KNOWING THE PATIENT – PERSON CENTERED CARE

Knowing the patient?  We never knew Mabel.

Mabel died today. Minutes later, a nurse hurried down the hall carrying two old books. She stopped and excitedly showed me what the staff found when they cleaned Mabel’s room. She held up books on physics. “Mabel wrote them! Can you believe that? I never knew she wrote anything.”

We had cared for Mabel for six years, but none of our staff knew she had written any books. When she came to us, Mabel was already afflicted with Alzheimer disease. We learned later, after her death, that Mabel had been a prominent physicist.

As I listened to the nurse, I thought. Wouldn’t it have been wonderful if Mabel could have enjoyed our expressions of respect, awe, and admiration? Now it was too late.

That true story isn’t an isolated instance. Too often the nursing home staff learns information about residents from reading the obituaries. The individual life stories never make it to direct care staff, even if it had been told to social workers on admission. The story had been diluted to minimum facts on a fill-in sheet at the back of the chart under the social service tab.

Book excerpt from: Please Get To Know Me – Aging with Dignity and Relevance

In this time of cost cutting, healthcare workers managing more than one job to make ends meet, and the multitude of problems with patients requiring more care, it is hard to get to know the patient.  This book provides the information for anyone, friend or family member to become actively involved in a patient’s care.  When there is a patient and a caregiver involved, it is the family who knows the patient and can provide that bridge between the two.

Click on the picture of the book, on this page, learn how to become part of the team creating person centered care for your love one.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

SHOPPING FOR A NURSING HOME – WHAT DOES PERSON-CENTERED CARE LOOK LIKE?

PART III

Having regular access to the out of doors has been found to be necessary for happy and healthy living.

  • A protected outdoor space, garden or patio where residents can come and go independently.
  • Outdoor garden spaces are provided in raised beds so persons in wheelchairs as well as standing residents can participate in gardening.
  • A safe outdoor walking or wheelchair walkway that is not part of the city landscape.
  • Over head paging is used only in emergency situations.
  • Children are welcomed into the nursing community on a regular schedule
  • Community groups are invited to use space within the home and residents are welcome to join the community events.
  • Home has guest rooms available for residents out of town visitors.
  • Home has a cafe or restaurant on the campus available to residents and visitors.
  • A kitchen is made available to famlies with a refrigerator, stove and sink.
  • Staff are scheduled to work with the same residents on a regular basis.
  • The regular nurse and nursing assistant are included in the quarterly care conference.
  • The staff wear street clothes not uniforms.

While touring a nursing community be aware of how often you are greeted by nursing home staff. Just as when staying at a fine hotel, and employees greet you asking if there is anything they can do for you. A nursing community should display that same feeling of sincere welcome.

Great questions to ask staff as you tour are “how long have you worked here,” and follow up with “what do you enjoy about your job here?”  Happy people will want to tell you all about all of the great things about their job and nursing community. Happy and enthusiastic staff will be the most important item on your checkoff sheet.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SHOPPING FOR A NURSING HOME – WHAT DOES PERSON CENTERED CARE LOOK LIKE?

PART II

What to look for when searching for a person-centered center:(continued)

  • Private rooms – the best choice for person centered living
  • Privacy enhanced rooms – where a resident can access their space without going through the roommate’s space
  • No traditional centrally located nurses stations
  • A personal window looking out to nature – not past another resident’s space
  • Bathroom is wheelchair friendly – sinks are able to roll wheelchair under – mirrors are positioned where a seated person can look in the mirror
  • Bathrooms and entrance doors have adaptive handles
  • Residents and families are welcome to decorate and personalize  their room
  • Extra lighting is available on request
  • Individualized heat and air conditioning controls in every room
  • Individualized refrigerators in residents rooms
  • Workout room is available to residents
  • Bathing rooms have an additional heat source
  • Towels are heated for baths
  • Gift store is on site or a cart is used for personal care products
  • Personal clothing is laundered in the unit where the resident lives – not sent to a whole facility laundry somewhere in the basement

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SHOPPING FOR A NURSING HOME – WHAT DOES PERSON CENTERED CARE LOOK LIKE?

PART I

Hopefully if you have been touring nursing communities, the term person centered care is familiar. Healthcare workers are becoming comfortable with this terminology, yet many would not be able to say just what this looks like. Person centered care can be many things and it would be hard to find one community that is doing everything.

What to look for when searching for a person centered care center:

  • What kind of dining experience do they provide? Restaurant style, (where someone takes your order), buffet style where residents help themselves or staff assist the, family style  where bowls and platters are served on the dining table, 2 hour dining where residents can decide within a 2 hour window when they want to eat, or the 24 hour dining where the kitchen is serving around the clock.
  • Snacks and drinks are available 24 hours a day (and are always free)
  • Baked items are made and baked in kitchen in the resident’s living space
  • The community celebrates individual birthdays as well as a monthly group celebration
  • Special amenities are available such as massage or aromatherapy
  • There is a dog or cat who lives in the community (this is a very important question when there are allergies)
  • Better yet the community allows for the resident to bring their own cat or dog to live in the community
  • Residents are able to make choices: when to get up in the morning, when to go to bed, when to take a shower or bath, and are able to bathe as often as they would like
  • Living areas include a kitchen, dining area, and living room – a self contained household
  • No centralized nurses station – a person centered community looks like a home and no home has a nurses station

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

PERSON CENTERED CAREGIVING, MEANS HAVING A RELATIONSHIP

Person centered care means not only knowing an elderly person you are taking care of but knowing them so well that you have a relationship. When two people are in a relationship they know so many small things about the other. What are the elder’s favorite foods, drinks, as well as what does she really dislike. What are her favorite activities and what activities can she live without. Who are her favorite people and having easy access to these people so that you can always reach them for her.

Person centered care-giving means the control, is always with the elder. Having control, means giving the elder choices all day long. At every interaction, whether choosing what to wear in the morning, what to have for breakfast or where to go for a walk. Letting the elder know that you take their concerns first over any chore or task you need to do.

Knowing the elder’s usual routine, is she an early riser or likes to sleep in, makes all the difference. I took care of Carl who was difficult to say the least. He seemed to wake up grumpy and stayed that way all day. I was just about ready to give up, when his daughter shared that her mother had brought Carl a cup of coffee in bed every morning all their married life. Knowing this was the definition of, person centered care for Carl.

Bringing Carl his cup of coffee in bed made all the difference to him. This now was his routine, and he started the day happy, gone was grumpy Carl. The family is always the bridge between the elder and the caregiver. The family knows those seemingly small things that make up person centered care, that don’t turn out to be small at all.

Letting someone know that they are more important, and spending time with them is more important than any chore, is empowering to the elder. It puts me in mind of a poem found on stitched samplers and framed in babe’s rooms. It starts out “cleaning and scrubbing can wait till tomorrow – quiet down cobwebs, dust go to sleep”, (my tweak) Grandma needs me now and Grandma won’t keep.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

5 CRITICAL AREAS OF DEMENTIA CARE

Dementia care involves first and foremost, providing for the safety of the person with dementia. One of the major symptoms of dementia, is the loss of safety awareness. Hand in hand with that, is the loss of the ability to reason, or think your way out of a situation. A real problem, if the situation is dangerous.

Added to providing for safety, is having good dementia communication, knowing what a happy environment looks like for someone with dementia, providing for social and spiritual needs as well as addressing everything physical.

5 Critical Areas of Dementia Care:

  1. Safety – walking alone across a busy highway, putting something on a hot burner and walking away forgetting about it, going outside in sub-zero temperatures without a coat, and more. Protecting the confused elder without having him feel he is being controlled, is good dementia care.
  2. Communication – just having the most beautiful home, with the best security system, won’t lead to great dementia care. Especially if the caregiver doesn’t know how to effectively communicate with a confused person. Good communication involves the speaker and the listener. When the confused elder is no longer able to communicate well, the burden is on the caregiver. The caregiver must know how to communicate through touch, gestures, smiles, patience and kindness.
  3. Environment – the environment needs constant review, and may change over time. Thinking of the environment as a way to make the elder with dementia know where they are and what is expected, is great dementia care. Clutter needs to be eliminated as it contributes to confusion. A kitchen needs to be used for preparing and eating meals. Having a TV running at all times in a kitchen reduces the environmental cues, that are telling the confused person, where he is. Creating a happy environment involves using music, activities, creating enjoyable smells, like the smell of cookies baking.
  4. Social and spiritual needs – whether this means continuing in church attendance, or participating in social groups, these connections remain important.  When the elder can no longer play that card game they won at for years, continuing the activity, while changing the level of the game is what is important. Getting together with familiar people, playing a game, laughing together, watching a movie together, these are important parts of dementia care.
  5. Physical – involves really knowing the person physically. What are the physical problems the person is challenged with other than dementia? Does this person have a vision or hearing deficit? Also good dementia care means knowing when the confused person has had a physical change in condition, when they cannot tell you. Physical also literally means engaging in physical activity to keep the body strong.

Many of these areas crossover to other areas. The person with a hearing deficit, will have an added burden of communication, increasing their confusion. The person who may be diabetic, will no longer be able to understand, how unsafe it is to not follow their diet restrictions.

To provide over all wellness, only 5 areas of dementia care turns, into a very big job.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

BEST CARE FOR ELDERLY – PERSON CENTERED CARE

“I am feeling so bad, about how I have treated some of my patients,” the nurse told me. She went on to name patient after patient, that she said she has never taken the time, to get to know. This nurse works in an Alzheimer’s unit with 68 beds, that are always full. I was more than surprised at her statement. I have known her to be so involved and caring, that I couldn’t imagine she would see a problem.

“I just read your book, Please Get to Know Me” she said. She went on to explain that now she could see that while she knows her residents with behavioral problems, very well. And yes, those with very involved and sometimes needy family members she knows very well.  At times, almost too well.  But for those quiet, easy to care for patients, she said she didn’t feel she had really gotten to know them at all.

Nursing is a very fast paced job. No one watching a nurse would fault them for not really knowing each and every patient. After all their jobs are very hard, stressful and yes, fast paced. But as I said, this nurse is a very involved and caring person. I could see that this realization of what person centered care could and should look like, had hit her hard.

When an elderly person has dementia, and is no longer able to share who they are with their caregivers, the family is the bridge between the patient and caregiver. Now this nurse understood, that there is more to taking care of a confused person, than knowing their diagnosis and medications. Knowing who has a skin ulcer, who is diabetic and needs to have their blood sugar monitored is very important of course.

But isn’t it just as important to know who was a kindergarten teacher? Who did some missionary work in their 2o’s and lived in Japan? Who raised 5 children, and now has 13 grandchildren and 10 great grandchildren? Knowing just this can prompt the nurse to remember that every time there is an activity that involves children in the nursing community, this patient needs to be there. Because, she loves children.

Please Get to Know Me – Aging with Dignity and Relevance, is a guide for a family member to help their loved ones receive the best care through caregivers who know them. It is a guide for the caregiver, to help them see that for the patient, the best care is to be taken care of by someone who knows you.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ADULT COLORING BOOKS – GREAT ACTIVITY FOR SENIOR WITH DEMENTIA

Adult coloring books are everywhere, from the internet to your neighborhood craft or book store. The choices are suddenly endless from floral, to animals and even the chance to color the masters of the art world. In this fast paced, goal driven, digital age, opening a fresh new coloring book and colors is soothing in itself. Taking any individual to a place of quiet and relaxation, but especially so for the senior with dementia..

For the person with Alzheimer’s disease, or another related disease causing dementia, coloring brings many benefits.  Coloring is among other things, an activity of reminiscing. Everyone remembers the wonderful feeling of opening a new box of crayons. And if you were the fortunate child who had the set of 64 with the built in sharpener, the feeling was quite amazing.

Coloring, gives the senior with dementia an opportunity to be successful. When you color it gives you chances to make decisions about which picture to color, where to start and which color to use. For a person with dementia who makes many mistakes all day long, due to memory loss, coloring is very safe. Art is in the eye of the beholder and there is no way to be wrong.

Find a quiet place, avoid a cluttered kitchen table, instead pick a place where the supplies can be spread out and enjoyed as well. Do not have the distraction of a TV, or even a radio unless it offers soft background music, preferably without lyrics. Even if the person with dementia never cared for art or crafts before, this is an area where they can do well now. This activity doesn’t require remembering facts, people, places or use any language skills. Just the ability to hold onto a coloring pencil or crayon.

When a person does an activity mainly engaging the right side of the brain where art, music and the softer side of life resides, it becomes a little vacation for the mind. As almost a form of meditation it can bring mindfulness to the person and make them more focused. Distraction is a major problem with dementia and developing activities which bring greater focus are worth the effort.

Having many coloring books and colored pencils or crayons around is a great way for the senior to do an activity with a child. The child knows instinctively how to get to the right side of the brain where there is only color, choices to be made and those spaces to be filled in.

Not only is coloring a great activity for the senior with dementia, it is also great for his caregiver. Time can fly when you are engrossed only in choosing which page to color next or what color to use. And the companionship created while you compliment each others work of art creates a pleasant feeling of friendship for both. Feelings that can last long after the crayons are put away.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

 

GRANDMA CAN’T FIND THE BATHROOM – WHEN THE ELDER IS INCONTINENT

Grandma Lucy always has a big smile on her face. She is already in the late stage of Alzheimer’s disease. Grandma no longer talks or seems to understand what others are saying to her. She now needs total assistance bathing, dressing and eating.  Yet, Grandma Lucy can still walk and while she cannot go through the many steps of dressing. Once dressed she is able to pull down her slacks, as well as  incontinent brief, and then go to the bathroom.

The problem arises because Grandma no longer can identify the correct place to toilet. When she feels the urge to go to the bathroom, any flat surface she can sit on, will do. She no longer plans or anticipates that she will be needing a bathroom. In the moment when she feels the urge, she answers the call in a public place, secret place, anywhere she finds an opportunity to sit.

Missing the toilet, and using either another object such as a waste basket, or a flat surface such as a chair, sofa, or recliner is common, in a dementia unit, in a nursing home setting. Especially common, for those elderly who continue to be able to walk independently. Grandma Lucy always was a great walker, and has continued to be able to walk, even though now she walks without a destination. She just appears to be wandering as she keeps retracing her steps, all day long.

But contrary to the many who are no longer this active, she has no problems with constipation. On the contrary, Grandma is as regular as clock work. And this fact provides the solution for Grandma’s problem.

When a confused elder like Grandma Lucy can’t plan or anticipate needing to use a toilet, the caregiver needs to provide this service. Her caregiver knows that Grandma Lucy has a bowel movement everyday, about a half hour after breakfast.  As many people know, having a cup of hot coffee in the morning, and chewing breakfast, stimulates the colon and bowel.

Now the caregiver keeps a close eye on Grandma Lucy after breakfast, and right on time walks her to the bathroom. Grandma Lucy is now greeted with smiles and welcome during her wanderings instead of looks of suspicion.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

THE NURSING HOME – WHY THE FAMILY IS AN IMPORTANT PART OF THE TEAM?

PART III

(Four things to notice when visiting an elder in a nursing home, cont.)

2. Observe the elder’s skin. Skin is the largest organ of the body. In the average person, the skin stretches about two square yards and is about 15 percent of the individual’s weight. We consider the skin the first line of defense against environmental factors. Skin is also a barometer of health. We want to be aware of any redness, warmth, or swelling. It is perfectly appropriate for family members to ask the nurse or nursing assistant “Does Mom have any skin breakdown?”

When elder sit for hours in a wheelchair or are unable to move themselves independently, they may be at risk for skin to break down because of decreased circulation. Nursing homes may provide special pressure-relieving mattresses to prevent skin breakdown. A special pressure-relieving gel cushion is an excellent aid for wheelchair-bound elders.

3. Report any significant change. The rule of thumb is that a dramatic change in any body system must be reported to the physician immediately. This includes an abrupt change in:

  • Behavior
  • Difficulty arousing the elder
  • High fever
  • Dizziness or unsteadiness
  • Sight or hearing
  • Ability to communicate or speech pattern
  • Personality
  • Eating
  • Difficulty swallowing
  • Weakness or decreased use of an extremity

Book excerpt from: Please get to Know Me – Aging with Dignity and Relevance Available on Amazon.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing