Nurseknit

Hi! I'm also a new grad who finished the same time as you. I'm definitely going to look up those book recommendations. I lucked out/found out that where I am did hire new grads so I've been in palliative care for almost a year now. I know a nurse who did palliative care straight out of nursing school and did it for 15 years. I think the hardest part for me was... well learning everything since we didn't work with palliative patients in school. Learning to fine tune my assessment skills from natural end of life restlessness vs confusion due to urinary retention or constipation. Being comfortable discussing death and asking questions that people may not be comfortable bringing up. I think a huge learning curve for me was just being around dying people. It really made me face my own fears of death and changing my mentality to not fear it, but accept it as a stage of life. I hope that you have a good orientation. I had 3 full days of workshops learning about symptom management as well as a mentor who I could rely on to ask questions and help me work through issues I came across. This also applied to any nurse (regardless of experience). Use whatever resources are available that work provides from reading material to the educator. Definitely look up your policies about symptom management guidelines. The ones that are common are pain (which is managed differently for palliative patients), nausea and vomiting, constipation, restlessness, seizures, exsanguination, congestion, spinal cord compression. Majority of the patients we come across have cancer. Learn about the signs of actively dying patients like cheyne stokes breathing, "death rattle", restlessness, skin mottling, no longer swallowing, decreased output, increased sleep, etc. There's a ton of paperwork to learn but I think that's with all nursing haha. Definitely talk it out with your coworkers. It's emotionally rewarding to help patients and families go through the end stage of life but it can be draining when a lot die within the same time period. I really love how it is more holistic care as well. We've had issues with nurses burning out so definitely take care of yourself. During my orientation, there were 2 things that stood out for me. 1) It may be your XXX death you've dealt with. But it's the patient's first death. 2) Think of the end of life process with the patient and family like a dance and you're a bystander. You're there to support their dance. But know when you get too involved when you start dancing as well and trying to change things up. It helps to recognize boundaries. I'm really happy working in palliative care and can see myself doing it for a long time. Feel it out and see. I know some people who got oriented to it and didn't come back after their orientation. I hope it goes well for you :)

Hi sorry! This was my first time posting and I didn't realize there were responses. I work in palliative home care and I sent two patients with cancer (2 different occasions) to the palliative tertiary unit in the hospital. They both had abdomen pain that we couldn't manage at home. When they arrived in the hospital, the doctor suspected there was a perforation somewhere (but in the end both chose comfort measures). The doctor felt because it happened twice, I should have better assessment skills to recognize these were emergency situations rather than something less emergent like uncontrolled pain... if that makes sense. I did end up asking for help today at palliative rounds to differentiate. Another doctor explained it to me that for an acute abdomen pain, it's a term they use for emergency situations that require surgical intervention (eg- perforated viscus). She said the patients normally describe the pain as something different from their "normal" cancer pain, client does not want to be moved/touched due to pain, the abdomen would be firm, distended and bounces back when you palpate, decreased/no bowel sounds, and it's a rapid change from their baseline (eg within hours). In the end, the palliative team said I did the right thing sending them to the hospital and the two cases were complex (isn't that always the case hah) that masked the acute abdomen pain (eg ascites, pain management issues with their "normal" cancer pain, etc). Thank you for your help!

I'm a new grad and I received feedback from a palliative doctor today that I need to fine tune my ability to recognize when a patient is going through an acute abdominal situation vs. disease progression. I know for acute abdominal pain (eg-bowel perforation), to look for: abdominal distension, sharp pain, possibly nausea/vomiting, decreased bowel sounds But how is that different from constipation, ascites, or those who have pain management issues to the abdomen?