Archive for the ‘Uncategorized’ Category
Posted on March 19, 2013 - by Nurse Virginia
REMEMBERING MOM- DEATH OF A PARENT
I truly feel the warm thoughts and sincere prayers coming to me at this time, due to the loss of my Mom. As I worked with my sister clearing out her room I was struck by the flow of nursing assistants, nurses and activity staff who came to the room to pay their respects. With tears and hugs they said how they would miss this very old woman. Miss this woman who had to be so much work? A woman who just had to be a burden for anyone charged with her care.
Webster tells us that a “burden” is a heavy load, something that causes grief, hardship or worry. Taking care of Mom was a heavy load.
I knew what those words meant. Mom was an elder who needed a mechanical lift to move anywhere. She was an elder unable to help with even the smallest step in her care. Mom had a debilitating stroke 13 years ago which cost her, her place in the community, and won her a permanent place in the nursing community. Once she entered the nursing community I never heard any bitterness in her voice. Though to many her life would certainly have seemed very bitter, I never heard her say, “why me?”
Mom had just celebrated her 90th birthday. Many years that brought not only changes in abilities for her but this once beautiful woman lost teeth, hair, became contracted and had to be fed all her meals.
As the years went by and the nursing community changed and there were too many new faces and new names for me to keep up with, what didn’t change was the connection Mom made with her caregivers. When I entered the unit where Mom lived, I would be greeted by a happy, smiling nursing assistant calling out to me “I got your Mom up today.” Why so happy? Why the smile? I know how hard that task was for you.
But taking care of Mom also meant one on one time talking to Mom, and Mom was filled with joy. When Mom passed away I know everyone in that nursing community knew where Mom went. Because when you spent time with Mom the conversation didn’t just center on her care issues. In that shared room in a nursing community in southern Wisconsin Mom let her light shine, and she shared her joy.
To find your joy, you can start where Mom did at John 3:16.
Virginia Garberding, Daughter
Posted on October 15, 2012 - by Nurse Virginia
ON BEING A LEADER – WE CAN LEARN IT ALL FROM GEESE
Tomorrow is National Bosses Day, while many people are born leaders and always seem to know the right direction for the group. Some of us can learn a little from nature.
GEESE FLY IN A V SHAPED FORMATION
The lead goose takes the brunt of the wind and the flapping of all their wings creates an updraft that helps all the other birds in the formation. When a goose leaves the formation they quickly try to get back into formation because they experience a drag and it is harder to fly without the others.
GEESE TAKE TURNS BEING IN THE LEAD
The lead goose, when they get tired will move to another place in the formation, letting another goose take the lead.
GEESE ENCOURAGE EACH OTHER AND TAKE CARE OF THE SICK AND WOUNDED
Geese in the formation honk to encourage those in the lead. And when a goose becomes too weak to keep up – two other geese leave the formation with that goose. These two will stay with that goose until it can rejoin the formation or they join another formation. If needed, the two geese will even attempt to revive the fallen goose.
What if people acted the same way? What if instead of everyone wanting to be the leader, everyone took turns leading? What if everyone was interested in supporting each other instead of number one?
What if everyone learned a way to show their support and encourage others? Especially, to those among us who have been hurt and need some helping hands.
Sometime it takes trouble, or if you will a disaster, to get the best out of people and make them act like – well like geese.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 17, 2012 - by Nurse Virginia
DEATH AND THE DYING
PART II
Many times when the dying person is asked their last wishes the dying individual will just ask to be able to die at home. At the time when George asked, this didn’t seem to be such a large decision. After all thought Mary, we will get hospice in and a 24 hour care giver; yes of course we can do this.
The dying process.
Before death the person will have a decrease in appetite, sleep more, and have a decrease in blood pressure and temperature. The pulse becomes uneven and difficult to take. You will start to see the person’s lips and nails begin to turn pale blue and then purple.
The whole body begins to have purple blotches starting with hands and feet, progressing up arms and legs. This is the blood beginning to pool from lack of circulation.
What is this “death rattle?”
People are always swallowing their saliva, even when sleeping. It is an automatic response that you are unaware of. When dying, the person is no longer able to swallow and their saliva accumulates in the throat. When the person breathes, air is forced through this accumulated fluid and causes a “rattle” that is difficult to listen to. Although this condition before death is not painful for the dying, it is painful for the family to hear because it sounds like the person is choking.
The dying person may also have an erratic breathing pattern with rapid breathing and chest movement alternating with long periods where the breathing ceases. This is called Cheyne Stoke breathing and is very common before death.
The person may be confused and agitated at times. Many people have a last surge of strength, maybe raising their voice or attempting to get up and out of bed. This lasts a short time before death.
It is widely believed that the last sense to go for the dying person is the ability to hear. The family is strongly encouraged to keep talking to the dying person. Words of peace and encouragement, “you did well, your job is done, you can go now.” I have seen many people able to die after being told that they did a good job and can go now.
Looking at the calendar – Mary saw that it was filled with so many appointments those last weeks and then suddenly the days were empty, just like her house.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 6, 2012 - by Nurse Virginia
DEATH AND THE DYING
(Part I)
It wasn’t supposed to end like this. Mary looks at her calendar on the wall and yes it was still August 2012, and there they were written, her husband’s appointments. The date George was going to the doctor about this terrible pain that had been growing in his abdomen, causing him such nausea that he couldn’t keep down any food.
There was the date the next week when they would hear the results of the tests and hear the “plan” the doctors had put together to treat his pancreatic cancer. Yes, that pain had really been so much more than the flu bug that he thought he had caught. That day they had heard the dreadful news – he no longer had the 3-9 months they had originally predicted. There was no plan only two choices go home and die at home or go to a hospice facility.
There was the date marked and the time that the hospice furniture would arrive, the social worker would come, the cell number of the nurse and the instructions she had left.
Mary stared at the date, in that last week of the month, the day George died. In the course of just one month, symptoms, diagnosis, plan, no plan, hospice and then his death.
George’s sister had died of cancer in July after a two year fight, battling her cancer all the way. One had two years, the other had not even a month to make decisions, plans and say good bye.
As unbelievable as the month had been for Mary, she had experienced a closeness of family and friends that she had always hoped would be there for her when she needed it. Above all, what had happened to Mary, what she couldn’t get over now, what it was that was giving her sleepless nights, was the way George died.
No one had told Mary what dying would look like. No one in the family had ever been with someone when they died. When George died Mary was there with her three adult children and a live-in caregiver, and no one knew what to expect and what to do.
It wasn’t supposed to be like this.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on November 8, 2011 - by Nurse Virginia
END OF LIFE DECISIONS – WHEN MEDICINE JUST DOSEN’T KNOW TO STOP
When continuing treatment is pointless, who determines it is time to stop? Arlene was 87 years old and had suffered significant decline in the past year cognitively as well as functionally. But the last four months had been nothing short of a nightmare. Arlene was in a house fire and sustained burns over 50% of her body. Now, in the emergency department of a large hospital, where Arlene was now going to be a patient for some time, the team swung into action to save her.
The hospital did numerous skin grafts that were really difficult on the elderly Arlene. But during the last four months she had also suffered a stroke, pneumonia, multiple infections, heart failure, respiratory distress and now after all she had been through she was unconscious and on a ventilator for the last month.
Before the fire Arlene had often spoke of her readiness to die. All of her contemporaries had already passed away and she was ready when her time came. But even though she had a Do Not Resuscitate form signed, the fact that she was in the fire changed everyone’s expectations of Arlene’s “end of life.”
When Arlene’s daughter tried to bring up the subject of “letting her go,” to the hospital staff, they only spoke of the immediate issue; a stubborn graft that just wasn’t healing, increasing her nutrition via the tube in her stomach, etc. The fact that she was 87 years old and unconscious didn’t seem to be of significance and no one even suggested that a decision should be made.
Arlene’s daughter had to become very assertive. She went to the Medical Director who reviewed Arlene’s chart since admission and could clearly see how the staff had become caught up in the many facets of this case and no longer saw Arlene. Once someone could see Arlene, the staff could move on to support her daughter.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on November 7, 2011 - by Nurse Virginia
THE FUTURE OF HEALTHCARE – COMMUNITY BASED CARE AND CAREER OPPORTUNITIES
Healthcare is rapidly moving out of the hospital setting and into the community. Only the most difficult and complicated cases are remaining behind in the hospital. This shift in practice in not only in the U.S. but around the world and will be responsible for many changes.
If you are hospitalized in the U.S., they better get it right while you are there because re-admission will be frowned upon. There will now be a monetary penalty against a hospital of 1% in 2013 for re-admissions, according to the Hospital Readmission Reduction Program. From there it will increase to 2% penalty in 2014 and 3% penalty in 2015.
The point being, that when a patient is discharged from a hospital the facility must provide education on the disease process before discharge, and will be held accountable. Making mistakes in self-care including miss-medication will be regarded as poor teaching and a patient that was not ready for discharge.
I well remember a member of my family who was caught up in the hospital revolving door situation about 10 years ago. George had congestive heart failure and needed frequent monitoring of weight gains, diet and medication usage. After many re-admissions his wife literally threw up her hands and said – “you take care of George.”
From that day on, over the next six years George was never re- admitted to the hospital again. When he died, it was in his apartment, with his caregiver at his side and not hooked up to any machines.
What it took was constant vigilance to watch for symptoms and adjust accordingly. Eventually his caregiver was able to monitor his well-being with little additional input.
This change in healthcare opens up many new opportunities for nurses as well as other healthcare professionals. A need for what will be referred to as “Transitional Care” and “Transitional Coaches” will be needed to assist in accomplishing the goal of reducing hospital re-admissions. The Georges of the future will be getting much more help and support.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 24, 2011 - by Nurse Virginia
THE FAT OF LIPEDEMA IS VERY DIFFICULT TO HEAL
Carol said she had, had a “little accident,” someone had spilled scalding hot water on her leg. This would be a serious situation for anyone but for Carol, those words held special significance. You see, Carol has Lipedema a rare fat disorder that causes fat to be stored in her lower extremities, never to be released from her legs. Since her teen years the lower half of her body had just grown larger and larger. Until now, at close to 300 pounds Carol is pretty much immobile and home bound.
Although an accident with scalding hot water would be terrible for anyone, for Carol this event could be potentially life threatening. Fat is very difficult to heal and the fat associated with Lipedema even more so. The potential for infection to set into the wound is very high indeed, due to the limited circulation in fatty tissue.
The person with Lipedema needs to take very good care of the skin on their legs and do a daily inspection. Many times the individual with Lipedema is unaware of an injury.
Barb wanted to try a new cream on her legs that offered some comfort measures for the aching that accompanies Lipedema. While applying the cream, Barb was surprised to see an open bleeding wound on her thigh, that she wasn’t even aware that she had. She had felt no pain and was unaware when she might have injured herself.
Carol’s burned area was the size of a dinner plate. She needed to go immediately to an emergency treatment center to begin the three step program of preventing infection, healing the injury and receiving pain relief. Carol reported a week later that she did have a nasty looking green area on her leg that was draining, but on the whole the area does look like it is healing.
When you are dealing with a disorder like Lipedema, there is no such thing as a “little accident.”
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 17, 2011 - by Nurse Virginia
BEING WITH SOMEONE WHO IS SERIOUSLY ILL
Book excerpt:
Sometimes the thing people need from you the most is the hardest of all….to just be with them. It’s easier to run around doing things, keeping busy and solving specific problems, than it is to just be there with their pain, their fear, their anger, their guilt.
Listening, without interruption, can be difficult for those of us who are “talkers.” But listening has its rewards. You may truly learn what it is like to be in someone else’s place. You may gain remarkable insights from people facing their mortality. Only one thing is certain. If you allow the seriously ill individual to fully express himself, it will bring you closer. There are many things you may never have to do as a caregiver but listening is not one of them.
Learn to listen. Try to be patient when people tell you the same thing over and over. Remember, the information they’re dealing with may be so shocking to them that it may require a lot of processing for it to sink in. No matter how understanding their doctors are, no one in the medical establishment can give them what you can …..time. Listening can be a form of healing because it lets them know someone cares.
For the dying person, their reality is shifting rapidly. Sometimes they go through psychological changes in a matter of months that would normally take years. If you don’t listen, you won’t know what’s appropriate at any given time.
Pay attention to what they say. If they say they can’t breathe, listen. If they say they don’t want to go to the hospital, listen. Also listen to the little requests. If they want a certain new music selection to make them feel better, listen. They’re already feeling like they’re losing control. If you don’t listen they will feel this even more.
Book except: Share the Care by Cappy Capossels and Sheila Warnock publisher, Simon & Schuster
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on October 6, 2011 - by Nurse Virginia
CELLULITE – THE SCOURGE OF EVERY WOMAN, CONNECTED TO FOOD INTOLERANCE
(Book Excerpt)
Fat storage in the body is controlled by special receptors in each fat cell. These receptors are called alpha2 receptors. Various hormones may stimulate alpha2 receptors and open the door into the fat cell to allow the deposit of more fat into the cell. The most prominent of these hormones is insulin. Insulin in the blood encourages more fat to be deposited into storage.
On the other hand, beta-receptors open the figurative back door of the fat cells to allow fat out into the bloodstream. Hormones that stimulate the beta-receptors are thyroxin and adrenaline.
As Dr. Dancy poignantly points out in her book “not all fat is created equal.” In women the fat cells around the hips, thighs, and buttocks have six times as many alpha2 receptors as beta-receptors. This implies that fat can be stored six times as fast as it can be released from these areas. Many women will attest to this truth. Elsewhere in the body there are six times as many beta-receptors. This means fat will be lost six times as fast from these areas. Therefore, physiologically, if fat is to be gained, it will most likely show in the hips, thighs, and buttocks. And when fat is lost, it will come from the upper body in most women. This is truly the worst of both worlds and explains a lot. No matter the reason for the weight gain, the overweight will appear on the hips, thighs, and buttocks of most women and on the upper body on men.
Book excerpt from: Your Hidden Food Allergies Are Making You Fat by Rudy Rivera M.D. and Roger Davis Deutsch – Three Rivers Press, New York
I highly recommend buying this book and passing it on to your nearest and dearest. Not only for cellulites, obesity, and Lipedema but also for all the many disease processes that are linked to inflammation.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 4, 2011 - by Nurse Virginia
INFLAMMATION – THE LINK TO MANY DISEASES
Every disease process seems to be tied to inflammation. Whether it is arthritis, diabetes, Alzheimer’s disease or even cancer, the health care community agrees that the common link when it comes to disease is inflammation.
The definition for “inflammation” is literally – to set on fire. Many people would agree with that definition because inflammation involves redness, heat, and always pain in a part of the body. Well not “always” – internal inflammation will most likely not be painful as there are few pain receptor sites on internal organs.
It is much easier to avoid something that causes an immediate reaction (say an itchy sweater) and can be seen then something that is causing inflammation inside the body. This is the difficulty with food intolerances, they can’t be seen. These foods are causing inflammation in you the individual who has sensitivity to it and not in others.
I found out years ago that I was allergic to oranges. By the process of elimination I found that citrus especially oranges gave me eczema. Up until that time I had horrendous eczema on arms and neck. When I gave up citrus the eczema was much better but not gone until I realized I also had a severe reaction to furniture polish. My answer was to not eat oranges and stay away from furniture polish and my eczema was gone.
What if there was something as simple as a blood test that could tell you all the foods causing inflammation – inside your body. A test that could tell you which of the 211 foods tested you are sensitive to, and which foods are making you sick.(the test I took required a prescription from a licensed physician – call for info at 847 640 1377)
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
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