KyleC

Yet another question from me! Individuals who spend most of their day in a wheelchair can benefit greatly from therapeutic positioning. For those not familiar: It is a designated time, once or twice per day, where that person transfers from their wheelchair to another device: Often a hard foam mattress or wedge, stand assist device, floor mat, etc. I imagine the person's ideal positions are determined by a physical therapist, and then a device/configuration is implemented to support this position for a set amount of time (for an hour, or as indicated). I have worked in homes where this was the norm for everyone who did not ambulate independently. I have also worked for homes where this is never done. My goal is to implement this practice for the homes that are not already doing it, and I am looking for some idea of where to start and how best to get it going. So, I have a few questions and I hope there are some of you out there who are willing to share your experience for the betterment of the people who are not currently receiving this type of care! 1. Do I start with an evaluation from a physical therapist? This seems like the best starting point, but most physical therapists I have worked with seem to focus on recovering function after an injury; they are not comfortable being tasked with this kind of preventative / maintenance care for those with permanent disabilities. Is there another type of specialist I should consult, or can a garden variety physical therapist serve this function if I effectively communicate the client's needs? 2. Obtaining equipment: The equipment used for positioning seems highly specialized, and doesn't seem to be readily available without going online. Are there any recommended retailers who deal in this type of equipment? 3. Working it into ADL: Much appreciation for any tips on training staff, setting the schedule, and ensuring that adequate staff are present to handle this added responsibility! Thanks again for any answers. This will go a long way to improve the health of a lot of people, both in the short and long term.

Hi everyone, I finished my ADN at Galen in St. Petersburg, Florida in 2011. I didn't find a position at a hospital, as most hospitals in my area at the time did not consider applications from new nurses unless they had a BSN. Fast forward four years: I am working in developmental disabilities in Georgia, in an oversight role. I like this niche I've found, but I have become very specialized. I've decided it's time to broaden my horizons and find my way into hospital-based nursing. I am considering BSN programs right now, on the assumption that a BSN is the only way I can be considered for such a position. Is it reasonable for me to assume that a BSN, a couple letters of recommendation, and a strong interview are enough to land me in a hospital? In the long term, I am looking at travel nursing and nursing informatics as career paths. Right now though, my priority is to have a strong application for gaining hospital experience. I appreciate any insight about the current job market for nurses who finish their BSN and whose job experience lies outside the hospital.

Hi again everyone, I am currently doing RN oversight on a contract basis for several DD group homes. This requires a lot of work as far as scheduling visits, keeping notes, and addressing issues that are brought to my attention outside of visits. Do any oversight nurses among you have software you recommend for tracking visits / generating reports of monthly activities, as well as scheduling and preparing a calendar for upcoming months? Thank you!

Hi again everyone, I have a clinical question for you! I have some clients who do not like to stand on a scale long enough to have their weight measured; no amount of encouragement can yield a usable weight reading. Chair scales help in some settings, but other settings do not have this option. Does anyone know a solution for a scale that might work on someone who does not stand still on a scale when asked? If there happens to be a scale that serves this function and is portable, that would be a life-saver, but all ideas are welcome! Thank you

Hello again everyone First off thank you for being such a great community! I perform oversight at my workplace and usually have to answer my questions by doing my own research, and your replies to my posts have been invaluable in helping to guide my study. I am getting ready to perform an in-service on individuals who report suicidal ideations. I want to equip staff to help guide an individual who makes statements such as, "I feel depressed," or "I feel suicidal." This is a group home setting, and individuals with a history of suicidal ideations often express these thoughts. Currently, the homes in which these particular individuals live are staffed by unlicensed personnel, so I want to give them some concrete teaching for handling these situations on a daily basis. So, here are my questions: 1. What classifications exist to categorize suicidal statements? I.e., "I feel suicidal," vs "I am going to commit suicide," vs "I plan to lay down in the street at night and let someone run me over." I know these statements can have very different meanings, but I would like to learn more about how to categorize them, and what actions to take in each scenario. 2. In each situation, what can a staff member say to the individual in order to determine the risk level, and find out whether the crisis prevention team should be called? Despite having past legitimate episodes, these individuals do crave attention, and I feel it is important to determine whether it is a genuine emergency. I realize that every statement of suicidal thoughts should be taken 100% seriously, but I am concerned about false alarms wearing down the vigilance of staff and emergency responders. Links to articles / sources are greatly appreciated! Thank you

I made a typo by writing Awake & Alert. I agree with that observation. A&O x 3, however, means that the person is awake and oriented to person, place, and time. It's easy to assess in a hospital or nursing home--you ask their name, where they are, who the president is, etc. But it's not so easy in a DD setting, where many individuals can't respond to such questions, but still have some awareness of where they are, who they are, and when it is. I am thinking of simply removing A&O x 3 from our flow sheets and replacing with Awake & Alert.

I am revising our flow sheets and I struggle somewhat with the ever-present "Awake & Alert x 3." I feel like this statement is appropriate for the elderly, where individuals with dementia may become confused about when/where/who they are. In the DD setting however, it's not as simple as asking. Individuals who do not speak can be fully aware of where they are, who they are, what time of day it is and what day of the week it is. Sometimes we can infer that a person is oriented x 3 based on their behaviors, but I'm sure there are individuals who are more alert/oriented than they are able to express. Does anyone on here have an alternative shorthand for recording mental status on a flow sheet, which is appropriate for the DD setting? Thank you, Kyle