Spot Light: Culture Change and Break Rooms

One of the things so many people like about the Culture Change movement is the upside down chain of command structure. Residents call the shots; next the CNAs have this “power”. Nursing homes that are seeking to change their culture often do a lot of window dressing but actually change very little of the management and leadership culture. Fear is the reason for this.

When a facility is looking to really change, actions do speak very loud. Pioneer Network has been working tirelessly to assist nursing homes and assisted living facilities with culture change. Matt over at Setting The Nursing Home On Fire found this gem of an article at the Pioneer site:

Low Cost Practical Strategies to Transform Nursing Facilities

it is a pdf report.

One of the things I noted quickly was the attention to the staff break room. When the staff are respected and trusted, it shows in many ways. Having a retreat style break room is a viable and cheap idea most nursing homes could manage. With the right motivational leadership, the nurses and aides would be more than willing to assist with creating this room.

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Staff Amenities
Overall Goal:
Routinely staff members have been assigned break room space in the basement of a facility that is
furnished with cast offs, has equipment and appliances that often malfunction, and space that is expected to serve the dual purpose for staff who want to socialize as well as those who want a quiet time. Reverse this trend and provide staff with an abundance of spaces including tables in main dining room, a computer station and quiet space for reading or meditation.


Examples of Improvement Strategies:
• Enhance the staff break room. It should have good lighting, comfortable chairs, conversation arrangements, appliances that work, flat surfaces for both eating and writing and a quiet corner

• Provide computer area or computer station for private staff use

• Designate a table and regular day as “give-away or exchange” where children’s clothes, extra produce from gardens, reading material, videos, and other items can be exchanged or given away

• Provide prayer corner or small meditation room designated for staff

• Encourage staff to use lounge or dining spaces to hold baby or wedding showers or other celebratory events. Invite residents to participate along with members of the community

A big bulletin board might be the only resemblance to the “old” break room.

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Wow. Comfortable chairs and seating arrangements that mirror a living room more than a waiting room? Why not? When respected, staff deserve such spaces. Most of the furnishings for such spaces can be purchased cheaply through group purchasing associations, trade group memberships and, the old fashioned way- yard sales and thrift shops.

Another GREAT source of help is the resident families. I am quite sure most would donate a chair or small table; an area rug and some table lamps. The residents themselves could make wall quilts and other artwork. Bookcases and ottomans (YES- so the tired feet of CNA’s have a place to rest UP on);
everyone has a book or two they would be willing to give to the new staff LIBRARY located in the break room (same with DVD’s and the TV/Player to go with it).

Think outside the lead box. A transformation can happen within a week if it is truly wanted. Under the culture change movement every room has significance and front line staff have much more value and respect.

Spot Light: Face, Hands & Butts?

Much of the work we do is aimed at keeping our residents clean, dry, fed, toileted and hydrated. We focus on these things because it is OUR job. There are other things though, that often get lost in the daily shuffle. I work for an agency as a part time job (as well as a full time job at a rehab facility) and through my experiences here, I’ve seen a lot of rushed care and the results of it.

When working short, there’s a saying among aides: Face, Hands and Butts. FHB. This means that our time should be spent washing faces, hands and butts and the rest can go unattended. This isn’t ideal but it is the reality when we’re pressed for time.

Even when our units are well staffed I have seen some pretty poor quality cares that leave me wondering if some of us cannot put ourselves in our residents’ shoes…

No matter how short staffed, we must always consider resident dignity.

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Complete bed baths, whirlpools and showers can be postponed.

Washing faces doesn’t mean simply wetting a wash cloth and wiping it over a face. It means using gentle soaps/cleansers. It means using another wash cloth dampened with water, to rinse off the soap. It means paying close attention to the eye areas, removing the residue and drainage we often see. It means making sure noses are clean and the area around mouths is clean as well. Shave the men.

Oral care MUST always happen- how would YOU feel if your teeth weren’t brushed???

Care must be given to underarms. They need to be washed, rinsed, dried. If needed, a light coat of deodorant is called for. Body odor is a major dignity issue for our residents.

Hands have to be washed. Period. Several times each shift. Nail care can wait, unless they are long and ragged or dirty.

Incontinent care has to happen. Buts and other areas MUST be cleaned. Period. No skimping here.

I can’t count the times I have witnessed residents being brought out with messy hair, or worse, with hair dos that are not becoming to them. Ladies like to look presentable. Imagine how you would feel with greasy, slicked back hair…it’s up to US to make hair look nice. Hair should be combed/brushed no matter what; if ladies’ hair is permed, a little spritz with some water often works wonders to bring back some curl.

Clothing choices? It usually doesn’t matter when it comes to staffing issues. Residents have clothes and we assist them with dressing. BUT what does matter is matching colors at best and avoiding clashes at worst: Striped shirts do not go with plaid pants! Just like an elegant fluffy blouse doesn’t go with sweatpants. Some of our male residents prefer to wear t shirts under their tops; and MOST of our ladies like to wear bras. Don’t skimp on this.

A quick note about briefs: For the residents who use them, we have to ensure they are correctly applied. The right size is paramount. Too big a brief is not only wasteful but a major cause of discomfort. Small briefs often lead to nasty red marks in the groin areas. Make sure the brief is centered, and the front portions are pulled up enough to allow for movement. Don’t let the brief bunch up anywhere.

Residents who use wheelchairs need special attention for comfort AND skin issues. This is a no brainer but I have seen countless times, bunched up shirts in the back and sides. Pants that are wedged up in front. We need to make sure these things don’t happen. Take the time to pull down tops once a resident is positioned in their W/C; fix the wedgies and pull down the lower parts of pants. Make sure the resident is seated properly and is comfortable.

As much as most of us don’t like providing less than ideal care, we can do so on shifts where we just don’t have time. Assignments are often increased with two or three residents when there’s been a call out. Always check with the charge nurse about your priorities when staffing is an issue. Better yet, ask the nurse for a meeting with all the aides on the shift, to plan ahead for those times.

Always consider safety, comfort and dignity. Some will say not always in that order, either.

SPOT LIGHT: 7 Tips To Deal Effectively With Difficult Residents

We’ve all been assigned to cranky, demanding rude residents/patients. You know them: Mean, belittling people who have elevated themselves above all others in level of need. Not just pillow fluffers, these residents demand strict attention to minute details not because the attention is necessary but because the resident believes they are entitled to it. Resident families can be just as hard to work with. I’m not sure who is worse: The demanding resident or the demanding family member. Regardless, here are 7 tips on working effectively with the Mrs. Cranky’s of the world:

Check on the demanding resident 1st thing: Once you know you’re assigned to Mrs. Cranky, go to her room and check with her right away. Let her know you’re her aide.

Ask her if she has any special requests for today: Perhaps she wants her bath later in the morning; or she isn’t feeling well and would like to skip breakfast. Or maybe she has guests coming and would like to wear the hard-to-don red dress. By asking her what her plans are for the day, you are giving her a real say in how her day will go. Based upon her feedback, schedule your workflow to accommodate Mrs. Cranky’s needs. This does not mean you neglect your other residents.

It is perfectly acceptable to let Mrs. Cranky know that your other assigned residents have the same needs as she does. Make it clear that you are responsible to others and that you cannot cut back on time they need. You can say all this in a polite, professional and caring manner. Even further, I would let Mrs. Cranky know the order in which you will tend to her care. Give APPROXIMATE time frames. By doing this, you are alerting her that you hold your other residents’ needs just as high as hers.

Unless she is your first resident, check in with Mrs. cranky every so often. Anticipate her needs. Use your knowledge of her demands as a tool: If you know she usually rings the bell at 10am for bathroom use, be one step ahead of her and show up in her room at 9:55am to see if she needs the toilet…

5) TALK!
When performing actual cares for Mrs. Cranky, listen to her if she speaks. If she is rude or insulting you, let her know that this offends you! Tell her that her words hurt your feelings. By doing this, you put her on notice that you won’t stand for rude remarks and the like. Try to find some common interests to talk about- this shows her that you do have a genuine interest in her. Ask her about pictures she has; ask her where she has traveled in her life; ask her questions about HER LIFE in en effort to show your curiosity. If she answers your questions positively, GOOD! Keep aiming for this positive energy. If she continues to gripe and complain, remain quiet. Don’t ignore her, but ignore the negativity.

If Mrs. Cranky seems upset or angry, while doing her care, ask her if something is bothering or upsetting her. Sometimes people are uptight or nervous about things and take it out on the nearest person. If she expresses sadness let her know she can speak with you about those things and offer to pass on her concerns to others as needed. Let her know she can trust you. If she is angry at her family, offer to speak with the nurse to see about a family meeting. If she is mad at other staff, listen but don’t give any feedback. Give her attention for her positive words and say little about her negative words.

During the shift,after her care is completed, check in with Mrs. Cranky. Again, ANTICIPATE her needs! When you take a break, let her know. By doing this you are letting her know you care about her. At the end of the day, if appropriate, check in with Mrs. Cranky one last time. Ask her if she needs anything. Ask her how she thinks her day went- and what could be done to make it better. When we ask people to help us with planning schedules and work flows, it’s amazing how much feedback we get! It’s always appropriate to say goodbye and other polite remarks.