midazoslam

I live in Australia and I am a proud Australian Nursing & Midwifery Federation member. What our union has done for the nursing profession is astronomical: 1. Mandated 1:4 ratios in public hospitals in Victoria 2. Strive to fight for better wages, conditions and recognition each time a new EBA is time for negotiations 3. Provide legal assistance and representation if required 4. $10 mil professional indemnity insurance 5. There's a current campaign to improve care and conditions provided in residential aged care 6. There's another campaign to reduce the violence/aggression in EDs, particularly surrounding ice 7. Protected industrial action and stop-work time (non-essential, non-patient related tasks) 8. Another campaign called Care before KPI's which is as it sounds This is just the tip of the iceberg. All I have to say is thank God for my union.

I apologise if this comes off as harsh, but I hate the term "redirection". Why? Because it provides no quantifiable or meaningful information about what was tried or even what it means. To some, redirection may just be taking the resident away from an area, to others redirection may mean sitting with them and talking to them to minimise their distress. It's a subjective and very vague term; please consider being more specific when talking and documenting your interventions. Before even trying to find solutions to a behaviour, it must first be understood. Why is it happening? What does it mean to the person? Was there a trigger? Is it an acute change or has it been slowly developing? Asking these questions can help to formulate your interventions and subsequent nursing care plan. With dementia, you've really got to step into their world. Their understanding, perception, and recognition of reality can be so different but there is no use in challenging their reality. Accept it and use it to your advantage. For wandering, there could be a host of reasons. To name a few, assess for things like pain, boredom, social isolation, psychotic symptoms, delirium, basic biological needs (hunger, thirst, thermoregulation, elimination), or side effects from antipsychotic medications (extrapyrmidal side effects such as restlessness and impaired gait). Like with most BPSDs, there are no recommended first line medications. Simply put, the risk outweighs the benefit, and most BPSDs can be managed effectively with non-pharmacological interventions and creative thinking. For wandering, considef the following (of course tailor it to the individual - what works for Sue may not work for Jan): -Aromatherapy and hand/shoulder massages -Addressing emotional,and psychosocial needs (include them in activities that they may enjoy, not just the standard bingo or word puzzles) -An exercise program to help burn off energy -Review of medications -Full delirium screen, including B12, thyroid fn, FBE, LFT, U&Es etc -Implementation of a multisensory diet (check out sensory modulation and Snozelon rooms in dementia) -Provide meaningful tasks for the person to do (i.e wipe down a table, fold towels, do gardening) -Using subjective barriers on places you don't want the resident to go. Subjective barriers include 2D images of bookshelves which can mask a door, or using bright/contrasting colours to encourage use of a particular door/item/area etc. I love non-pharma management of dementia. I hope my rant helped. Midaz 😄

I would also consider EPSEs from antipsychotics such as haloperidol. All above suggestions are great too, particularly delirium and opioid neurotoxicity. God bless your dad

Hi there, I've worked in aged psychiatry for the past three years, and before that I did my grad year. I did a short course in palliative care and came across a position for inpatient pall care which I applied for and was surprisingly successful. I start on 03/03! Good luck and I can see you're passionate and determined - keep that up throughout uni and you'll do great. Midaz

Congratulations back to you, indygirl!! What an exciting and wonderful opportunity to have as a new graduate - I wish you all the very best 😄

Thanks for your kind words, nutella. I'll need to find the Aussie equivalent of the HPNA, but thanks for the tip. I shall have a look at their website at the very least. The course I had done was excellent and has lots of information about symptom management, which I've read again and again. I've done a short course for Advance Care Planning too, but it never hurts to learn more 😄. So I've got the theory, it's just putting it into practice! Thanks again!

A good few months ago I posted on here about wanting to transition from my current specialty of aged psychiatry into palliative care. I had an interview with my hospital's oncology department, however I didn't get the job because I didn't have any recent acute medical experience. This was a blessing in disguise, although at the time I really felt that I was doomed to remain in psychiatry. I finally completed my Master of Nursing, and a short palliative care course and I was itching for a change for 2016. I had been perusing employment in a major metro town that is closer to my family and to my partner; I am 2.5hrs away from them at the moment. I popped in a couple of applications for jobs here and there, but none ever felt *right* in my soul. So, I prayed to Jesus for a miracle, and He delivered well. Within a week of each other, I found two positions that were ideal for where I want to be - 1.) A palliative care position at a reputable organisation, and the one I did the palliative care course through 2.) A dementia behaviour consultant position, at another reputable organisation Both of these were an easy 45minute drive from my family and partner. So with anticipation and more nerves than I care to admit, I submitted an application for both of them. I honestly didn't think I would hear from either of them; first interview was regarding the dementia behaviour consultant, and they seemed to like me and I liked them. I currently work with a clinician who works with the same team, however is based in a rural area so I was lucky to know a lot about the intricacies of the job and values (non-phamarmacological strategies to manage BPSDs as a first line strategy please!!). Anyway, the day my boss gave the reference check, they called me to say I had the job. It is a 0.6EFT position, and only until June as it will be going up for tender again, but I took it. I was stoked. By this stage, I had pushed the palliative care position aside because it was a good week and a half since applications closed, I had called them and asked what was happening and the NUM said she'll call me back but didn't at that stage. It was literally two hours after I accepted the dementia consultant job that the palliative team called me to ask for an interview. I accepted of course; the interview was in the same week so I had to travel down to the city to do it. The interview went well, and I was quite open about my angst about having to relearn technical skills, but also stressed that I am more than happy to learn and I can bring a unique skill set to the team, namely surrounding delirium identification, dementia strategies and managing mental illness. They seemed to like me because they laughed at my ridiculous humour and found what I said about the scenario relevant, because a week later (being today) they offered me a position. I am going to be working 0.4EFT with the palliative care team, and the DON seems to think I will be a good fit. I am so excited, so nervous and ecstatic all at once. I really thank the big man upstairs for giving me the strength and courage to even apply. It is seriously not something I ever would have imagined being able to do. Anyway, if anyone has any tips, tricks, resources or wisdom that they would like to impart of a soon to be practicing palliative care nurse I would be most appreciative!! Squee, I did it!!! Midaz x

Haha, this is true Gucci. Thanks for your kind words again xxx

Further to my previous comments. I had received contact from the NUM on oncology - unfortunately I did not get the position. This was attributed to not having recent clinical experience. That's OK though, I am glad that I tried and that I even made it to the interview stage. The saying does go, every cloud has a sliver lining :) So, we'll see where the sliver lining exists.

Thanks DatMurse :) We shall see where I end up!!

Ok, so I had the interview today. It lasted 15 minutes, and had six questions. I hope I answered them well. Two were clinical scenarios, one being able to identify IVAB allergy which I knew, and the other I presume was febrile neutropenia ("you receive a phone call from a patient who had chemo 7 days ago, stating that they feel unwell. What do you think it may be and what do you do?"). I said I'll try to ascertain their symptoms of febrile neutropenia, with the outcome to send them to ED for treatment and management. My clinical skills are very rusty, working in mental health, and I truly fear this may be a hindrance. Sigh, I really tried to put across that I am more than happy to relearn, and I in fact enjoy learning. We'll see I suppose. I hope to hear from them in a few weeks. Glad that one is over!!

Jensmom, Baker is my number one as well. But holey hell Capaldi does something to me haha.

I have such a crush on Capaldi. He is dark, humourous, scary, dapper and EVERYTHING the Doctor should be. He's brought old school back. *sighs dreamily*

ChikaBoom, it's like you have just laid down my life in cyberspace... Minus the being close to parents thing. Spooky.

Bahahaha, I don't believe this kid exists either. OC, you need videoed proof Thanks for the tip about Prezi, Cayenne. I'll check it out :)

Hrm... what have I learned today? 1.) How the El Nino is going to affect us this summer coming, and just how ikky the fire season is already and it's still winter. Sigh. 2.) That under different states in Australia, there can be differing legislation on refusal of treatment (including palliative care), both for competent and those who are incompetent and have an alternative decision maker for them. 3.) That Thai green curry is delicious, but tastes even better the next day. 4.) ...I unfortunately cannot lick my elbow. This will not stop me from trying though. 5.) That Powerpoint presentations are horrendous to complete. WHO MADE THESE?! 6.) That I am ridiculously nervous about presenting at a conference, but at least I am organised. 7.) That it's OK to want to change career directions, and it's OK that I'm going to miss where I work now (if I get the new job). Thanks for the giggles everyone :)

Awesome! I'm in rural NE Vic :)

I too would love the name of the flip book, please and thank you.

I really appreciate all of your responses. It is really interesting to read how you all approach such a sensitive topic with your own unique, yet honest approaches.

What a beautiful and heart warming story, Potassium Magnesium Sulfate. It sounds like you are all a bunch of well rounded and smart kids. Your mum will be super proud of you all. PS, where in Aus are you?

This is an interesting read. Thanks for sharing all of your experiences. I left home at 18, after being accepted into uni. My father and I were at loggerheads and he never took the time to understand me, and was a super hard orifice. Both of my parents were immigrants in the 70s, and both had blue collared jobs. My mother became a stay at home mother when she had children. After the marriage ended and they split, she became a Personal Care Assistant. I'm the first in the family to go to uni, finish uni, work professionally and have a Master's degree. However I was not congratulated for it, or offered support. I wasn't supported financially or emotionally; my father always expected me to perform academically though... For years when I was at uni he would call me "Doctor Doe" in front of others as though as he was ashamed I was going to become a nurse. He berated me when I said I wanted to work in mental health or palliative care. I couldn't win. Financially, I had to work my butt off for three years because I was considered "dependent", despite the fact that I was out of home and was financially supporting myself. That took a toll on my health as a whole. I was finally able to qualify for assistance through Centrelink which was a major relief. Fast forward to now and I am still financially and emotionally independent. No approvals needed from here. Learning to be self sufficient was a hard task at a young age, but I made it. I'm proud of my resilience and tenacity.

Hugs. It sounds like that you really need one or many of them. Feel free to vent away, about anything. Your husband sounds like a bit of an ungrateful toss I say so myself. I'd let all the things he expects you to do pile up just to antagonise him and prove a point... Then again I am petty like that haha. You sound like an amazingly empathetic nurse and strong. Please look after yourself though.

What an achievement!! Congrats!! On a side note, it's always the time when the Big Wigs are coming along that we end up running late/forget our ID/ran out of black socks and had to wear rainbow hahaha :)

Says you who has an avatar of a Never Nude

Whilst I have to agree with your point, Ruby that some tattoos are ugly, that does not detract from the main point. That acceptance and tolerance should prevail over discrimination and/or judgement based on what a person chooses to place on their body. I have worked with many a nurse who has had ink, and there have rarely been any occasions that patients found them offensive or requested that they be covered. In fact, working in psych it is quite the rapport builder. Maybe it is just you, Ruby who is conservative in nature. This is not meant as a snide comment or with snarkiness, but a mere observation from your response. Alas, the times are a changing and more and more people are getting ink as a form of self-expression; at the end of the day it doesn't make you any better or any worse of a nurse.