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