quirkystar

A couple of times I have had comfort care patients(meaning that treatment is stopped and only measures to improve comfort are taken such as pain medications, and repositioning) where the patients themselves do not look like they are actively in pain and some even state that they do not have any pain yet family members INSIST they need morphine. It kind of made me have the impression that the family wants death to occur and they think pain medication is going to move that along? Some nurse colleagues have told me to just give the medication because they are dying and it's not going to hurt them as well as it will help to appease the family. I kind of had an ethical issue with this but... What do you think?

I had this patient who is actively dying and basically "comfort care" meaning treatment was stopped and measures to improve comfort are placed. If the patient's O2 is dropping from a previously >92% level, but is not showing any discomfort or respiratory distress, should I be hooking him up to oxygen? Hooking up to oxygen could be seen as prolonging the dying process, no?

The infectious disease doctor put an order in for a sputum culture: tracheal aspirate and I didn't know how to obtain this(patient has a tracheostomy). No one else on my floor knew either. I thought maybe it required suctioning?

Thank you for your feedback! It's really nice to get responses and maks me feel there is hope in this world lol.

Hi Everyone! Just joined this forum after being a longtime-lurker. So I started my first nursing job about three months ago on an Oncology/MedSurg floor after graduating with my BSN last May. I work evening shift and overall I have been surviving through each night by giving the basic care to my assigned patients(administering meds, keeping track of intake outputs, calling doctor for orders), but I feel that I haven't progressed at all with my knowledge level. In fact I actually think I'm getting worse than I was during nursing school, that is, I'm forgetting basic protocols and procedures. For instance, in school I memorized the steps for the insertion of a foley catheter, maintaining sterile technique, etc. But yesterday I was being directed by another relatively new grad nurse on the insertion of my first "real" catheter and..let's just say there were discrepancies. I've noticed this in a lot of areas, such as changing IV tubing every 72 hours, scrubbing hubcaps for 15 seconds, maintaining isolation precautions, etc, etc. I realize the real world is not as perfect as the nursing world. While I am getting a lot of real-world experience, I worry that I am losing basic and proper nursing knowledge. I am developing some bad habits because there is always a rush for time. My biggest discomfort is that when I am taking care of my patients, I don't feel that I fully know how to best care for the patients or know the patient plan. Such as if a patient is admitted for pancreatitis, I don't know the standard treatment plan and can't anticipate what may be needed in the future. As a result my report to the next shift sounds sloppy and undirected. I don't have time to look and analyze all the meds that the patient is getting throughout the day, mostly only the ones on my shift. Basically all I can really do is give the scheduled meds and do basic assessments as ordered by the computer system. Another piece is lab values. I almost never look at lab values because the doctors and nurses during the day shift have already looked at them and ordered the necessary interventions. Even if I did look at them, I wouldn't be able to understand them. If I am giving blood during my shift though, I would look at the H&H. A lot of the times I also have no idea why a patient is getting a certain antibiotic, whether it is for prophylaxis, improve kidney function, or what antibiotic is for which infection. As a nurse I think I should know these details, but most of the nurses on my floor don't either so I can't get answers to certain questions. Doctors will order stuff and not let us know why something is being started. Perhaps this is just the nature of the nursing environment, but I want to do my job well and understand all the little actions I'm giving. So that's my rant...is there any advice you guys can provide for me on how to improve my skills and knowledge base? I am already planning on posting questions here every so often.