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pmabraham BSN, RN

Hospice, Palliative Care

Follower of Jesus • BSN, RN serving others as a Hospice RN Case Manager • Lifelong Learner

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pmabraham has 3 years experience as a BSN, RN and specializes in Hospice, Palliative Care.

Follower of Jesus • BSN, RN serving others as a Hospice RN Case Manager • Lifelong Learner

pmabraham's Latest Activity

  1. pmabraham

    ManorCare York, PA

    Hello: I'm considering an RN Supervisor position. Do any of you currently work at ManorCare or used to that has any advice to share? Thank you.
  2. Dear friends, please allow me to share with you the various lessons I've learned as a visiting hospice registered nurse. One of the primary lessons I've learned as a hospice nurse is that being mortal teaches one about the value of human life as well as how to live life. The journey continues to bring me closer to God, and at the same time expose my weaknesses, my sins, my frailty before God. I'm sure I've not seen it all, but what I've seen over the past year... --- like late afternoon today where I was the one to tell the spouse their loved one has less than one to two weeks to live and to witness the breadth and depth of emotions of the spouse and their adult child; they were told their loved one was terminal, but they didn't recall being told how terminal. --- having a patient take their last breath before you and witnessing the love of the family who was also present. --- helping to calm down a family member who was punishing themselves to the point of an anxiety attack from not waking up at 4:00 AM to give their loved one a medication to help them be more relaxed. --- the joy of getting a patient's pain so well controlled they were able to plan and go on a family vacation before they died a comfortable and natural death. Each day, each moment God cared for me and directed my paths though I fail Him often. I'm thankful that God has not given up on me. Speaking of not giving up on people, it was a surprise on having patients ask me if I will be there all the way for them, something to the effect of hearing "my oncologist gave up on me, will you?" I still remember the one patient ask me at least once a week before they passed if I was coming again, did I give up on them. As I write about this patient, it brings tears to my eyes. Their spouse was one of the handfuls who broke down in front of their loved one crying, "I cannot do this anymore, I just cannot do it." People don't understand how hard it is to take care of someone who is terminally ill. This is why I often share with my families that with no disrespect to the angels in heaven, they are angels here on this earth. Some days are hard, some days I want to cry for no reason other than the sadness about being around those who are dying, and trying to be supportive to the families. Yet, I cannot see myself doing anything different. God called me, I must answer to the best of my ability. On the psychosocial aspect, Professor F. (one of my RN school professors) has been an inspiration because I find her teaching about mental health to apply to almost all social interactions. Assess and validate feelings. Do your best to make sure the other party knows they are being seen, know they are being heard. Validate their feelings, and then pick the most positive outcomes to encourage them to engage and move forward. Always encourage, always show how much you appreciate them. For the one daughter who showed so much self-doubt about her ability to care for her dying mother, find and highlight the areas she is awesome, and give regular praise. For the recovering drug addict managing the pain medication of a dying patient, praise them for how well they are doing while letting them know you are keeping counts for all home patients (not just their loved one). Encourage them with positive ways to deal with the stress of caring for someone they love deeply who is dying before their eyes. For the elderly daughter who has her own health issues caring for her dying mother, give them praise and bring up memories of the journey that are pleasant. Show and remind them you have been watching, have been hearing, and care. You see, it is not only the terminal who are dying but from a point of view their loved ones dying inside from watching the ones they love to whittle away and die. They need to know they are not alone as they let their loved ones know they are surrounded by love. Know, we are called by God to make a difference in this world. Doing so will not save us; I'm not talking/writing about doing good works. Good works NEVER save anyone. Yet, God works through His people who are called for His purpose for His Glory and Honor. Will you answer your calling? When I first started writing this summary, I was thinking of all of the clinical sides I've learned from becoming an expert in pain management including opioid conversions, knowing among the best practices for symptom management (pharmacological and nonpharmacological), I was reminded of the #1 reason why I love hospice, and why while the clinical side is important it can never be number one... and that is people matter the most. So I encourage each and every one of you, dear friends, to look for every opportunity to be grateful for the life you have, to appreciate others even with their flaws (we all have flaws), to be kind, considerate, gentle, and show compassion towards others. We truly have no clue what others are going through in their lives; you might be the bright light in someone's storm through your acts of gracious kindness without knowing it. Be that lighthouse!
  3. pmabraham

    Quotas for visits, mandatory overtime?

    Thankfully the company for whom I work pays their visiting staff hourly vs. salary. Nurses have a form of a quota system and that is 20 points per week where a routine and recert visit is 1 point, an admission visit is several points (I forget the #), and so on. There is no chastisement for being under 20 points. What they look at come raise-time is the overall average of points for the review period.
  4. pmabraham

    Understanding the Risk of Firearms: Suicide vs. Homicide

    The evidence is in the Bill of Rights itself. I'm glad you own a gun and you are teaching your son good information about guns. Yet, keep in mind the 2nd amendment wasn't put into place for hunting but as protection against government tyranny.
  5. pmabraham

    Understanding the Risk of Firearms: Suicide vs. Homicide

    Read https://constitutioncenter.org/images/uploads/news/CNN_Aug_11.pdf
  6. pmabraham

    Understanding the Risk of Firearms: Suicide vs. Homicide

    The 2nd Amendment was written after liberating our nation from tyrants which is the exact intent of the amendment. So that legal citizens who are willing to take up (buy) arms and ammunition and keep those weapons in good order (WELL REGULATED) become the militia at the ready to not only defend their own lives and property but our country from tyrants. And, those rights "SHALL NOT BE INFRINGED!" A lot of people who are either afraid of guns or buying into the liberal media will focus on the words "well regulated" thinking that means laws and regulations; it DOES NOT! See https://constitutioncenter.org/images/uploads/news/CNN_Aug_11.pdf "Well regulated" means being ready, being able to fight, willing to maintain the very arms that are being owned and used. The words "SHALL NOT BE INFRINGED" means just that -- no legal restrictions! Now as it relates to being out in the field, I find cases where I go into the home (I'm a hospice visiting nurse) where there's a sign on the front of the house "Trespassers will be shot; survivors will be shot again" and I smile. I'm not afraid because the issue isn't guns, it's the heart, and I'm happy to be a service to those who respect the 2nd amendment vs. trying to dismantle it and misunderstanding both the words "inalienable" as part of "inalienable rights" and the words, "shall not be infringed."
  7. Yet without ethics, there lacks compassion and humanity. Now, since you've previously jumped to assumptions vs. assessing, let me be clear I'm not accusing anyone of anything. I'm sharing ethics matter and the patient bill of rights matter.
  8. Wuzzie, you are assuming in several areas. I was not trying to school anyone. Since you are a seasoned nurse, may I suggest start assessing more than assuming? I work in hospice, so I know what gray is, but gray NEVER take away patient's rights. Now I'll end here, because you come across as having all the answers given your assumptions vs. assessing.
  9. As I shared, check with the POA... and unless the POA is legally removed as the POA, they are the POA. You are free to read into things, so if you are reading into the responses with a certain tone, that's your choice. I'm just sharing from a neutral perspective as well as one who cares about the patient bill of rights.
  10. In my comments, I'm referring to the patient's bill of rights which includes the ability to refuse medications and treatments. When it comes to dementia patients, please lookup validation therapy by Naomi Feil. Wuzzle, which is why living wills are very important.
  11. Then you go to the healthcare POA before you do anything which is unethical. Paternalism/Maternalism in healthcare should always be questioned. Also, nonmaleficence (as an ethic) comes before beneficence for a reason. One can actually cause harm by thinking they know what's best and forgetting the patient and their POA (when the patient cannot make their own decisions) have the final say (not the healthcare provider/worker).
  12. pmabraham

    Social Media and Doxxing - Your Thoughts???

    1: Is it okay to post selfies regarding work situations? This is extremely high risk and very dangerous action to take. Are any patients in the picture? Are any belongings of any patient or coworker in the picture? Are any visitors or other people who may not want their picture taken in the picture? Best case, don't do it. 2: How about the person who reported it? Two wrongs don't make a right. While #1 may show a level of a "stupid" action, given the extremes some organizations go to when receiving a report where the punishment far outweighs the wrong activity, in my opinion, the reporter was in the wrong. 3: Do you know your facility policy? Far too strict.
  13. pmabraham

    Rounds and patient expectations

    "At my facility the ratio is 1 nurse to 19 patients" My wife and I were recently at a rehab unit visiting a relative. Their unit has a ratio of 1 nurse to 5 patients on the worse of days and 1 nurse to 3 patients on the best of days. 1:19.... ouch
  14. Home health and hospice visiting nurses; you drive solo the overwhelming majority of the time. My experience working in hospice, the doctors tend to take your recommendations either Carte Blanche or tweak them.
  15. Yes, misleading is wrong and paternalism/maternalism (trying to put beneficence before nonmaleficence and patient autonomy) is never a good thing.
  16. pmabraham

    How long for license in different state to go through?

    Sadly, this is going on in our state: https://www.pennlive.com/news/2019/09/pa-nurses-fed-up-with-delays-and-rude-answers-dealing-with-state-licensing-board.html I do recommend calling the board itself.
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