4/2 WILTW: Disney Edition

Farawyn · Apr 3, 2016

So... how was Disney?

((((ixchel)))) Welcome back. :inlove:

ixchel · Apr 3, 2016

So... how was Disney?
((((ixchel)))) Welcome back.

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OrganizedChaos, LVN · Apr 3, 2016

I know how you feel on the epilepsy front ixchel. *hugs* I have been put on Seroquel & been twitching up a storm. My father thinks I don't have epilepsy any more but I know I do. It's really not fun because I've had to turn down so many jobs that I would've love to have but couldn't take because they were night shift.

Between having epilepsy & being bipolar it's really a drain.

luvsltcrn · Apr 3, 2016

I have learned that I still love taking care of patients and I strongly dislike dealing with unrealistic families that you can NEVER make happy.

LadyFree28, BSN, LPN, RN · Apr 3, 2016

Welcome back!

Juggling work and home life in the midst of a "trauma storm" (what I'll call my PTSD/eposodic mood disorder-my documented psych diagnosis) is no fun. :no:

I started my meds again; I'm down from 2.5 of Zyprexa to 1/2 tabs...I'm almost inclined to go back up to the 2.5, but taking the half pill made me groggy and just EXTRA moody-but I digress...

What I learned this week:

I still have awesome wound care skills that if I wanted to specialize in Pediatric Wound Care, it would be worth a shot;

I have the uncanny ability to aggressively command a pts care; sometimes Drs-and this batch of residents seem to have a missing intellect of insight this year :mad: - miss, especially in Pediatrics, or rather, have a difficult time transitioning within that first year of independent practice due to the ever paranoia of getting sued, is some pts, especially children will guard, avoid, and will give off several physical characteristics of anxiety that can look like definite symptoms when they aren't; my pt became a r/o appt when the symptoms and my physical assessment was purely constipation; having the child sometimes guide the assessment will give a more accurate assessment, regardless of the situation, even if the ED is on fire;

Even though indicated as useless as another thread; guided imagery DOES WORK; even when you use tools from CBT (cognitive behavioral therapy) and EMDR (eye movement desensitization and reprocessing) therapy can work when people are in pain or anxious, even for the short time-which is needed in an ED setting;

Being part of the solution can be a huge responsibility: During the past week and a 1/2 ago, as I alluded to on a past WILTW thread, I went to a "mandatory meeting" with Flu A, sweating and panting; when people aired out their issues and TPTB wanted people to volunteer for a project, out of sheer perspiration and frustration, I volunteered-so now I have to display the soft skills to my peers to help improve morale; not sure what will work, but thankfully I recent connected with my former NM who ridiculously spoiled me on what an ideal manager and leader should conduct themselves, and will reach out to her for some ideas-it will probably be a great lifeline I can use career wise later on. :yes:

The best thing coming up will be Shared governance meetings, and the list of issues I plan to arm with EBP, since we use it...I plan on going in and presenting material, being all aggressively assertive and such.

And the next CBA meeting is this week-lots to learn there. :yes:

Stayed tuned and wish me luck.

LadyFree28, BSN, LPN, RN · Apr 3, 2016

I have learned that I still love taking care of patients and I strongly dislike dealing with unrealistic families that you can NEVER make happy.

It's been quite a week-between the unrealistic anxiety families, to the families that are about the tiniest BS while their family member could turn in an instant is total :banghead:

calivianya, BSN, RN · Apr 3, 2016

The crazy families are indeed the worst part of nursing. Picking up a day shift tomorrow to try and catch up on the hours I don't have yet towards this round of incentive pay and I'm dreading it. At least it's a Sunday in the south - hopefully the family members are all MIA until at least 1200 because of church. Sundays are just about the only day shift I'll pick up because there are usually at least a few uninterrupted hours to get work done because of church.

I have learned that occasionally we actually DO accomplish some good on my unit. I had been feeling pretty low about never getting anyone better lately... until this week, when I had a mid-40s lady, post two codes - one at home with husband giving CPR, one with us - who got extubated and got better at the speed of light. Seven days after the second time she coded, she was WALKING to the bedside commode, on room air, and talking about how sick she was of her job and she thought she was going to use this as an opportunity to find something else to do. She was cracking jokes and smiling. She had been POSTURING with minimal response to stimuli at one point, and she's fine. Usually, the best case scenario for people who code on my unit is LTACH placement, not talking about going home. It was an awesome week.

Debilpn23 · Apr 3, 2016

Hi Ixchel

I just want to send you a hug . I'm sorry for everything you re going through.

nutella, MSN, RN · Apr 3, 2016

Ixchel, I am sorry you had a rough time at Disney !

I went to Disney and can't do most rides because of debilitating motions sickness. When I went with my kids I mainly followed them around and mostly waited outside since I did not want to throw up all day long.... I love Epcott and animal park. But I can see how somebody with back issues and limited mobility might not like Disney.

I have a child with OCD/anxiety - she is now a teenager and is able to deal with the OCD in a good way - so there is hope... If you like reading - I found the books from Tamar Chansky helpful as a parent :

Freeing Your Child from Anxiety - Tamar E. Chansky

It is not like the title suggest that it will fix it all but it gave me a solid basic understanding of anxiety in children and enabled me to look at it in a different way. She also has a book about OCD that was helpful. My daughter also saw a therapist specialized in OCD/anxiety for CBT - but it really has to be an experienced child therapist because the approach is somewhat different from adult CBT. My daughter went from missing a lot of school and avoiding, handwashing, OCD times 1 million to OCD time hundred and mostly managing fine.

What I learned this week:

Connecting patients with community services remains a problem despite the Affordable Care Act. There are just so many barriers to effective self management of a chronic illness including inadequate housing, no caregivers, and inability to afford copays.

Once a patients is known as "having drug seeking behavior" and it comes up in medical notes - even if this behavior was identified years ago and not currently applying - it results in stigma and judgement from health care professionals. At times it is not even clear to me if the behavior was truly drug seeking - meaning for "pleasure" or inappropriate tx of anxiety/sleeplessness with narcotics - or pseudo addiction. In the last one the patient has truly unrelieved (often severe) pain and continue to ask for pain meds, which in turn is seen as addiction behavior. The narcotic crisis results in bias all around.

Liquid morphine is great to palliate shortness of breath for patients with COPD or CHF . When there is nothing left to "fix" things up more. Unfortunately the "narcotic discussion" now leads to patients who want to focus on symptom relief getting not the help they need. Really - if a patient has end stage COPD, on oxygen, short of breath with minimal exertion - there is only so much left to help. Liquid concentrated morphine has increased the quality of life for those patients.

Healthy People 2020 is still around with some new "topics".

Patient risk - the Swiss Cheese Model of accident causation makes total sense to me.

Systems Approach | AHRQ Patient Safety Network

While I thought that the Mayo Clinic diet was a great idea (but has not done anything for me in terms of weight loss) my menopause specialist (yes there is such a thing..) told me that a lot of her clients do the South Beach Diet. Personally, I think that low glycemic index is nonsense and just another food and weight related obsession. I am not cut out for those kind of things - which is why I liked the Mayo Clinic Diet to begin with. I do not enjoy to obsess over food/nutrition and I feel that it has become somewhat similar to religion in many aspects. It is even hard to keep up with all the trends like caveman diet and such.

xoemmylouox, ASN, RN · Apr 3, 2016

I met a parent this week who wasted my time beyond belief. The things she asked me to do were ridiculous and pointless. I still attempted to meet her needs so I could get what I needed done.

Then I had enough. When I put some responsibility on her plate she quickly let us do things my way. Guess what. Less than 10 minutes later we were done.

I understand needing control, but when you waste over 45 minutes of my time to collect a urine sample. I'm done. Poor customer service score or not.

I hate that so many of us are still suffering.

That some people do recognize my intelligence and worth as a nurse.

meanmaryjean, DNP, RN · Apr 3, 2016

Two weeks into my work from home job in academia- I learned that I miss my co-workers and my patients. What I don't miss is playing waitress to families in the name of satisfaction scores (because in the PICU world- the patient doesn't fill out the satisfaction survey).

It has officially been 21 days since I put on isolation gear!

Putting the treadmill desk in my new work-from-home office was the smartest thing I could have done.

Uninterrupted lunch breaks are the bomb! Never really truly had one until two weeks ago.