An interesting article about dysphagia screening and assessment, and the various professions roles in this process:

Hospitals that are credentialed as stroke centers must have a screening tool for dysphagia in place, according to the American Heart Association. Furthermore, the Joint Commission states that a screen for dysphagia should be administered to patients with stroke before they are given “food, fluids and medications by mouth.”1

In compliance with these requirements, some hospitals are introducing a swallow screening procedure designed specifically for nurses. The purpose of the procedure is to enable them to screen newly admitted patients who may be at risk for aspiration and quickly determine if they are safe for oral intake.

And:

It’s important to note that the nurses who perform the screening are not performing swallow evaluations, nor are they replacing speech-language pathologists.

“My job is to perform a comprehensive evaluation on every patient. This [procedure] allows nurses to more accurately determine who needs a full evaluation and who can start their oral intake. An evaluation is far greater than that,” said Audrey Cohen, MS, CCC-SLP, of the Department of Speech, Language and Swallowing at Massachusetts General Hospital (MGH)in Boston.

Training the nurses:

Staff can access a Web-based training module via CD or the hospital Intranet. The module includes background information on the nature of dysphagia, aspiration and oral hygiene. It also differentiates between a swallow screen and a comprehensive evaluation and explains the role of the nurse in caring for patients with dysphagia.

The training module shows a demonstration of how to perform the screening appropriately, with video clips of patients exhibiting normal and abnormal responses. As part of their training, nurses must perform the screening at least five times under the supervision of a speech-language pathologist.

Where CNA’s come into this:

If a swallow evaluation is warranted by an RN, nurse practitioner or physician, the speech-language pathologist establishes the patient’s safest diet level and discusses safe swallowing techniques with nursing. All of the information is placed on a swallowing instruction sheet in a Communication Binder that the departments pass back and forth.

“We write down the patient’s diet level and any safe swallowing strategies that we feel need to be implemented with the patient during the meal,” said Repsher.

In each dining room a trained certified nursing assistant (CNA) is assigned to a supervision table and uses the information on the swallowing instruction sheet to ensure the patients eat safely. The CNA adds specific comments, such as if patients are having difficulty during the meal.

The facility offers dysphagia groups for patients. Speech-language pathologists instruct patients on compensatory strategies and safe swallowing techniques. They assess the safety of the patient’s swallow and increase the diet level as tolerated.

When appropriate, the nursing staff is given a demonstration on how to carry out these instructions.

“We show them what the patient needs to do,” said Repsher. “If the nursing assistant is in the dining room at the same time that we’re at the supervision table, we would instruct the nursing assistant on the strategies the patient needs to use.”

This information is then included in the Communication Binder.

CNA’s are on the forefront of dysphagia. We see it, hear it, watch it happen when we witness coughing, choking, strained swallowing, pocketing of food, slow or incomplete swallows. Our observations are critical to the entire process. It’s very important to share these observations with the nurses or SLP when they ask. Episodes of difficult swallowing or choking must be reported and potential illnesses watched for. The CNA is the vital link in this.

Nursing homes should have a similar plan in place for these issues. “Resident Oral Intake” Guidelines should be set up for each resident who eats.

From California:

LOS ANGELES, April 11 /PRNewswire-USNewswire/ — The California Nurses Association/National Nurses Association today condemned the Service Employees International Union for targeting CNA/NNOC leaders and members with threats and intimidation, stalking them at home and in patient care units at hospitals.

In a statement today, CNA/NNOC — the nation’s largest RN union — demanded SEIU International President Andrew Stern “immediately renounce the actions of SEIU staff and cease and desist these despicable attacks against anyone who speaks out against his pro-corporate agenda.”

“SEIU’s behavior, sending swarms of staff to threaten women in their homes, is especially disgraceful, and another illustration of their contempt for a predominantly female profession that they treat as chattel in so much of their activity, including trying to force RNs into his union,” said CNA/NNOC Executive Director Rose Ann DeMoro.

Roving bands of SEIU staff, four or five at a time, arrived on the doorsteps of at least two CNA/NNOC female Board members in Southern California Thursday, with video cameras to film their abusive exploits.

Is this what we pay dues for?

“Union membership is about collective democracy. Nurses decide they need a union and then choose the union of their choice,” Cuaresma said. “We will continue to give voice on behalf of our patients and we will never be intimidated in our struggle to defend our ratios and our hard-won benefits. Stern should rethink his strategy — he will not intimidate me or the CNA.”

Thursday’s attacks on CNA/NNOC Board members are the latest escalation by the Service Employees Union which has in internal conversations bragged about its intent to “destroy” CNA/NNOC for challenging SEIU’s practices which the RNs say compromise patient safety, erode RN standards and professional practice, and undermine workplace and union democracy.

Also on Thursday, CNA/NNOC obtained a letter from an SEIU staffer who resigned in disgust with the behavior of SEIU International and quoted a top SEIU official bragging of plans “targeting ten to fifteen C.N.A. bargaining units.”

SEIU’s corporate partnerships compromise patient safety

Perhaps the most egregious behavior of SEIU International, says CNA/NNOC are its deals with corporate hospitals and nursing homes, sacrificing patient safety for agreements to help it recruit more SEIU members.

For example, SEIU has signed pacts with nursing home operators in California and Washington state agreeing to lobby for the nursing home chains. Under the 2003 California deal, SEIU agreed to oppose legislation requiring nursing homes to provide enough staff to keep patients safe and healthy, and to not report health care violations to state regulators except when required by law.

Five years later, according to a report cited in the Los Angeles Times this week, despite increased state funding for nursing homes, the direct result of SEIU lobbying, nursing homes are spending less in California on direct patient care, and reports of patient mistreatment have shot up 38%.

Similarly, in partnership with hospital corporations, SEIU lobbied in California against the RN-to-patient minimum ratio law, and worked to erode the law after it was enacted.

Unions should work for the people who pay them to represent them. Not against them. Clearly the SEIU has held the hands of nursing home industry leaders, who have goals that are not in favor of good patient care. We might think unions are a good thing, but we should be careful consumers (that would be me and you!) when it comes to what a union really offers, AND how it operates behind closed doors.

Our very own Patti is interviewed by Elise over at the PHI web site. Go check it out!

Ahoy there! We’ve been very busy this week, WORKING tons of shifts and not having ANY spare time for this site. Next week looks less busy for us so we will resume our regular posting schedules then.

Have a good weekend.

It would seen pretty simple- at work the phone rings as you’re walking by the nurse station. The unit secretary isn’t there. You answer it. You’re polite and take messages, right?
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Check with your supervisors first, but note CPR guild lines are changing.

NEW YORK (AP) - You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim’s chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

“You only have to do two things. Call 911 and push hard and fast on the middle of the person’s chest,” said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

For years I have seen the books and articles titled, 7 Habits of Highly Effective People…so I thought I would come up with a list for CNA’s.

1) She is proactive. Proactive CNA’s use their resourcefulness and initiative to find solutions rather than just reporting problems and waiting for other people to solve them.

2) She has a personal mission statement. This is based upon personal morals and values- and it is almost always used as a stepping stone to make choices and decisions.

3) She knows how to balance her time between residents/patients. The CNA can set priorities based upon residents’ medical needs vs. non-medical wants. She recognizes when a needy resident truly requires some TLC and when something else is going on.

4) She isn’t interested in being in CONTROL. The CNA seeks a win/win relationship with her residents, but realizes this isn’t always possible. She will go out of her way to allow the resident to maintain control with as many choices as possible. The resident’s dignity and individuality is always respected.

5) She listens to her residents. And uses effective communication skills to make sure she understands what is being said. The CNA knows some times a resident doesn’t understand her, so she goes out of her way to make sure she is understood.

6) She works WITH the resident to overcome conflicts and misunderstandings. Instead of being defensive, the CNA will admit to her faults in the problem, and will seek to improve and correct these issues.

7) She knows when to step away. She knows she’s getting burnt out and is in need of a vacation, or a change in assignment.

Do you know other habits of highly effective CNA’s? Please share them in the comments section.