Client Feedback

We receive a lot of positive client feedback about the quality of care provided by our caregivers. This note arrived today and was so lovely, I thought I would share it:

Dear Ms Wiseman:

"We are so grateful for the care that Jean gives our mother. We welcome her each week and are at ease knowing that she is so well taken care of.

Jean is always cheerful and warm.  She is intelligent and shows genuine concern not only for the welfare of our mother, but makes sure that I and my siblings are well informed and also cared for.

I give her the highest commendations.  She is truly a gem."

We appreciate the hard work and effort of our caregiving staff. Our clients and their families do too. Working with positive and caring people makes for a wonderful work environment.

(And by the way, if you know a Registered Nurse with a specialty in Geriatrics who is bright, skilled, social and funny, let them know.....we're hiring!!)

Lisa

Request for advice-removing rings safely from mom's swollen fingers

I often get asked for advice from families who are caring for seniors.  As you might imagine, the questions cover a wide range of topics. Thought I would share this set of messages in hopes that anyone else facing this dilemma might get some bright ideas...(also, I think it's one of those problems no one talks about!)
__________________________________________________________________________________

From: Joan
Sent: December-29-11 5:42 PM
To: Lisa Wiseman
Subject: Removing rings from a Nursing Home Resident with Alzheimer's Disease

Good afternoon:
My mother is a resident in a Nursing Home. The staff are concerned that her wedding ring band & engagement ring are cutting off her circulation, as her fingers are very swollen, and have suggested the family get the rings cut off. My mother has Alzheimer's Disease, and is not able to travel out of the residence. Her hands are also very contractured, and it is painful for her to open her fingers.

I have seen online suggestions to remove a ring using a lubricant, ice, and/or dental floss. I don't know if any of those would work, under the circumstances.

Do you have any suggestions on how we can remove the rings with the least amount of distress to my mother? Do you know who to contact regarding a ring-cutting service?  I have sent emails to a local Jewellery store, the hospital and fire department.  We would like to get Mom's rings resized and returned to her.

I look forward to hearing from you. Thank you.

---

From: Wiseman@eldercarehomehealth.com
To: Joan
Date: Fri, 30 Dec 2011 12:16
Subject: RE: Removing rings from a Nursing Home Resident with Alzheimer's Disease

Hello Joan,

We recently had a client in a very similar predicament.  We tried some of the interventions that you’ve listed, but they were not successful.

In the end, our Registered Nurse purchased a small wire cutter with a flat tip, from Home Depot. She cut the ring off without incident.  (You could then have the ring repaired and re-sized by a jeweller.)

I hope this has been helpful. 

  

Lisa

_____________________________________________________________________________________

Good afternoon, Lisa:

Thank you for your reply. I thought you might want to know how it was resolved.

On Friday, Dec 31/11, the Nursing home called 911, and Paramedics arrived at the Nursing home, but did not have the tools to remove the rings.  They escorted my Mom by non-emergency ambulance to a local hospital emergency department, where her 2 rings were cut off. Mom was then returned to the Nursing home, again by ambulance, within an hour. The rings were quite damaged, but our family will pick them up and hopefully be able to get them repaired and resized and returned to my Mom.

Again, thank you for your interest in our situation.

Sincerely,
Joan 

Want to spread the word on studies that relate improved health outcomes to exercise habits? How about hiring a vampire?

In today's Globe and Mail The Bloomberg Manulife Prize For The Promotion of Active Health was announced.  It has been awarded to Dr. Steven Blair who's research shows that as little as 30 minutes of moderate physical activity per day is all it takes to decrease mortality rates by 50 per cent. He says lack of physical activity is the single biggest health issue facing North Americans today.

Unfortunately the headline of this announcement reads: 

"No magic pill. No trendy diet. Just 30 minutes of light exercise."

Well, that's going to be a major problem.  Who can make money from that kind of advice?

The pharmaceutical companies won't promote it if they can't formulate and sell the next magic pill.

The weight loss companies won't advertise it by hiring famous actors to promote it because there's no trendy diet.

Health practitioners won't become famous and be sought after as highly paid speakers and they will have difficulty selling millions of books with it because it's not trendy or complicated.

Infomercials will not be made because there are no special blenders or pieces of exercise equipment to sell.

Even your family doctor won't give you a medical prescription for it. (Not to mention that doctors are not necessarily experts about exercise anyways.)

I congratulate Dr Steven Blair, but I do have one request: Next time you discover an accessible lifestyle change that might have a significant impact on the health and wellbeing of the entire population,  couldn't you make it a little more exotic or mysterious or even sexy?  Maybe throw in a secret recipe or two, suggest impossible exercises or even hire a vampire as your spokesperson...seems that's a sure fire way to grab everyone's attention.

Depression, Mental Health and Exercise

Here's an interesting statistic; According to the Public Health Agency of Canada, mental illness will be experienced by 20% of the population in any given year. 

Depression affects people of all ages.  The one treatment that does not involve drugs or specific psychiatric interventions is exercise.  All types of exercise have been found to provide some beneficial effect. 

Exercise boosts mood, helps reduce stress, improves sleep, and boosts low serotonin levels which are linked to depression. Exercise can reduce blood pressure, assist in weight loss, improve respiratory function, digestion....

Of the thousands of seniors that I have seen in my Practice over the last 25 years, can you take a guess at how many had been advised by their family doctors or psychiatrists to increase or start an exercise program to improve their physical and mental wellbeing? If the answer is not zero, it's pretty darn close.

How many of that same group were given prescriptions for sleeping, anxiety or depression?  At least one third. Is it just me, or is there something wrong with this picture?

Mental Health and our Nursing Practice

Last night I, along with eight members of the Eldercare Home Health Care team, attended a dinner and presentation featuring John Thomas, who is a member of the geriatric mental health outreach team at Baycrest. John did a great job, as he always does, highlighting the signs and symptoms of depression and anxiety in the elderly.  He outlined some commonly  prescribed medications and their side effects as well as reviewed the use of ECT.

There's only so much that can be covered in an hour's presentation and by all measures, John's presentation was excellent.  However, it was a reminder about the importance of our assessments as Registered Nurses and front line care providers and the scope of interventions possible for the care of older people. The interventions that do not involve medical "treatments".

There are a multitiude of factors that contribute to our mental wellbeing-and absolutely the same is true of people who happen to be over 80 years old.  Yes, there may be complicating features, but there are also many very basic healthy interventions that can be addressed;

There are seniors, who, for a variety of reasons, don't eat well. There are those who are chronically dehydrated. Pain, particularly chronic pain, wreaks havoc on a person's mental health. 

Research has suggested that many interesting factors contribute to positive mood;  exposure to Vitamin D, Vitamin B sufficiency, adequate daily doses of sunlight, an environment with pleasant odours (think lavendar, cinnamon and peppermint), meaningful life activity, pets, the company of others....to mention but a few important findings.

One of the happy coincidences with these kinds of interventions is that they have a distinct lack of serious side effects and many can be very cost effective and accomplished with a minimum of expense.

I know that John did not set out to exclude these important factors from his discussions last night, but I also know that they do not comprise the mainstay of his Practice (I did mention that he only had one hour!!). 

But these kinds of considerations should be part of our Practice.  I'm absolutely certain, in fact, that if we paid more attention to these basic healthy issues, only people who were truly ill would need medical interventions!

A rant about weight measurement in facility settings...

"Accurate weight measuring is a simple yet often neglected aspect of basic care that contributes significantly to determining an individual's overall and nutritional health" (Canadian Nurse October 2011 Volume 107 Number 8 p20)

In an article entitled Taking the Weight, authors report that the lack of weight measurement and documentation in a facility setting were affected by the following issues;

-a lack of time due to workload demands
-confusion about which clinical team member is responsible for weighing a resident
-a lack of understanding of the significance of weight measurement
-inaccessibility of scales and confusion as to which scale was appropriate for the resident
-limited space for documenting weights on nursing flow sheets
-difficulty locating weight data in the medical record

Really?  Health care teams made up of professional, caring, intelligent adults cannot figure this one out without studies, multiple meetings and work sessions only made possible with additional money from the Ministry? Imagine if they have to tackle something really difficult!

The team writing the article developed the Bruyere Weight Measuring Protocol and Process. It included education, a protocol guide, a data-fax standardized documentation procedure for collecting and recording data and the production of individualized graphs to track patient weight over time and flag weight loss and gains. (Hope they didn't go to too  much effort, because these kinds of tools already exist.)

The authors claim a dramatic improvement in the accurate documentation of weights.

Is it only me or does it strike anyone else that the monitoring of weight within a health care setting is an important, basic indicator of a person's wellbeing? It is a relatively simple procedure in most cases, (no bloodwork required),  and can yield important warning signs of impending and/or changing health conditions. 

The excuse of workload demand is too often the "go-to" excuse for any and everything in a facility.  It's hard to know when the claim is justified, although sometimes there's no doubt that it definitely is. 

In this instance, the provision of education and direction regarding when and where to document, as well as the monitoring of compliance, was enough to change Practice. It doesn't sound like workload demands were a factor at all.

The working group that developed the protocol now propose introducing an e-learning weight module to provide more education to staff.

Since they received funding from the Ministry of Health to develop the protocol, it seems to me that the strategies and documentation that resulted should be distributed to all facilities in Ontario, even Canada, where there is a need to monitor patient/resident health.

Now, whether that weight record is reviewed on a regular basis and how the information figures into Client care....that's an entirely different issue and a topic for another day.

Hospital meals gone terribly wrong....

A Client's wife told me of her experience with the delivery of meals to patients in a hospital setting.  Mrs "Smith" spent her days in hospital by her husband's bedside.  He was elderly, was diagnosed with dementia and had recently had a stroke.  Mrs Smith spent long days in that hospital room which housed four patients and had this observation to share about the meals. 

She said that the meal trays would be delivered to the patients by the kitchen staff.  Sometimes the trays would be placed outside of the reach of the patient in the bed. Often no one came to assist the patients with their meals. She took on that responsibility for the four. The patients in the room could not reach the trays without assistance, nor could they open the containers holding the meal items.

Most days, she said, no assistance was offered to these patients, and very often they did not get to eat the food on the tray.  She recalled the day that the four trays arrived, each with a lovely, whole orange. Being that none of the patients could manage to peel and eat an orange without assistance, the unfinished meals, along with the lovely whole oranges, were collected by the kitchen staff, carted off and likely placed in the garbage.

In this scenario, a Dietitian would be overseeing the menu that was supposed to ensure that patients in the hospital  get nutritious meals.  The Dietitian would have wanted patients to receive the benefit of fresh fruit. 

The Nurses, who would have created a careplan to outline the care needs of patients, charted that the patients required assistance with their activities of daily living, and the reports they created for Ministry of Health would have indicated that this was a Unit with patients who had heavy care needs. 

The Doctor would wonder why the patients were failing to respond to treatment, why their weights were in decline, (if the monthly weight chart was even consulted), the Physiotherapist would wonder why the patient was so fatigued that they were unable to participate in an excercise program, (and they would soon give up offering a physio session). 

The Pharmacist would supply a multivitamin due to the deconditioned nature of the patient, the Dietitian would order an expensive meal supplement....and the fresh fruit on each patient's tray would go uneaten day after day....

I'm sorry to say that this is not a made up scenario.  It is a scene played out day after day in various hospital settings, where older adults require more assistance than they are receiving in order to benefit from the treatments offered and even at a more basic level, to avoid other pitfalls of being hospitalized; becoming deconditioned, dehydrated and ill.

A caregiver's role in an acute care setting is to assist Patients with all activities of daily living, to advocate for Patients with the clinical staff and to remind the staff of the particular care needs of the Patient.

Sometimes that means peeling a couple of oranges.....