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vampiregirl BSN, RN

Hospice

Content by vampiregirl

  1. vampiregirl

    Criteria for GIP

    GIP = General Inpatient level of care for hospice. Most hospice patients are "routine" level of care which provides for hospice care in their residence (home, group home, SNF, ALF etc). Other levels of hospice care are respite and continuous care. Respite is a benefit for caregiver respite and continuous care is for intensive symptom management requiring the presence of hospice staff for a specified period of time (there are other criteria as well).
  2. vampiregirl

    Wound care

    Wound care in hospice typically has different goals than other environments such as PCU. The focus on hospice wound care is typically on management of drainage and odor as well as patient comfort/ quality of life. However it is also helpful to have a basic working knowledge of the general principals of wound care. Knowing how to accurately measure wounds and wound care documentation is standard in most settings. Knowing the appropriate terminology is very helpful and being able to identify specific characteristics of wounds is essential for not only documentation but also in describing them to providers so that you can obtain the appropriate orders for patients. Understanding pressure ulcer development and prevention is important - pressure ulcers can be very painful. Not all of them are preventable in hospice patients but minimizing risk by being proactive and treating appropriately makes a difference for the patient. Venous ulcers, skin tears, fungating cancer wounds and moisture associated skin conditions are also areas of wound care it is very helpful to be familiar with. Most hospice agencies have a basic formulary/ protocol for skin care that includes recommended dressings. If you are caring for hospice patient's in SNF, wound care typically involves collaboration with the facility wound care nurse - even though hospice has the responsibility for the POC, this collaboration is very important. I use several references frequency, probably my favorite is "Quick Reference to Wound Care" by Pamela Brown - I think I have the 4th edition. I like this resource because I think it does a good job addressing palliative wound care considerations.
  3. vampiregirl

    Dismissed from a Nursing Program (Need Advice)

    I'm sure there are some private schools like this. However there are some fantastic private schools as well. Some private schools are reasonably priced and are very supportive for their student's success... if the student is willing to work hard. I would encourage you to talk to some nurses you know and respect to find out about their school experiences. Who knows... you may find a school that accepts you and that is a good "fit" for you. When I first went to college, I did terrible (failed out) at a big well known public university. Years later I graduated Summa Cum Laude from a private college. I put a lot of effort into my studies and it paid off.
  4. vampiregirl

    Making the Most of a Working Christmas

    As a single nurse with no family nearby I always volunteered to work holidays when I worked at a SNF. I appreciated having people to spend the day with. My coworkers with little ones especially appreciated being able to spend family time. On some SNF units, a fair amount of patients had LOA for the holiday. I always tried to spend a little more time or do a little something special for those that stayed at the unit. Most holidays were actually more "fun" shifts. I particularly remember one Christmas Eve I worked as an aide (due to adequate nurses but not aides)- being able to provide care residents in this capacity was awesome. And a good reminder of the physical effort required as an aide!
  5. vampiregirl

    Criteria for GIP

    I can't think of circumstances where discontinuing pressors would automatically qualify a patient for GIP. GIP eligibility requires not only a terminal diagnosis but symptoms of discomfort that cannot be managed any other setting. On the flip side, pressers typically are not continued on hospice due to not being consistent with hospice philosophy. Sometimes the same patients for whom pressors are being discontinued are also experiencing symptoms that require interventions and frequent monitoring to transition the patient to a plan of care that can be implemented in another setting. Especially if they are already in patient at the hospital. For example, transitioning from frequent or higher doses of IV push pain meds to other routes of medication administration is one of the more common scenarios. Also patient's who are on very high flow oxygen. Seizures, nausea/ vomiting and severe anxiety are other symptoms that may be appropriate for GIP. Also extremely complex wound care needs.
  6. vampiregirl

    On call: visit or not?

    On call hospice can be tricky at times. All we can do is make recommendations/ assessments based upon the information we have available at the time of any call interaction. From the information provided, I don't see any red flags that would prompt me to identify this patient as a visit need at the time of the call either. As for knowledge that a patient has recent history of substance use/ misuse for me that doesn't trigger a "bias" per se but it does warrant some considerations for care planning. Safety (patient and hospice staff), potential medication interactions and knowing that symptom management may be more complicated are all things to be aware of. Also, in order to be eligible for hospice an individual has to have a terminal diagnosis. Where I'm going with all this is that your patient has elevated risk for death. Reviewing cases such as this can be beneficial for everyone if done appropriately. It's a good time to review processes (including on call) and gather input. But I hope you (the OP) is being supported by your agency. Sometimes even when we make sound decisions based upon available information things don't play out like we'd like them to. But that also doesn't always mean someone is at fault.
  7. vampiregirl

    Advice for new hospice admissions RN

    Lots of great advice in Katillac's post! I typically inquire what they understand about their diagnosis and it's expected progression. This gives me a barometer of their understanding (or unfortunately in many cases, their lack of understanding). I typically then transition into what their goals are. I try to relate this information into my explanation of hospice philosophy, benefits and services. I often listen for misconceptions about hospice and address those early on. Give yourself time to develop your own style. For me, as I figured out my basic template or agenda it helped me to figure out how to initiate more meaningful, less awkward initial visits. It does take time though! Good luck!
  8. vampiregirl

    Ohio Hospice

    The short answer is yes, hospice is available in home in Ohio. Hospice eligibility requires a terminal diagnosis with a life expectancy that is less than 6 months if the disease process runs it's expected course. There are also more defined eligibility criteria for certain diagnosis. This is Medicare/ Medicaid guidelines which are the "gold standard" for hospice eligibility. Most types of insurance go by this, but a few private insurances have additional stipulations. Eligibility is assessed on an ongoing basis and more formally at the end of each certification period. After 2 - 90 day certification periods, additional 60 day certification periods available. Patient's can continue hospice as long as they continue to meet the criteria (which also typically evaluates progression of the disease process/ decline). Medicare/ Medicaid also outlines the levels of care and basic services a hospice is required to provide within the US so I'm guessing this is standard no matter what state a person is in. Routine hospice care is provided at a patient's place of residence (private residence, group home, SNF, ALF etc). Hospice facilities are typically only for individuals who have symptom management needs that cannot be managed in any other setting (pain, dyspnea, seizures, anxiety, very complex/ complicated wound care etc). This is referred to as General Inpatient Level of Care and is intended to be short term in most cases; just until symptoms are managed and plan is place for continued management after transfer to another location (returning to routine level of care). Hospice facilities are sometimes also used for the respite benefit; which is up to a 5 night stay to allow for a caregiver to get rest/ relief from caregiving. A good starting place would be for your friend to either ask their medical provider if they are appropriate for hospice care or contact a hospice provider in the area in which they live.
  9. vampiregirl

    Mailing Medication

    As a camp nurse, we frequently get a request to return "forgotten" meds by mail. Several years ago, we became aware that only prescribers and pharmacies can legally mail meds. Not sure about regulations from shipping services... https://pe.usps.com/text/pub52/pub52c4_019.htm?_gl=1*i4vq95*_gcl_dc*R0NMLjE1NzUyMDc2NDQuQ1A2ZzVkekpsT1lDRlUyWkFRb2RCM2tBSmc.
  10. vampiregirl

    Continuing Education

    Have you considered joining a professional association relevant to your area of experience or pursuing certification? I have found professional associations to offer so many learning opportunities and I learned so much as I was studying for certification in my specialty area.
  11. vampiregirl

    I keep getting my fingerprints rejected.

    When I needed digital fingerprints for a previous job, I was able to get them done by a company called Identogo which in my area (Indiana) performs this service at local Goodwill Career Centers. I just had to online to schedule an appointment, I seem to recall this as an uncomplicated experience all around. Looks like they are a national company. https://www.identogo.com/services/live-scan-fingerprinting Good luck!
  12. vampiregirl

    Panic Attacks

    Makes me wonder whether the parents influenced the student's view on mental health treatment. Sad that the stigma regarding mental health continues...
  13. vampiregirl

    Panic Attacks

    Not a school nurse, but have encountered an increasing number of kids in the camp setting who have anxiety attacks that aren't listed on the medical and/ or confidential forms submitted prior to camp. Some of these kids are have already identified strategies that work for them and just need some encouragement to be able to implement them. I think one of more important roles for healthcare professionals in this situation is to empower these kids to self-implement calming techniques. Having symptoms of anxiety can just be miserable - no matter what age the patient is!
  14. vampiregirl

    Tips for first camp interview?

    ICU experience can be applicable to the camp setting in several ways... think about things like being able to think clearly in an emergency, great assessment skills, ability to multitask. All of those are so relevant to camp nursing. What personality traits help you in your current nursing position... those translate to the camp nursing world. Good luck in your interview! Camp nursing can be amazing!
  15. vampiregirl

    R.N. debating to pursue BSN

    I completed my BSN a couple of years ago at local private college. It was actually less expensive compared to other programs I looked at. It was designed for working adults and very organized. I think I learned as much from my cohort as I did from the courses themselves. And most of our projects, papers etc allowed me to delve deeper into topics relevant to my area of practice. I also found the research class very beneficial (but I love EBP anyways). No regrets here about getting my BSN.
  16. vampiregirl

    Dry, Cracked Hands

    Ugh. Dry cracked hands are the worst! And I too am not a fan of the infection risk (or being a biohazard risk with bleeding)! In addition to the recommendations of the previous posters, I made the switch to non-antibacterial soaps with not a lot of fragrance in them throughout my home. This was another piece of the puzzle for me. I'm also careful with the hand sanitizers that I use outside of work (vehicle, purse etc). The alcohol content oddly enough doesn't seem to cause issues for me - it's the highly fragranced ones that I've noticed are more irritating to my hands. Good luck!
  17. vampiregirl

    Webcams in Nursing Homes?

    Like several other posters, my concerns lie in ensuring patient dignity (in some cases both the targeted patient and the roommate) and how the video footage would be used/ who has access to it. This is yet another area where technology has progressed faster than regulations and legalities can be addressed/ implemented. So many different aspects - both positive and negative. It will be interesting to see what the future brings in this area.
  18. vampiregirl

    Med/surg to Inpatient hospice empath health job

    An hour for an admission isn't bad at all. When I worked inpatient, I could complete an admission in 2 hours if I didn't have interruptions and I was considered one of the quickest. Where I work now in home hospice, it typically takes 2-4 hours to complete all the tasks associated with an admission depending on the complexity of the patient. Not only the software, but the tasks associated with admissions can make a huge difference in time requirements.
  19. vampiregirl

    Med/surg to Inpatient hospice empath health job

    I've worked both inpatient and home hospice. For me, I love my current job which is hospice case manager for small, local non-profit with a commitment to quality. Both inpatient and home hospice can be great IF you work for a good company. Good leadership and a strong team (Social Work, Spiritual Care and aides) are essential. Learning good self care is also critical. Hospice done right is ensuring that patient's symptoms are well managed and that the caregivers have the education and support they need to care for their loved ones. Hospice can be sad but there is also a lot of joy and satisfaction with hospice nursing. It's a sacred privilege to be present for some of the things I've witnessed. I would be a little cautious about salary. I've not worked a salary position in hospice but have worked salary positions before... and am not sure I would again in the future.
  20. vampiregirl

    Scary commute for work?

    One more consideration is the addition of 2 hours to your day. If typically nurses get out in reasonable time after their scheduled shift, it might not be too bad even when you are scheduled with shifts on consecutive days. Also, how are you with flipping shifts. I know for me an hour drive home after I'd worked a night shift made me a little extra cautious (especially when I had recently worked days).
  21. vampiregirl

    fluid/electrolyte replacement

    We used slightly weak gatorade alternated with water. Electrolyte popsicles and regular popsicles were also offered as needed. We also had lemon-lime soda available in the clinic. Our camp ordered gatorade powder by the case, on super hot days we had it available for all campers at "water stations" around camp. On those days, popsicles were available for everyone and lifeguards had access to electrolyte popsicles. Campers were encouraged to alternate gatorade with water. All campers were required to have a water bottle of some sort. Bottled water was distributed as the beverage for afternoon and evening snacks (8 oz bottles). Counselor training included education about preventing dehydration and early identification of dehydration. These strategies worked, we did not have to send anyone out for further medical care all summer to have dehydration addressed.
  22. vampiregirl

    RN to BSN or straight to BSN??

    This may be true in some areas. And for a while I saw this in the area I live. Now I'm seeing more institutions hiring ASN prepared nurses with a stipulation that they must complete a BSN within so many years (typically 3-5). Typically the hospital offers a tuition reimbursement or tuition assistance. Also, there are a variety of RN to BSN options.
  23. vampiregirl

    RN to BSN or straight to BSN??

    I'm not convinced there is one "right" answer to this question. I graduated with my ASN and worked for several years as an RN. I went back to school to complete my BSN. My work experience made some of the material "more" relevant (because I had experiences to apply it to) and I got so much benefit from interactions with my cohort members. I paid for school as I went along; this route made the most financial sense for me. I know others who got their BSN before they started working in the field. I've talked to several nurses who are glad they did it this way because they could focus on their careers and family without having school thrown into an often complicated equation. I think evaluating one's circumstances and the opportunities available to them would be the best option.
  24. vampiregirl

    Should I try LTC?

    There are some good LTC's but you have to look carefully to find them. I was fortunate enough to work at one as a new grad and gained a strong skill base there. Currently I'm a hospice nurse so I visit several different SNF's. A couple are provide good care to our mutual patients, one downright scary and the rest middle of the road.
  25. That's a lot of changes at one time, the emotions you are expressing are completely normal. Give yourself time to adjust to this huge learning curve. Figure out who are the good resource people on your new floor. Find things that you are already good at and let yourself shine in those areas. Find some positive people on your new unit - and this doesn't have to just be nurses. At several of my previous jobs I've found the most delightful environmental services, unit clerks etc that have cheered me on as I've figured out a new job. Being kind to people can make a world of difference and help you feel better. Several months ago I switched jobs to a small non-profit in the same specialty I been in for several years. This agency is amazing and I'm so thankful that I work there. But the learning curve was rough for me. Hang in there and see where the journey takes you.
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