|The Mississippi River in the other direction and some bridge or other.|
I went to a case presentation of a patient with borderline personality disorder who was dying from her cancer in an inpatient hospice unit. They gave specific details of the behavior and the intervention, but the take home was that in their case it worked really well to have the behavior clearly identified (pick your battles), limit set in a way to make sure the patient didn't feel abandoned, have everyone respond exactly the same way (to the point of here are some specific words to use), to define consequences clearly to the patient. In the case they gave, the consequences were that the patient would be discharged from the hospice house and go back to the hospital. This particular patient was such a good staff splitter that they had to have the nurse that she had put in the "good nurse" column off from work while they implemented the behavior change plan. They talked about borderline personality disordered patients as having three states of feeling: held (the ideal state), threatened (where the undesirable behaviors come out to help the person feel they are getting back to held) and alone (where the person gets impulsive, dissociated and, at worst, paranoid). I think I can recognize BPD in patients, but had never been walked through here's what's going on or here's what to do about it. Interesting stuff.
Otherwise, today was spent about half and half in patient care and filling out the dreaded hospice certs and other forms. Not too bad.
I am thankful for Terry's new bike and the fact that it is warm enough he can ride it. I am hopeful for continued thaw and de-snowing of my neighborhood.