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!
Tuesday, November 8, 2011
Friday, November 4, 2011
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.
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.
Wednesday, November 2, 2011
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.....
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.....
Tuesday, November 1, 2011
Medically proven, but likely not found on a prescription pad....yoga
What has been shown to relieve headaches, insomnia, back pain and fatigue? Furthermore has been shown to relieve stress and mild depression? Helps to prevent osteooporosis and improves digestion?
A miracle cure? No, it's practicing yoga on a regular basis. There are even some claims that it may help regulate heart beat, and lower the risk of a stroke. Research by the University of Kansas Hospital showed that after three months of doing poses, breathing exercises and meditation, patients suffering from atrial fibrilllation reported less anxiety and depression and fewer irregular heartbeats.
This can be a social or solitary activity, may be modified for a beginner or someone with limited mobility. It can be a senior friendly intervention and best of all has no known negative side effects.
A miracle cure? No, it's practicing yoga on a regular basis. There are even some claims that it may help regulate heart beat, and lower the risk of a stroke. Research by the University of Kansas Hospital showed that after three months of doing poses, breathing exercises and meditation, patients suffering from atrial fibrilllation reported less anxiety and depression and fewer irregular heartbeats.
This can be a social or solitary activity, may be modified for a beginner or someone with limited mobility. It can be a senior friendly intervention and best of all has no known negative side effects.
Subscribe to:
Posts (Atom)
Posts
