resident. You certainly can remind a cna that sitting 1 to 1 for a few minutes when you request she do so IS her job.Sometimes when you are a new nurse in LTC you 'll come across and aide or two who may try to test you.You will have to make your expectations clear from the start and follow through.If you tell someone to do something and they refuse to do it you'll have a problem if you permit it to continue. As for the tylenol issue-I don't see a problem with any staff member asking a resident if they have pain. I don't believe that is out of the scope of practice. It's not different then asking if they are thirsty or hungry.The cna's know the residents best in LTC and sometimes the resident won't complain to the nurse. I am a big believer in tylenol/motrin etc in the afternoon especially with the dementia residents.You'll soon learn to address basic needs first when a resident has increased agitiation (hunger,thirst,pain,toileting) That is often all you'll need to do. Their is a thread on here dealing with alzheimer's pateints -it's full of tips and tricks for dealing with behaviors.Do a search-it's a "not to be missed "thread. Good luck.
  12. ktwlpn

    Unbelievable !!

    A classmate of mine thought this method would be prefectly fine-and argued with our instructor.She did not make it out of the first semester...As far as the OP-I am betting it is an urban legend BUT haven't most of us come across some really,really un-educated,un-informed patients?Is this really so far -fetched?
  13. As another poster stated,communication is paramount.If you have any shadow of a doubt do exaclty what that person stated. Rephrase your question,repeat the answer to make sure you understand your direction. It's true-often after we make a mistake we'll get so overwrought about it that we will make another.That's something you'll need to get ahold of fast. A nurse I worked with LOST HER JOB over a mis-commmunication between a student, an instuctor and herself. I am not sticking up fpr witchy floor nurses but remember that when you come across one-that nurse is responsible for your patient,
  14. ktwlpn

    Was this a HIPAA violation?

    Our family doctor told our son that the reason why ADHD is so prevalent in the US is because most of the early settlers had it-that's why they could not get along in society in their old countries.Interesting theory.
  15. ktwlpn

    Rough Nite

    sure-I also have moments when I think " Man, I need to get the nurse" then realize that's me....That's nursing-the highest of the highs followed by crashing lows-and plenty of chances to make a fool of yourself.