Archive for the 'Educational' Category

“The Best Friends Approach To Alzheimer’s Care” — it is one of the best books out there on caring for people with Alzheimer’s Disease. I have personally read the book many times and continue to read it now and again. It is a set of ideas and practices facilities can adopt to make serious and profound changes in culture. The book is up for review at Provider this month.

Article/PDF

In order to care for their residents, staff members in a dementia wing need to learn and periodically be reminded of the difference between normal aging and dementia-related changes.

Very true, and this book offers lots of educational articles on this subject. In plain language.

One of the things I like most about this book is the chapters on utilizing ALL nursing facility staff to engage residents in activities.

The activity department must be considered a staff group that supplements the activity-focused care provided by other departments.
All team members can be trained in reminiscing techniques using events that happened long ago, sensory stimulation such as massaging the hands or scalp, discussions of smells in their environment, reading a story, or normalization tasks like sorting silverware, folding towels, addressing envelopes, winding yarn, and organizing drawers.

Person centered care is the other hallmark of this book:

The person-centered care approach gives personal attention to the people who live in seniors housing and empowers staff members to be resident advocates. A caregiver’s knowledge of each resident’s pre-dementia story is essential to be able to gain the attention of that resident quickly when his or her behavior needs to be redirected.

Finally, an Alzheimer’s Disease Bill of Rights:

According to “The Best Friends Approach to Alzheimer’s Care,” every person diagnosed with Alzheimer’s disease or a related disorder deserves the following rights:
■ To be informed of one’s diagnosis;
■ To have appropriate, ongoing medical care;
■ To be productive in work and play for as long as possible;
■ To be treated like an adult, not like a child;
■ To have expressed feelings taken seriously;
■ To be free from psychotropic medications, if possible;
■ To live in a safe, structured, and predictable environment;
■ To enjoy meaningful activities that fill each day;
■ To be outdoors on a regular basis;
■ To have physical contact, including hugging, caressing, and hand-holding;
■ To be with individuals who know one’s life story, including cultural and religious traditions; and
■ To be cared for by individuals who are well trained in dementia care.
Source: “The Best Friends Approach To Alzheimer’s Care,” Virginia Bell and David Troxel, Health Profession Press, 1997, www.bestfriendsapproach.com

I highly recommend the book even if it was published several years ago. Get the book HERE.

The Direct Care Alliance is seeking a few good people to attend it’s annual Voices Institute Workshop.

The Institute is accepting applications until April 31.

From the VI Brochure: (PDF)

The Voices Institute workshops are intensive, week-long retreats that help direct care workers develop their leadership and advocacy skills.
Attendees learn about advocacy, fundraising, organizational development, message development, and more.
Graduates become bolder and savvier, more confident, and more active in advocating for themselves and their profession. Our 2008 graduates are already changing the world by:

Testifying before lawmakers
Building relationships with legislators to raise their awareness of direct care worker issues
Putting on conferences for their worker associations
Writing letters to government officials to request better wages and working conditions
Raising funds and building membership for their worker associations
Speaking at conferences and other public events
Each year, more Voices Institute graduates will provide their critical perspective to the movement to improve direct care jobs.

More: PDF

This week-long workshop provides an intensive, in-person leadership development experience to a select group of direct care workers from worker associations and coalitions around the country, providing them with the skills and support they need to be effective leaders.

The 2009 National Leadership Training is being held from September 27 to October 3 at a retreat center in Racine Wisconsin, near the Milwaukee airport.

All travel, meal, and lodging expenses will be covered by the DCA. In addition, an $80 daily stipend will be paid to all attendees who qualify. However, attendees will need to contribute a $300 participation fee. We will help the people accepted into the program raise their participation fees.

Candidates must meet the following criteria:
1. Employed as a direct care worker (certified nurse aides (CNAs), home health aides, direct support professionals, personal care attendants, private duty aides, geriatric aides, and other frontline workers).
2. Recommended and/or nominated by their direct care worker association or workforce
coalition. Preference will be given to workers in leadership positions.
3. Demonstrate commitment to active involvement in an advocacy campaign at the state or
national level and coordination with DCA’s National Advocacy Director.
4. Have access to computer and e-mail.

If you’re interested, apply ONLINE HERE, or download this form and mail it to the DCA. I am tentatively planning to attend and would love to meet some of you there! For some ideas about what to expect, a couple Direct Care Workers have posted their experiences HERE and HERE.

As the saying goes: Let’s roll!

Provider Magazine features an article (PDF) about how an assisted living facility in Nebraska has made good use of the Nebraska Health Care Association’s Learning Center. This is an innovative program.

From Provider: PDF

Attracting and retaining well-trained long term care professionals can be particularly difficult for nursing facilities in rural settings, but that hasn’t kept Good Samaritan at Pineview from luring staff to its remote community of Valentine, Neb.—just nine miles from the South Dakota border and nearly 300 miles from Lincoln.
[...]
The learning center was created in 2003 by the Long Term Care Workforce Institute in an effort to attract better candidates and offer standardized education for Nebraska long term care professionals.

One of the driving forces behind the center was Nebraska Health Care Association (NHCA) Executive Director Pat Snyder, who worked with September Stone, RN, to get the center off the ground.
“Ms. Snyder identified a significant need for educational excellence in long term care and believes standardized high-level education can have a major impact on the residents served in long term care,” says Stone, who is administrator of the learning center.

The goal of the learning center, which is now considered a post-secondary career school licensed and accredited by the state’s department of education, is to promote growth and leadership through education for the long term care setting. In addition to offering classes in Lincoln, the center contracts
with nursing facilities and assisted living communities throughout the state so they can hire instructors and offer courses. With seven training sites across Nebraska offering classes periodically, the center has graduated more than 800 students to work in long term care.

From the LTCWIN site:

Mission Statement
The goal of the Nebraska Health Care Learning Center is to promote growth and leadership through education for the long term care setting. Nebraska Health Care Association/Nebraska Assisted Living Association (NHCA /NALA) and Long Term Care Workforce Institute of Nebraska (LTCWIN) work closely together to provide essential educational opportunities throughout Nebraska in long term care fields.

Of specific interest to Nebraska CNA’s:

Basic Nursing Assistant
6.5 Quarter credit hours
This program is designed to train the beginning nursing assistant (NA) to provide safe, effective, and caring services to the patients of any health care setting. It is designed to meet the training requirements of both federal and Nebraska laws for nursing assistants working in a licensed nursing facility. The skills and knowledge contained in this material can be adapted for any health care or residential setting.
Employment settings: nursing facilities; assisted living, home health, hospitals, ICF-MR.

And:

Medication Aide
4.0 Quarter credit hours
This program is designed to prepare the participant to meet the requirements of the Medication Aide Act and to assume the role and responsibilities of a Medication Aide. The training is intended for the Medication Aide in an assisted living facility, nursing facility, or intermediate care facility for the mentally retarded. It may also be used to train Medication Aides in other settings.

Excellent! Now if we could only have such programs available in ALL states.

A week or so ago I wrote an endorsement for Just4CNA’s- an online CE web site for CNA’s. Since then, I received a sample of hard copy Inservices (as a “thank you”) and I AM IMPRESSED.

The materials came in a binder, all labeled and ready for use. I got 3 inservice packages neatly organized into plastic separators. Instructor pages which include handouts, quizzes and more are included. This is a quality product. Upon further exploration, I found that Just4CNA’s parent company, In The Know, has a blog about the different topics and offerings. A couple relevant postings MUST be read by Staff Educators, DON’s and CNA Instructors.

7 Tips for Giving Great Inservices to Your Nursing Assistants

Have you ever gathered your nursing assistants for an inservice meeting and found yourself staring at a bunch of tired, dull-eyed and disinterested people? Wouldn’t you rather be greeted by excited, eager to learn employees? Try implementing these 7 tips to freshen up your CNA inservice training…

Please go read the article to find out what these 7 tips are! This is very useful information…and trust me, as I working CNA, I know what it’s like to sit through a boring and dull “meeting”…even when it’s about something important, even though I really like to learn.

Another great post:
Rewarding Positive Behavior

One way to empower your nursing assistants is to reward positive behavior. Obviously, positive behavior is more than just getting to work on time and performing an assignment. As you go through your day, look for all the little ways in which your aides are growing–both as employees and as people. For example, be sure to praise your employees when they:

Set a good example for others.

Ask to join committees.

Ask for help when they need it.

Share their knowledge with others.

Approach their work creatively.

Come to work/meetings on time.

Are willing to stay late.

Set goals for themselves.

Listen to others.

Give help to others when asked.

Other articles include topics such as CNA of The Quarter, Tips for Picking a CNA Inservice Provider, and right now there’s an offering of a FREE INSERVICE about Domestic Violence (in reaction to the recent nursing home shooting where a CNA was a victim of DV and her estranged husband went on the killing rampage).

I highly recommend In The Know and Just4CNA’s for all your inservice needs- whether facility based or individual CNAs. THIS IS NOT A PAID ENDORSEMENT. IT IS A PERSONAL one!

Contact Linda Leekly with questions and thoughts.

I received an email notifying us of a brand new continuing education web site for CNA’s…literally it’s Just For CNA’s.

In The Know manages this venture, which offers many opportunities for CNA’s to get CE credits at a reasonable cost. This is very important since the state survey processes will be looking more closely at employee records for just this.

Here’s just a few of the titles of the educational modules:
Feeding Your Clients
The Importance of Activity for the Elderly
Using Assistive Devices
Performing Mouth Care
Working With Difficult & Combative People
Understanding Drug-Resistant Bacteria
Understanding Advance Directives
Taking Care of Your Back

There are many more. CNA’s can download these in services, read and study the materials provided then go online and take a quiz. After this, CNA’s are taken to a page that will show them their score and the correct answers to any that were wrong. At this point, a Certificate of Completion is available for download. CNA’s will need this to prove you took the in service.

Each module cost 9.95 and can paid for with a credit card, ECheck or Pay Pal. I think this makes it much more accessible to CNA’s- using ECheck or Pay Pal!

I’ve used Pay Pal for many online purchases and it’s easy to set up an account with them. You deposit funds into an account there as you wish- then the money is available when you need it. It’s just like cash.

Over at Long Term Living, resident blogger Kathleen Mears writes a very timely and important post about the modern training of CNA’s. This article is one that I believe every aide should read. It’s that good.

Just one section, which is VERY pertinent:

I have found that some people are easier to train as aides. Those who are very perceptive do not need to be drilled. But I wonder if nurses’ aide trainers now have realized that some of their trainees do not possess the social skills that most of us learned growing up. With single-parent families and families with two working parents, it is probably more difficult to teach social skills. Also acceptable social behavior has to be taught at home and reinforced in the schools.

Some younger nurses’ aides have not learned these social skills. Today we live in a casual society where we are not required to dress appropriately for very many of life’s events. Schools do not usually have dress codes. Years ago, aides were required to wear specific uniforms usually pressed to perfection. Like nurses, their hair had to be off their collar and their nails had to be kept short. Today’s rules now are not nearly as stringent, or aides reject them soon after training. The common sense rule of a clean and relatively wrinkle free uniform is important. Many aides have nails that are too long. Artificial nails are fine if they are kept at an active or sport length.

A recent article stated that most young people would benefit from reading a Miss Manners’ book. That same idea would be helpful for nurses’ aide trainees. Knowing etiquette and using proper manners make life easier. It is never too late to learn what is proper in order to feel comfortable in most situations.

PLEASE read the whole thing; whether you’re an aide or one who trains them, a DON, a nurse…I know a lot of this will ring some bells! Leave Kathy a comment, too- share your thoughts on this with her.

Did you know your scrubs probably harbor more germs than you’re hands???

You see them everywhere — nurses, doctors and medical technicians in scrubs or lab coats. They shop in them, take buses and trains in them, go to restaurants in them, and wear them home. What you can’t see on these garments are the bacteria that could kill you.

Dirty scrubs spread bacteria to patients in the hospital and allow hospital superbugs to escape into public places such as restaurants. Some hospitals now prohibit wearing scrubs outside the building, partly in response to the rapid increase in an infection called “C. diff.” A national hospital survey released last November warns that Clostridium difficile (C. diff) infections are sickening nearly half a million people a year in the U.S., more than six times previous estimates.

Ewww. I wear my scrubs to work, ONLY. I go directly home after my shifts, and remove them, shower, and re-dress.

The problem is that some medical personnel wear the same unlaundered uniforms to work day after day. They start their shift already carrying germs such as C.diff, drug-resistant enterococcus or staphylococcus.

Really? I don’t know anyone who wears dirty uniforms to work…at least I don’t THINK I know anyone.

Do unclean uniforms endanger patients? Absolutely. Health-care workers habitually touch their own uniforms. Studies confirm that the more bacteria found on surfaces touched often by doctors and nurses, the higher the risk that these bacteria will be carried to the patient and cause infection.

That’s a no brainer.

So what to do??

Until about 20 years ago, nearly all hospitals laundered scrubs for their staff. A few hospitals are returning to that policy. St. Mary’s Health Center in St. Louis, Mo., reduced infections after cesarean births by more than 50% by giving all caregivers hospital-laundered scrubs, as well as requiring them to wear two layers of gloves. Monroe Hospital in Bloomington, Ind., which has a near-zero rate of hospital-acquired infections, provides laundered scrubs for all staff and prohibits them from wearing scrubs outside the building. Stamford Hospital in Connecticut recently banned wearing scrubs outside the hospital.

When I first began working in healthcare, I remember the hospital DID indeed wash the SCRUBS- but not the required white UNIFORMS- which we all purchased and maintained on our own. This was 18 years ago.

Across the pond, a British study found that one-third of medical personnel did not launder their uniforms before coming to work. One British surgeon who specializes in hip and knee replacements reduced postoperative infections by two-thirds at her hospital by protecting patients from contaminated uniforms. Before approaching any patient’s bed, nurses put on disposable, clear plastic aprons that were pulled off rolls like dry cleaning bags. Each one costs a nickel.

A nickel is certainly a small price to pay to prevent an infection.

And that old standby- washing our hands- would most likely curb the spread of infection 95% of the time- if we complied 100% of the time.

Does your employer launder your scrubs? Or offer gowns to wear at each patient-care session?

Parts 1-4.

The experience of aging:

Along with 15 colleagues and a reporter, Mrs. Ramirez, a social worker at the facility, put on distorting glasses to blur her vision; stuffed cotton balls in her ears to reduce her hearing, and in her nose to dampen her sense of smell; and put on latex gloves with adhesive bands around the knuckles to impede her manual dexterity. Everyone put kernels of corn in their shoes to approximate the aches that come from losing fatty tissue.

They had become, in other words, virtual members of the 5.3 million Americans age 85 and older, the nation’s fastest-growing age group — the people the staff at the facility work with every day.

Read the article and learn some empathy. Nursing Assistant Educators and others (DON’s…Staff Development Leaders) might want to consider making some of these exercises a part of the CNA Training/Orientation process.

Wheelchairs. It seems like they are everywhere we go within the walls of so many nursing homes. Many believe they are a needed, if not required, piece of equipment. For some residents, the wheelchair is their ticket to independence. For most though, it’s a one way street to declines in almost every aspect of life. How many residents do we see slumped over in these chairs, belted in, reclined or otherwise forced to stay in them? Do we see the connection between wheelchair use and physical decline?

I can attest to this over dependence on wheelchairs. It starts out innocently enough- the aides are working short (again) and meals are being served. Time is short. Residents walk slowly. It’s easier to just pop them into a wheelchair and push them to the dining room. Or to the bathroom. Or to the activity room…and so on. Soon, the resident begins losing their confidence and desire to walk themselves. Perhaps they’ve had a fall and we are nervous to let them walk again…whatever, it’s insidious and sneaky- this overuse of chairs.

Provider Magazine has an excellent article (PDF) about wheelchair use, or more like, abuse. The article stresses that nursing home culture includes having so many residents sitting in these chairs that it’s almost expected. The article highlights one facility that decided to end the abuse, and how the residents have benefited. The Administrator started this process and walks readers through the steps she took to go “wheelchair free”…

WHEN FOREST AT DUKE, A continuing care retirement community in Durham, N.C., began planning its renovation and expansion, Leslie Jarema, administrator and director of health services, seized the opportunity to dramatically reduce wheelchair use in the community. “My many years in nursing home environments convinced me that wheelchairs created the discomfort that resulted in many negative outcomes and behaviors of residents,” says Jarema.

She has a tough policy:

Jarema instituted a new policy that limits the use of wheelchairs to two purposes: to enable a resident to be independent in ambulation or to transport a resident from point A to point B.

So, even the common “Walk-to-Dine” programs aren’t acceptable here, it seems. This isn’t a bad thing.

And what happened?

For the residents of Forest at Duke, the outcome of the wheelchair policy was nothing but positive, Jarema says. Dignity, comfort, improved skin condition, and residents’ range of motion were improved. “But there are some less obvious, more subtle outcomes,” she says. For example, the feel of the home became quieter, calmer, and more visually appealing. “The new program has totally eliminated the residents who typically sit around the nursing station crying out in discomfort.”

Jarema admits that the new policy meant more work for staff, who at first put up some resistance. “Even families and some residents resisted the initiative,” she says. “But one
must be committed and convinced that this change is for the better. Perseverance, persistence, and patience go a long way in achieving this highest level of functioning for our residents by getting them out of wheelchairs.”

A few reasons to re-consider the over-use of wheelchairs:

Over the years, the image of someone who resides in a nursing facility has become synonymous with an elderly person seated in a wheelchair. According to a study in the Journal of Rehabilitation Research and Development, wheelchairs provided to the elderly are often the wrong size, are in poor repair, are unsafe, and have fixed armrests and foot rests—factors that could lead to “poor posture, pain and discomfort, decreased sitting tolerance and function, decreased mobility, and pressure ulcers.” The authors conclude that psychological factors associated with “inadequate or inappropriate mobility devices” include loss of self-esteem, depression, diminished quality of life, and social isolation.

Does your facility abuse the use of wheelchairs? Are residents transported and then kept in the chairs as a means of convenience? Do you think it could be better to go to a policy such as highlighted in the article? What steps can CNA’s take to prevent this dependence upon wheelchairs? And who is more dependent: The resident or the CNA?