Paul's Passing Thoughts

A Blog for TANC Ministries

Posted in Uncategorized by Andy Young, PPT contributing editor on February 19, 2016

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The Medication Aide’s Best Assets are Fear and Humbleness

Posted in Uncategorized by Paul M. Dohse Sr. on June 2, 2021

By Paul Dohse, STNA/MA-C

Medication Aides are coming to Ohio, and though most nurses disdain the program, there is no stopping it now, especially in assisted living facilities. Unfortunately, an Ohio MA-C (Medication Aide-Certified), is often confused with a certification of completion (they do not receive certification) in developmental disability group homes. That certification entails about 16 hours of in-class training and no clinicals. Neither does it require a state test.

The MA-C certification is through the Ohio Board of Nursing. It is a nursing certification. It qualifies an individual to administer medications in long term care including skilled nursing facilities, with some restrictions. However, regarding skilled nursing and nursing homes, the MA-C must also have an STNA (State Tested Nurse Aide) certification through the Ohio Department of Health. Resident Assistants (RA) must have at least one-year full time experience in the last 5 years in assisted living facilities in order to qualify for certification.

Medication Aides have changed the face of healthcare in many states for a long time: Ohio is very late to the party, in part, because Ohio has stringent healthcare regulations that surpass the majority of states.

But the slow, uphill rollout of MA-C in Ohio has other causes. In Ohio, nurses have a strange dysfunctional relationship with passing medications. The task is a merciless tyrant that excels in the tyranny of the urgent, yet nurses object to being saved from the unhealthy co-dependent relationship. I have devoted the rest of my life to serving nurses, at least until I become one, and my experience as a MA-C, especially in assisted living, has shown me the amazing potential of MA-Cs to enable nurses to deliver higher quality care and to do more of what they have been trained to do. On one point alone, nurses having more time to interact with concerned families can serve to elevate the census of that facility expeditiously.

Look, I hesitate to share this because nurses are my heroes, and as an STNA, I have worked with very few bad ones, but it is clear that medication passes are a nurse’s worst enemy whether they admit it or not. I have watched it for years, but the past year has been the most interesting. Why? Because as an STNA with a MA-C certification, I have watched nurses struggle with med passes, and in the beginning, suggested that I could help, which resulted in being attacked and demeaned for the suggestion. It was never any skin off my back, I enjoy being an aide, so I quietly and joyfully cleaned up the pitchers of water off the floor dropped in their panic, said nothing when they poured water into a medicine cup, didn’t pass judgment when too much of the plastic spoon was in the resident’s mouth, and offered to do their treatment orders when their eMAR was all red. As an older, male STNA, I always enjoyed overhearing nurses talk about their bad relationships with boyfriends; it always made me think of their med passes as well.

Do I think med passes are the number one cause of the rampant pressure ulcer epidemic in long term care facilities? Yes. Clearly, med passes rob time from attention to wound treatments and making sure aides do what they need to do to prevent them. Nurses who do too much are also directly related to the nurse aide shortage. Having little time to involve aides in the care of residents diminishes the value of being an aide in the minds of the aides. When aides refer to themselves as “certified butt-wipers,” you can be sure that severe staff shortages are coming.

I have been an aide for a long time in the heaviest of skilled nursing facilities. How many times has a nurse wanted to do a report with me while saying things like, “These are my diabetics, and these are the people who need to get their trays first, and I need vitals on these people by this time,” ect., ect? Once, one time, and frankly, I wondered what the hell was going on. Aide work is the hardest work out there. If you want to erase participants, detract from its value while making your own job harder. Yeah, do that, brilliant.

With all this said, and Ohio facilities finally seeing the light after the necessary amount of suffering, the first MA-Cs are burdened with a huge responsibility. All eyes are on us. As far as I can tell, and after asking people who are in a position to know, there are probably less than 20 experienced MA-Cs in Ohio. The future of the program and its benefits will be judged by our performance. We have two jobs: to be the best MA-Cs we can be, and to convince the sceptics because we believe the program will result in higher quality healthcare.

However, a much larger consideration looms. Medication errors kill more people annually than traffic accidents. And like traffic accidents, it only takes a moment of non-focus or distraction to change someone’s life forever or end it. As medication aides, we live by the “Six Rights,” the right resident, the right drug, the right dose, the right route, the right time, and the right documentation. And we are not passing over the counter drugs, we are administering very powerful medications. Last week, I found myself passing meds on a unit that I was much less familiar with than the unit I am usually assigned to. Not being totally familiar with the residents on that unit, I applied the two-check system for identifying the right resident. The residents were not in their rooms, so I focused on the full names for one check. I was unaware that two residents on that unit have the same last name. My inquiry revealed different first names, which also revealed the fact that I was standing before a resident with the wrong cup of meds. I returned to the med cart stunned. It took me about 15 minutes to collect myself.

This brings me to a suggestion that is a carryover from a creed I always practiced as an STNA: ALWAYS take the resident’s concerns seriously…always. I delight in a resident who is on top of the medications prescribed to them. If you have a healthy fear for what we do, you will welcome this seventh check. In fact, I insist that there are really seven checks with the seventh one being, “ALWAYS listen to the resident.” You can call it “Paul’s seven rights” and that will suit me just fine. Again, if you have the healthy fear, you will be humble enough to listen. Besides, according to my firsthand knowledge, listening to residents has prevented drug errors.

Though MA-Cs are not nurses, they are an extension of the nurse aide calling to aide nurses. Nevertheless, it must be pointed out that Ohio STNAs are not fully used to benefit nurses to begin with. Be sure of this: the nurse aide identity crisis in Ohio has led to severe shortages of both. Lack of value regarding aides, and burnout regarding nurses. MA-Cs are an important hinge that will swing both ways and cure both shortages. Healthcare facilities are beginning to figure that out.

The first qualification of a MA-C is a healthy fear of our task at hand. Secondly, education, but the first qualification will determine how much we excel in the application of what we learn.

A healthy fear and enough humbleness to listen are our greatest assets.  

Eternal Salvation: What is It?

Posted in Uncategorized by Paul M. Dohse Sr. on May 16, 2021

Faith

According to the Bible, eternal salvation comes by hearing the word of God and believing it. This is not a mere intellectual assent, but what the Bible calls “faith.” Faith puts its hope in God, God’s wisdom, and God’s way of life. Faith and hope are closely related. Actually, faith is what the Bible is referring to when it speaks of belief. “Abraham believed God and it was credited to him as righteousness” (Genesis 15:6). Faith results in a different mindset and behavior. Romans 10:17, Hebrews 11, Psalm 1:1-6, Psalm 119.

Faith, Seed, and New Birth

Faith comes by hearing and believing resulting in the new birth. The new birth is a supernatural act of the Holy Spirit that transforms a person into God’s literal child, or what the Bible refers to as God’s “offspring.” It is the hearing of God’s word and believing it that results in the word of God being implanted within the individual by the Holy Spirit. God’s word and God’s life are synonymous (Matthew 4:4). In fact, God’s word, faith, God’s seed (offspring) are for all practical purposes of salvation the same thing. Matthew 17:20, Matthew 13, Luke 17:6, Romans 4:13, Romans 4:16, and Hebrews 11:11. Belief, faith, and miraculous new birth are a common theme throughout the Bible. And…

For you have been born again, not of perishable seed, but of imperishable, through the living and enduring word of God (1Peter 123).

So get rid of all the filth and evil in your lives, and humbly accept the word God has planted in your hearts, for it has the power to save your souls (James 1:21).

Along with this word of God residing within the believer, the Spirit, Christ, and God the Father live within the believer as well (1Corintians 3:16, Ephesians 1:13-14, John 17:23).

What the New Birth is NOT

The new birth is not a mere “experience” or perception, or a subjective sanctification. It is not the result of a mere “legal declaration.” The new birth makes a person truly righteous as a state of being. In the biblical new birth, true righteousness and the holiness of God are NOT outside of the believer. The believer is not merely declared righteous; the believer IS righteous as the true and literal offspring of God.

The righteousness of God is transferable to the being of those born from above. This does not mean that righteousness originated with us, and therefore, making a substitution necessary that is not truly part of the believer. This denies the reality that God can join holiness with mortality. The reality of God becoming one with those born again is demonstrated by Mary and the virgin birth of Christ. This was hardly a righteousness outside of Mary; God used her body to bring the Savior into the world. “Christ IN you, the hope of glory” (Colossians 1:27).

Therefore, Martin Luther’s “alien righteousness” should be rejected with disdain.

The New Birth and the New Covenant

Hence, under the New Covenant, the Spirit not only implants the word within us, but He baptizes us. This does three additional things: it puts the old person to death and resurrects him/her to new life, changes that person’s relationship to the law, and makes the believer ONE with Jews and Gentiles. The baptism of the Spirit makes one part of the “commonwealth of Israel.”

Therefore remember that formerly you who are Gentiles in the flesh and called uncircumcised by the so-called circumcision (that done in the body by human hands)— remember that at that time you were separate from Christ, alienated from the commonwealth of Israel, and strangers to the covenants of the promise, without hope and without God in the world. 13But now in Christ Jesus you who once were far away have been brought near through the blood of Christ.

For He Himself is our peace, who has made the two one and has torn down the dividing wall of hostility by abolishing in His flesh the law of commandments and decrees. He did this to create in Himself one new man out of the two, thus making peace and reconciling both of them to God in one body through the cross, by which He extinguished their hostility.

He came and preached peace to you who were far away and peace to those who were near. For through Him we both have access to the Father by one Spirit (Ephesians 2:11-18).

The old us is put to death with Christ, and the new us is resurrected with Christ.

What then shall we say? Shall we continue in sin so that grace may increase? Certainly not! How can we who died to sin live in it any longer? Or aren’t you aware that all of us who were baptized into Christ Jesus were baptized into His death? We therefore were buried with Him through baptism into death, in order that, just as Christ was raised from the dead through the glory of the Father, we too may walk in newness of life.

For if we have been united with Him like this in His death, we will certainly also be united with Him in His resurrection. We know that our old self was crucified with Him so that the body of sin might be rendered powerless, that we should no longer be slaves to sin. For anyone who has died has been freed from sin.

Now if we died with Christ, we believe that we will also live with Him. For we know that since Christ was raised from the dead, He cannot die again; death no longer has dominion over Him. The death He died, He died to sin once for all; but the life He lives, He lives to God. So you too must count yourselves dead to sin, but alive to God in Christ Jesus.

Therefore do not let sin reign in your mortal body so that you obey its desires. Do not present the parts of your body to sin as instruments of wickedness, but present yourselves to God as those who have been brought from death to life; and present the parts of your body to Him as instruments of righteousness. For sin shall not be your master, because you are not under law, but under grace (Romans 6:1-14).

The baptism of the Spirit changes our relationship to the law.

Do you not know, brothers (for I am speaking to those who know the law), that the law has authority over a man only as long as he lives?  For instance, a married woman is bound by law to her husband as long as he lives. But if her husband dies, she is released from the law of marriage. So then, if she is joined to another man while her husband is still alive, she is called an adulteress; but if her husband dies, she is free from that law and is not an adulteress, even if she marries another man.

Therefore, my brothers, you also died to the law through the body of Christ, that you might belong to another, to Him who was raised from the dead, in order that we might bear fruit to God. For when we lived according to the flesh, the sinful passions aroused by the law were at work in our bodies, bearing fruit for death. But now, having died to what bound us, we have been released from the law, so that we serve in the new way of the Spirit, and not in the old way of the written code (Romans 7:1-6).

Because the new us is no longer under the law and its condemnation, no substitution for the penalty of sin or a perfect law-keeping righteousness is needed. We have been set free to serve another Master once and for all. That freedom means that there is NOW…NO condemnation for those in Christ (Romans 8:1). Christ came to end the law Romans 10:4), not to continually fulfill it as a substitution in return for participating in “the ordinary means of grace.”

That doesn’t mean we are not under any law while under grace. The law, or Bible, is now our manual for loving God and others. “If you love me, keep my commandments.” The Bible is now useful for our “faith working through love” (Galatians 5:6).

The born again Christian now finds purpose in loving God and others aggressively with no fear of condemnation. “Sin” regarding a believer is really a failure to love and can bring Fatherly chastisement as well as practical consequences, but has no need of reacquiring Christ’s finished salvific works.

Note: any gospel that does not emphasize the TWO laws (both “nomos,” not two “realms”) of Romans 8:2 are necessarily a fulfilling of the law through a ritulistic substitution rather than fullfilling the law through love.

The Order of Salvation

All individuals born into the world are born with the abilty to ask God for eternal life because the works of the law are written on their hearts and their consciences either accuse them or excuse them. (Romans 2:12-16). Those under law are convicted of sin and the coming judgment by the Holy Spirit (John 16:8). And, as mentioned earlier, faith comes by hearing the word of God and believing it.

Hence, God seeks to save man through an internal conviction, an external conviction by the Spirit, and the preaching of the word by God’s children in the world. And, “God’s kindness leads to repentance” (Romans 2:4). Furthermore, creation testifies to God’s goodness and His wrath to come (Romans 1:18-20). The efforts of God to reach mankind is astounding to think about. The internal testimony, the testimony of the Spirit, the testimony of God’s people, the testimony of creation, and God’s personal testimony of kindness. Therefore, the Bible states that “man is without excuse.”

Salvation begins with an individual being persuaded by these messengers, believing it, and wanting this truth of God to be the reality of their own lives. In response to that, the Holy Spirit baptizes them. That is the order of salvation. To make this clear, the book of Acts describes a visual illustration that demonstrates it (Acts 10:24-48).

The Old Covenant

The Old Covenant was a will to which all sin was imputed. The New Covenant ends the Old Covenant (for believers) and all of the sin imputed to it. Galatians chapter 3, Hebrews chapter 9, Romans 10:4.

Saints under the Old Covenant had their sin imputed to the law, or “imprisoned” under the law. The New Covenant puts an end to sin altogether and baptizes Jew and Gentile into one body.

Justification

Justification is by the new birth apart from the law. Justification is by “the promise” of a seed apart from the law. Galatians chapter 3 states that there is only one seed. If the standard for justification is perfect law-keeping, the law is a second seed, but there is only one seed according to Galatians chapter 3. The law cannot give life.

Justification is the result of God’s seed being implanted within us. One who has the seed of God in them “CANNOT SIN.” This is just another way of saying a believer is justified and is the cardinal point of 1John chapter 3. Again, born again believers are righteous as a state of being.

Sanctification

Sanctification is the growing of the Christian life and not the progression of salvation in any way, shape, or form. Like any new birth, the birth event is a onetime finished event followed by the progression of life. The new infant grows by the “pure milk of the word” or in other words, the Spirit’s second use of the law to sanctify (John 17:17). The Spirit’s first use of the law is to convict the world of sin and the judgement to come.

Redemption

Redemption is the salvation of the body and is future; it is different from the salvation of the soul (Romans 7:24).

Fellowship

The church, inherently, is an institution, and therefore has no validity for fellowship among Christ’s called out assembly (ekklesia). All authority is vested in Christ alone, and the fellowship of God’s people is a cooperative body with Christ as the head. The body of Christ is a cooperative effort of collective gifts granted by the Spirit, not an authoritative hierarchy. True Christian fellowship functions like any other family would function.

However, we should also remember that we are ambassodors representing God’s kingdom and also a royal priesthood. A concerted effort to glorify God’s kingdom while we are here should be taken seriously and aggressively pursued through fellowship. Unity will be determined by agreement in the one mind of Christ. Fellowship is determined by who is fellowshipping together and not church membership.

What Justification by New Birth is NOT

It is not Catholicism versus Protestantism, which is an absurd notion. Both hold to a progressive salvation through church ritual. Catholicism refers to that as “the sacraments.” Protestantism refers to it as “the ordinary means of grace.”

Why The Church Gospel is False Via John Piper

Posted in Uncategorized by Paul M. Dohse Sr. on May 16, 2021

Video link: https://youtu.be/Yj9_RKwTY4g

“So, the record of debt that is mounting against you every day because you sin every day. The record of debt that is cancelled mounting against you every day is canceled. How? By being nailed to the cross. Now you know as well as I, nails in wood forgive no sin, so what does he mean? He means they went through a hand into the cross; they went through a foot into the cross, and whose was it, mine? Should have been. It was the Son of God, which is why mine can be canceled if I trust him. That’s the gospel. It’s the glorious gospel that we should be telling everybody in the twin cities. “

This is pretty much the Protestant gospel per Martin Luther and John Calvin. What’s missing? The new birth that changes our relationship to the law, or the Bible if you will. Note that Piper states, “That’s the gospel.” Actually, it is only half of the gospel and the half presented isn’t true either. Christ didn’t die to be an ongoing substitute for our sin, He died to end sin. He didn’t die once to be an ongoing covering (atonement for sin), He died to end sin once and for all. Christ doesn’t take away our sin as far as the East is from the West daily, He did that once and for all time.

Let’s think about this. The record of debt, according to Piper, and frankly, Protestant orthodoxy as well, IS cancelled even though the debt is mounting daily because we sin daily. Notice Piper’s tense swapping in the same context: sin is mounting (present continuance), while being cancelled (simple past). The long and the short of it is this: Jesus’s death is newly applied to present sin daily. This should clarify what is meant by, “We must preach the gospel to ourselves every day.”

Conspicuously absent is the resurrection which according to Protestantism merely confirms that Jesus kept the law perfect enough to obtain righteousness that is then perpetually imputed to our sanctification IF we live by faith alone. This is the Protestant doctrine of Double Imputation.

So, this changes the new birth into a church sacrament instead of a miraculous work of the Spirit that changes a person’s state of being once and for all time. And of course, this is a sacrament that can only be obtained where sacraments are found: in a temple, and in this case, the church.

Fellowship alone will not support church infrastructure; wisdom for loving others is not incentive enough either. Eternal salvation found only in the church is the big seller.

Sunday Home Fellowship Bible Study Live

Posted in Uncategorized by Paul M. Dohse Sr. on May 16, 2021

Assurance

Posted in Uncategorized by Paul M. Dohse Sr. on May 16, 2021