I work in Rehabilitation nursing, and some of this rings true. Residents who get depressed often refuse care and treatment. This is a great article about this issue, if you work in this field, read it. Even if you don’t work in rehab, this is something you might find helpful.

Situation: M.J. is a 32-year-old female currently in an inpatient rehabilitation program. She was admitted 5 weeks ago S/P Motor Vehicle Accident, with a diagnosis of traumatic brain injury (TBI). The patient was engaged in the rehabilitation program and had progressed well until 2 weeks ago. Since that time, her appetite has decreased and she has lost 5 pounds. She reported feeling more tired and taking multiple naps during the day. She has been voicing more concerns about the hopelessness of her situation, has refused to go to therapy, and has denied that she is feeling sad. Nurses report that she has required more PRN pain control.

Consultation: Anne Gnnderson, GNP CRRN-A, an assistant professor at the University of Illinois Chicago College of Medicine, Department of Medical Education, and John Tomkounak, MD, associate dean of curriculum at Rosalind Franklin University Chicago Medical School, reply:

Major depressive disorder (MDD), referred to as simply depression, is a primary mood disorder. For many rehabilitation patients, depression is a common medical problem that affects the patient’s recovery. MDD, however, is often overlooked by healthcare providers and inappropriately (or inadequately) diagnosed for many patients who present with depressive symptoms. Numerous studies cite lack of time, lack of knowledge and skill, and the stigma associated with psychiatric illness as causes of this deficit.

In inpatient rehabilitation programs, depressed patients tend to use the program less effectively, make less progress, and have an increased length of stay. After discharge, depressed patients leave the house less often, do not become involved in recreational pursuits, and report having less contact socially (Wu, 1995). Patients and families often tend to minimize the depressive symptoms or treat the symptoms as something that is “expected” after a traumatic injury. With MJ., it could be easy for her family, and even healthcare providers, to brush off the symptoms as part of an appropriate response to a TBI. Depressed individuals are also less likely to be referred for, seek out, or successfully complete rehabilitation programs or to use adaptive devices (Horowitz, 2003). Rehabilitation providers must recognize the symptoms of depression and provide the necessary treatment for these patients as part of the overall treatment plan.

Read the rest of this article—>

It’s that time of the year again, when our hands get dry…it’s nasty and uncomfortable and doing what we do for work doesn’t help. Here’s an article about how dry hands can spread infection.

Hand-Care Products: the Gloves Are Off
By Cantrell, Susan

Studies have shown that a reason oft-repeated by healthcare workers as to why they aren’t always compliant with the Centers for Disease Control and Prevention (CDC)’s “Guideline for Hand Hygiene in Healthcare Settings”1 is because frequent washing causes dry, cracked skin. That’s not just an aesthetic problem; it’s an occupational hazard for themselves and their patients. Cracks in dry skin provide perfect hiding places for pathogens that can be transferred from Healthcare workers’ (HCWs) hands to sick patients in the blink of an eye.

Sprixx hand sanitizers

The problem of hand care is so serious that it garners much attention from high-profile regulatory and advisory agencies. The CDC considers skin dermatitis to be a critical healthcare issue.1 Thejoint Commission on Accreditation for Healthcare Organizations (JCAHO) surveils for compliance with the CDC’s hand-hygiene guideline as part of its National Patient Safety Goals.2 The National Institute for Occupational Safety and Health notes that “skin disorders are the number one occupational illness across all occupations and cost $1 billion annually.1 The Association for Professions in Infection Control and Epidemiology Inc., (APIC) advises HCWs to “insist on products that promote and maintain healthy skin, reduce transepidermal water loss, increase skin hydration (moisturization), and have low irritancy potential.”4

The stepped-up attention to hand care has industry constantly developing new and improved hand-care products to address this important problem.

What should you look for?

Makers of hand-care products are a source of valuable advice when it comes to effective hand care. They’ve spent a fortune researching what works before their products go on the market. They’re not inclined to risk losing that fortune and potential profits by placing products on the market that they don’t have reason to believe will perform. What do these experts have to say about what to look for in hand-care products?

Compatibility

Kirsten M. Thompson, technical service expert, Ecolab, St. Paul, MN, suggested looking for alcohol-based hand rubs and lotions that are compatible with other antimicrobial hand products, providing this example: “Compatibility of hand-care products is important, because persistent antimicrobial activity of chlorhexidine gluconate (CHG) could be diminished if you followed a hand wash containing CHG with a lotion that wasn’t CHG-compatible.” Steve Rausch, director of marketing, Apollo Corporation, Somerset, WI, concurred: “The most expensive products you can buy are those that don’t work.”

Skin-friendliness

“It’s also important for hand-care products to be skin- friendly,” observed Thompson. “If users don’t like a product, they won’t use it; so, look for a formulation acceptable to most users.”

Thompson also advised HCWs to use waterless hand rubs, such as Ecolab’s Endure 320 alcohol gel, that have emollients built in. “HCWs may have to wash their hands or rub their hands with a waterless product 40 to 50 times per day. Their hands can become dry and cracked, which hurts. Dry, cracked, bleeding hands are vulnerable to infection, and the bacteria they harbor can be difficult to eradicate. A hand-rub product that leaves an emollient behind not only can kill bacteria, it can preserve the integrity of the skin. The Endure line encompasses the entire spectrum of hand care: soap, alcohol-based hand rubs, surgical scrubs, and lotion, which are formulated to work well together. SkinSynergy is the basis for the Endure line. It’s a patented system used to formulate a family of products. The combination of products works as good, if not better, together than each component does separately.”

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It’s hard to know exactly what happened in this nursing home, to warrant the action it got from the state. Reading this article, the place sounds like a typical home. There must be a lot more to it though.

CLEMMONS, N.C. — A nursing home where state inspectors found patient care problems can’t admit new patients and the state recommended that Medicare and Medicaid payments be cut off if the problems aren’t fixed.

Inspectors visiting Clemmons Nursing and Rehab Center for a five-day inspection said three residents failed to get proper toilet care, the call system for patients to summon emergency help was inadequate and a patient who wandered to others’ rooms wasn’t supervised.

“The documented violations indicate that conditions in the facility are found to be detrimental to the health and safety of the residents,” according to a letter sent Nov. 9 from the state Department of Health and Human Services to the 120-bed home.

Of the 79 patients in the home Nov. 5, the state said 65 received Medicare or Medicaid.

Department spokesman Jim Jones said the state will work with county officials to find beds if necessary. Nearly 400 nursing homes are licensed by the state.

Frank Littriello, who owns the home, said he has submitted a correction plan and that the home should be in compliance by the end of the month. Jones said the plan had been approved and federal payments can continue if the home passes its next inspection

“It is not a catastrophic situation,” Littriello said. “We will get through this.”

State officials have received 163 complaints about the home in the last two years, and 64 complaints were substantiated.

We have all heard stories about healthcare facilities phasing out LPN/LVN’s…I have yet to find an actual article about this, until today:

All 90 licensed practical nursing jobs at Mercy and Unity hospitals in the northern suburbs are being eliminated by next year, drawing criticism from unions that say the move is based more on saving money than improving quality.

The Coon Rapids and Fridley hospitals, which operate as one business, said the move to remove the licensed practical nurses (LPNs) was part of a plan to put more care-giving directly in the hands of the more highly trained registered nurses (RNs).

“By the time people are hospitalized, they are much sicker and have more complex health issues,” said Gloria O’Connell, a spokeswoman for the hospitals. “In response to this, over the past four years we have made many changes in how we provide care to our patients.”

The Minnesota Nurses Association (MNA), which represents registered nurses at Mercy, said it sees no evidence that its members will have the staffing or the support help that they will need once the LPNs are gone.

“They have slashed and burned at the bedside the number of people that are going to be available to give or support nursing care,” said Linda Slattengren, MNA president.

LPNs typically receive one year of training, compared with at least two years for registered nurses. The demand for LPNs has been greatest at nursing homes and home health care agencies, while employment at hospitals has been declining.

In 2004, there were 574 LPNs employed by the six large hospital systems in the metro area; 10 years ago there were nearly twice as many, according to the Minnesota Hospital Association.

Mercy and Unity told the LPNs last year about the change. Since then, several have left or used hospital scholarships to get training to become registered nurses. The phaseout will be completed by June.

“We are really not quite sure why the decision was made,” said Kathy Kapla, a union official with Council 65 of the American Federation of State, County and Municipal Employees, which represents the Mercy LPNs.

“It is definitely cost-effective to have a licensed practical nurse. They work in a partnership together with a registered nurse as a team,” she said. In Minnesota, average hourly wages for RNs are about $10 higher.

Slattengren of the MNA said that union is concerned about nursing support services within the hospitals owned by Allina Hospitals & Clinics, the parent company of Mercy, Unity, United in St. Paul and Abbott Northwestern in Minneapolis, as well as smaller hospitals in the state.

Slattengren, who is a registered nurse at United, said the Allina hospitals were setting staffing levels using rigid formulas tied to the number of patients, rather than basing staffing on how sick the patients are.

“It is direct cuts to the patient care units,” she said. “At Allina, we raised that this has been done without input from the registered nurses.”

O’Connell, the Mercy-Unity spokeswoman, said it was not possible to provide an exact breakdown of the type and number of employees who are replacing the duties previously performed by the LPNs. But she said that 140 registered nurses have been added over the past four years.

She added that LPNs are being offered positions throughout the Allina system.

“They have been essential members of the patient care team,” O’Connell said. “We look forward to continuing to work with them in other parts of our organization.”

New blood within some nursing homes is SO NEEDED. Especailly when the place has been managed by the same people, and even more of those people are of the OLD SCHOOL thinking.

PEKIN — The new owners of a Pekin nursing home are implementing numerous fundamental changes with the goal of not only complying with state regulations but going far above and beyond them.

“We feel we’ve made a lot of progress in just a short time,” said Amy Chiotti, new administrator of Timbercreek Rehabilitation & Health Care Center, 2220 State St.

Families have commented that they are noticing that staff morale has improved and that residents are happier, she said.

Chiotti’s nursing home is the former Pekin Living & Rehabilitation Center, which came under new ownership last month. It is now owned by Peoria-based Petersen Health Care.

Chiotti is a transitional administrator overseeing the changes and improvements at Timbercreek. When her tasks are complete, she will become regional marketing director for Petersen.

Timbercreek has 113 residents and a staff of more than 110, giving the home a ratio that is close to one staff member per resident. Their license allows them to have up to 202 beds, but with recent remodeling and reorganization, they now have only about 150 beds.

According to Doug Currier, Petersen Health Care’s director of development, in the last five years, Petersen Health Care has expanded from nine to 51 nursing homes and health care facilities in Illinois. It is now the state’s largest senior health care provider.

The company doubled in size this fall, acquiring 24 facilities on Oct. 1, including two nursing homes in Tazewell County: Pekin’s Timbercreek and East Peoria’s Fondulac Woods Health Care Center, now Fondulac Rehabilitation & Health Care Center.

Just five days after Pekin Living & Rehab’s change of ownership, the Illinois Department of Public Health announced a $55,000 fine on the facility for violations that led to the abuse or neglect of two residents.

The facility’s violations had fatal consequences or one of the residents, Lloyd Berkley, 74, who allegedly fell and suffered an acute subdural hematoma on July 4 while he was under the care of a woman who was acting without legal authorization as a registered nurse.

At a Sept. 8 inquest, Berkley’s death was ruled a homicide, and his death remains under investigation by the Tazewell County State’s Attorney’s Office.

“We knew the history of the place, and we went in with a goal,” Currier said. “One of the most valuable things that we can bring to the table has been our 30 years of experience in providing care to those in need,” he said.

Chiotti said she first became familiar with Petersen Health Care through past involvement in a nursing home residents’ rights group.

“Petersen has a really good reputation for turning things around in nursing homes, and I’d seen that in action,” she said.

The nursing home was given “a new name, to show a new start,” Currier said.

Petersen has already implemented several key changes at Timbercreek, including the hiring of new management to make necessary changes in how things are done in home, he said.

Currier also said that Timbercreek has also made a renewed committing to caring. The good care that the staff provided in the past was overshadowed by the bad publicity from the regulatory violations.

Read the rest of this article—>

A couple articles about Alzhiemer’s…

Test May Detect Alzheimer’s Earlier
An experimental test is allowing scientists to spot signs of Alzheimer’s disease in people with early dementia and even a few who don’t yet have memory problems, university researchers said.

Those findings were announced Tuesday by researchers from Washington University in St. Louis and the University of Pittsburgh.

Researcher Anne Fagan Niven with Washington University said the test to spot Alzheimer’s earlier is expected to undergo many improvements before it will become available in doctors’ offices. But, she said, researchers are moving forward in their efforts to detect Alzheimer’s disease before brain cells start to die.

Statins may delay effects of Alzheimer’s
Cholesterol-lowering drugs may help to delay the progression of Alzheimer’s disease, the leading cause of dementia in the elderly, French scientists said on Thursday.

In a three-year study involving 342 Alzheimer’s patients, they found that the illness did not develop as quickly in sufferers with high cholesterol levels who were given statins as in patients not taking the drugs.

Professor Florence Pasquier, of the University Hospital in Lille, France, said the drugs “may slow cognitive decline in Alzheimer’s disease and have a neuroprotective effect.”

Nearly 130 patients in the study had high cholesterol levels. About half were given statins while the remainder did not receive any treatment.

The findings, which are reported in the Journal of Neurology Neurosurgery and Psychiatry, support the results of other human and animal studies which have suggested that high cholesterol levels may play a role in the progression of Alzheimer’s.

Didn’t we already know this?

Taking vitamin D supplements may reduce the risk of falls in elderly people in residential care facilities, results of a study published in the Journal of the American Geriatrics Society suggest.

In the study, Australian researchers examined the effect of vitamin D supplementation in 625 residents of 149 residential care facilities. The subjects were not vitamin D deficient.

The participants were randomly assigned to receive vitamin D supplements or inactive “placebo” for 2 years. All of the residents were prescribed 600 mg of calcium daily. Care staff recorded falls and fractures in diaries. At the start of the study, patient characteristics were similar in both groups.

The researchers report that vitamin D use cut the risk of falls by 27 percent to 37 percent compared with placebo.

“This study supports the use of vitamin D supplements in older people in residential care,” lead author Dr. Leon Flicker, of the University of Western Australia, and colleagues note. “The demonstrated benefits in this study on the rates of falls for individuals with marginal vitamin D levels, even without…vitamin D deficiency, highlights the potential benefits of vitamin D supplementation in this population.”

SOURCE: Journal of the American Geriatrics Society, November 2005.