jessica

Whew! I just got caught up after 2 days of reading. Sufferkate, you're experiences are...well....scary. With that said, I would love to hear more

Bump.

Keep the stories coming! I adore this thread :)

A lot of times you only hear the complaints and definately not enough of the wonderful aspect of nursing. Many consider this forum as a "safe haven" to be able to vent and debrief regarding a situation/problem/or other general rant. It's all a matter of perspective. Yes, there are nurses that "eat their young" and everyone has to "do their time" doing the less then pleasant tasks. But again, it's what you make of it. If you let others determine your outlook on life, then it's certain doom. If you esteem to do your best and seek out the area of nursing that is fulfilling to you, on the otherhand, you will be greatly rewarded. Ultimately, it's a decision that you make. Are you ready for the challenge? Jessica, RN CHPN

Sounds like you are getting some pretty sound advice here! Perhaps the next opportunity will work out better. Jessica

I would contact the Office of the Attorney General for your state and submit a complaint so that they can investigate. On an aside, perhaps a different hospice agency would be a "better fit" for you. Good Luck

I spoke with my coworker and Morphine 1-5% can be compounded with Silvadine. Also, if the pain is more neuropathic then Ketamine or Gabapentin can be included as well. HTH Jessica

Here's a website that provides information and a picture of an individual Mepilex Border Dressing. I ABSOLUTEY love this product! I'll get you the ratio for the Silvadene/Morphine compund and post it tomorrow. http://www.molnlycke.net/item.asp?id=3759&si=32 http://www.directmedicalinc.com/wound/mepilex_border.html Jessica

i just ran across a book @ nursing knowledge international re:cpr and the palliative care setting! here's the excerpt from the site: palliative care resuscitation palliative care resuscitation begins by examining the history of cpr and how the procedures used today were developed. cpr was initially intended for victims of sudden, unexpected cardio-pulmonary arrest, unfortunately it has been applied to less appropriate situations and is now the only medical procedure which is consented against. the media have portrayed cpr as being invariably successful and appropriate, this can lead to anger and confusion from patients and families.

If the patient is deceased, and death is evident (as outlined by the Texas Nurse Practice Act) then CPR is not initiated. If I am present when a full-code patient ceases to breathe or the heart stops beating, then I am obligated to initiate CPR at that time. I do have a basic plastic mouth protecter with a one way valve in my car. Compressions would be initiated and 911 would be called. Once the parametics arrive, I would step aside and let them do thier work. Through my rudimentary research, CPR typically is sucessful in less than 15% of the time (in a "heathly" individual). I personally have never initiated CPR, and within the course of the last year I can only remember 1 nurse initiate CPR and is was not even a hospice patient. Jessica

I work for an open access Hospice company and we do not require that our patients be a DNR. It's about personal choice. Some individuals and/or families are not able/ready to accept a OOHDNR at the time of admission, or even through to the end. As a Hospice nurse, one of my most important roles is to educate the patient and family about various options in relation to thier care (physically, spiritually, and psychosocially). Of course, the rest of the team is involved as well. I always inquire about code status and typically through the response of the patient/family I can determine how ready they are to discuss the possiblitity of a OOHDNR, what is actually involved when CPR is initiated, thier current medical state, what would happen if they were found and had already passed, etc. So, truely the nurse that you spoke to was giving your father and the family many options in relation to code status and honestly, I believe that it should be the decision of the patient/family to decide code status not a company. You may find that with that agency you may have more choices all the way around. HTH Jessica

Unfortunately we have seen several fungating wounds recently. Often we find that compounded topical analgesia works very well as an adjunctive. Silvadene/Morphine Cream has been great! I can ask my cohort what strength the morphine is and get back to you if you'd like. During the woundcare aspect, my friend used vinegar douches as a lavage daily prior to applying the cream. It aided in removing some of the dead tissue, but was gentle enough (both physically and strength of the acetic acid) to be very effective. Patting dry, and then applied the cream. Once the woundcare was complete she covered the wound with large Mepilex Borders. The great thing about that is the fluid was wicked away from the tumors to the back of the pad (much like feminine products). Whereas ABD pads typically keep the secretions in direct contact with the skin. In terms of overall odor, charcoal under the bed was used. I suggested a natural orange spray that has a very fresh scent and can be used PRN when the smell is apparent. It's sold at most grocery stores in the air freshener section. HTH and LMK if I can be of more assistance Jessica

I'm so sorry that you are experiencing this. You obviously give your heart and soul to your patiets and I'm sure that you did everything that you could for that particular patient. I will keep you in my heart and send warm wishes with you as you work through this. Jessica---fellow hospice war horse

No way would I wear scrubs to an interview. For an entry level position, I may not wear a suit. However, I would be dressed professionally. So often, we nurses complain that we aren't taken seriously and are not perceived as professionals. I think that it starts from the second we walk in the door, the second that we recite our oath as nurses to present ourselves as the respected profession that we are. My little soapbox..... Jessica

I too would like more insight as to the statement of it causes more problems. In my experience, Methadone has been unbelieveable in controlling both visceral and neuropathic pain. Yes, it's slow to titrate but once the correct dose is found for the patient....it ROCKS! I'm a hospice nurse and the age of my patients range from 30's-Centurians. We have not seen that it has anymore side-effects or "problems" than other opiate analgesics. Also, it doesn't have the "euphoric" effect that some of the other opiates have. Jessica