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vampiregirl BSN, RN

Hospice

Posts by vampiregirl

  1. Do you have any grounding techniques that have worked for you in the past?

    Sometimes it's really easy to forget things that have worked in the past when you are experiencing acute anxiety symptoms. Reviewing what helps when you're not having anxiety is a great way to refresh your "toolbox". 

    If you're not familiar with grounding techniques, it might be helpful to google that term. There are so many different ones and many that can be done without anyone noticing you are doing themūüėČ

    Best of luck to you!

  2. There are many areas of nursing that may appreciate you, you just may have to look off the beaten path. I would encourage you to think about where your passion lies. What type of environment do you want to work in? What type of people do you enjoy working with? Are there areas of nursing that are of special interest to you? 

    Best of luck to you!

  3. 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).

  4. Edited by vampiregirl

    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. 

     

  5. Edited by vampiregirl

    On 12/24/2019 at 11:53 AM, Nursing pursuit said:

    Private schools just want your money so I feel like they accept people for that reason plus they would have to start over from semester 1 which is more money for them.

    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. 

  6. 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!

  7. 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. 

  8. Edited by vampiregirl

    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. 

  9. 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!

     

  10. Edited by vampiregirl

    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. 

  11. 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.

  12. 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!

  13. On 11/8/2019 at 1:26 PM, Mavnurse17 said:

      Student said he refused to go to counseling/therapy/etc because he "didn't believe in it."  Yet, he continued to have these breakdowns in school and he'd be escorted to my office every time.  Mom never answered or returned my phone calls. 

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

  14. 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!

  15. 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!

  16. Edited by vampiregirl

    Would it be helpful to start integrating breaks in the iPad use to engage in other activities with your patient instead of using it until the batteries go dead? Maybe consider allowing the iPad to be used during feedings (if they are bolus) or other "quiet times". If all of a sudden you stop using the iPad, I'm guessing the patient won't be very happy! Maybe it would also be helpful to shift your approach from "distracting" your patient to "engaging" your patient. If she is able to focus on the iPad for a length of time, that's great because it means there could be other activities she will be able to engage in.

    Starting to create a routine with this patient and addressing the environment can be very useful having a more positive-interactive relationship with this patient. If there is a routine during other day shifts, this might be a good place to start. If the child has PT/OT/ST then maybe ask them for ideas for similar activities you could do with your patient. They may also have ideas as to what calms this particular patient when she starts getting wound up. The other children in the residence may be a good source of info for identifying activities your patient enjoys. Keep in mind kids with autism that I've worked may have a short attention span, especially for a new activity. It also may take several attempts for her to be able to enjoy a new activity. It can also be a trick to figure out what she needs/wants and learning to address those needs/wants early. 

    Best of luck with discovering some strategies that work for your patient!!

  17. Thank you for this thought provoking article, well written!

    I've worked both as an EMT and as a nurse. Sometimes there are so many things stacked against a patient. Wondering if there would have been a different outcome if outside influences (weather, road conditions, delays) had not presented... These are the patients and circumstances we carry with us, those that influence our practice going forward. 

    It can also be even more challenging in circumstances when a patient's decisions contributed to their medical condition. It made my heart smile though by the caring and competence you captured by those involved in this patient's care - from the prehospital providers to the hospital staff. 

  18. 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.

  19. 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! 

  20. 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. 

  21. On 8/21/2019 at 11:16 AM, BrendaH84 said:

    They told me the software was really slow (i asked) She said it takes more than an hour to key in an admission. 

    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. 

  22. 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. 

  23. 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). 

  24. Edited by vampiregirl

    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. 

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