Thursday Thirteen #15

Thirteen interesting nursing items from a 1916 nursing journal
1. The journal titled The Nurse dated February 1916
2. The journal cost $2.00 a year and 25 cents a copy
3. An article titled The graduate nurse and our alien exclusion laws.
4. Every Advertisement was guaranteed
5. Chr. Hansen's Junket Brand BUTTERMILK TABLETS ideal food for invalids and healthy people of all ages.
6. Questions by the Nurses' Examining Board of Vermont
7. The questions were listed under three categories; Practical Nursing & Dietetics, obstetrics, Materia Medica and Urinalysis
8. Invalid Danties by Riley M. Fletcher Berry
9. Advertisement for the The Chase Hospital Doll- description over 5 ft. tall made of finely woven stockinet, is durable waterproof and sanitary
10. Hospital methods illustrated: Hypodermoclysis - twenty engravings from photographs
11. The Role of the Visiting Nurse 'Keeping Up The District'
12. Philadelphia's Street Cleaning Nurse - In order that she may conduct her work most effectively, she has been legally empowered as a special police officer, which gives her the power of the law to make arrests when necessary.
13. An ad for Welsh's grape juice

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Thursday Thirteen #14

Soothing Holiday Loneliness:

1. Look in the eyes, touch the hand, smile, and call the person by name.

2. Take time to be with the individual even when completing procedures.

3. Listen to stories.

4. Honor traditions.

5. Create gifts.

6. Use holiday music from the person's cohort.

7. Decorate with period ornaments.

8. Hold a holiday dance.

9. Have some special treats from the individuals' differing backgrounds (rum cake, Baklava, etc.)

10. Adopt a grandchild programs for those who have no family in the area is a way to bring children back into the holidays.

11. Arrange for carolers to come in and sing.

12. Warm apple cider and hot chocolate always brings a smile.

13. Hang the stockings with care.

Memories are precious. Too many holidays go by in which the memories of past holidays haunt and create want. We have the power to make them better by taking care to treat each person with consideration while helping them create a fond memory of this holiday.

Thursday Thirteen

Thursday Thirteen #13

Thirteen ways to help residents in a dementia unit.

1. Play a selection of favorite resident Christmas carols.

2. Structure an activity of making simple Christmas ornaments.

3. Watch Christmas programming.

4. Tell Christmas stories.

5. Create a personal bulletin board decorated with family Christmas pictures.

6. Have a discussion about a resident's most memorable Christmas.

7. Try to schedule carolers to come to the facility.

8. Bake aromatic dishes  that will provide wonderful smells of Christmas such as gingerbread.

9. Make gingerbread houses, decorate cookies.

10. Hang stockings.

11. Read poetry such as "The night before Christmas."

12. Serve apple cider or mold wine.

13. Don't forget the mistletoe, fresh pine garland or have Christmas potpourri.

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Thursday Thirteen

Thirteen things I am grateful for
1. The time I had with my mother and father before they passes on.
2. The traditions they passed on to me.
3. The family recipes that were passed down and now I can give them to my daughter.
4. Our humble house to enjoy with family and friends.
5. To be able to enjoy the sights and smells of the holiday season.
6. Thankful all the noise is only temporary.
7. A good excuse to break out the photo albums and relive all those memories.
8. Friends and family with which to share Thanksgiving.
9. Humor that happens between people who care about one another.
10. Guests to play games with.
11. Promise for the future.
12. Good health and the ability to work.
13. The hope to be able to do it all over again next year.

Best wishes to everyone for a memorable happy Thanksgiving!
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Nurses

I shouldn't be surprised at how different one nurse can be from another even though they work in the same industry Assisted Living. Nursing is like all professions, each professional determines how they will mold their career. I met a nurse today who has been a nurse for awhile however is new to the Assisted Living arena. She is very impressive and I believe will make wonderful contributions to the lives of the residents she serves. As I think about the qualities I observed about her I would say her sense of genuine caring was the hallmark. She thinks about what she is doing and how it will affect the whole community. When asked why she chose to do one thing a certain way rather than another her answer was immediate and her thought process was evident. I don't imagine she will do everything perfect, however look forward to working with her and perhaps learning a thing or two. Exposure to a new point of view is healthy.

Halloween evening of fun

I always enjoy seeing all the costumes the children wear on Halloween. We usually have quite a few come by our house. My 2 year old granddaughter who lives in Georgia, her mom and dad took her to the mall to trick or treat. I am hoping for pictures.

Thursday Thirteen Edition #11

13 positive features of an Assisted Living
1. You are greeted within seconds of entering the facility in a professional manner.
2. The facility smells clean.
3. Residents are involved with their surroundings and not just sitting.
4. There is a posted Activity calendar and you observe activities in progress.
5. There is a suggestion box/complaint box.
6. There is a menu that is posted in large lettering for residents to read.
7. Staff in the facility are pleasant, do not appear rushed, smile and greet you.
8. Staff interacting with residents in a friendly, caring, professional manner.
9. The facility is decorated like a home, with appropriate lighting, well maintained.
10. There is presence of an administrator, staff are visible.
11. Meal service is organized, well delivered, attractive, appetizing.
12. The outside grounds of the facility are well tended and attractive.
13. Sounds in the facility should reflect a calm comfortable atmosphere, be pleasant and inviting.

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High temperatures

This past week I came across a situation that happened several months ago, in which a resident was running a high fever 102.6 he was left alone in his apartment and was not checked on all night. He experienced a fall, laid on the floor and was not found until the next morning several hours later. The caregiver who took the resident's temperature failed to intervene by not calling the facility nurse to report the high temperature, by not assisting the resident to get his Tylenol and by not checking on the resident to see that the temperature was reduced.
Orientation and training of facility policies and appropriate protocol for staff are so critical. Had the caregiver received the orientation and training that is required the outcome for this resident may have been prevented.
Also the facility managerial staff failed to do an investigation of the fall. If the investigation had been completed it would have come to light that this employee was lacking completion of the orientation.
The investigation should have included the who, what, when where, and why of the fall, the actions of the caregiver, and an evaluation of the training of the caregiver. Development of appropriate strategies to prevent the situation from happening again was also indicated.

Thursday Thirteen Edition #10

13 suggestions for a fall risk assessment

1. History of falling
2. Cognition, mental status
3. Impulsivity
4. Vision (eye site elevated to target rather than looking at feet)
5. Ambulation ability
6. Continence
7. Use of high-risk medications
8. Use of assistive devices for transfer or ambulation
9. Attached equipment (oxygen tubing, catheters, intravenous lines)
10. Familiarity with the environment, lighting
11. Sleep patterns
12. balance, gait, footwear evaluation, appropriate shoes
13. Hydration status

This is only 13 suggestions and a thorough fall risk assessment should include additional factors that fits the make up of the facility.

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Thursday Thirteen Edition #9

13 suggestions for Post-fall assessment for the resident who isn't able to tell what happened
1. Always start with the resident and ask them to try to explain what happened.
2. Examine the resident for any skin tears, lacerations, or bleeding. After giving first aid and taking care of the immediate problem look for clues as to where the fall took place.
3. Review what the resident was wearing, clothing and footwear.
4. Conduct an environmental review looking for tripping hazards.
5. Examine the amount of light in the area.
6. Determine possible causes of why the resident was up and about if the time the fall took place was at their usual sleeping time.
7. Review what activities were in progress at the time the resident fell. Was the resident agitated?
8. Do a review of the chart to determine if there have been falls prior.
9. Was the call cord, telephone, lamp with in reaching distance of the resident?
10. Was there a night light on?
11. Has there been recent medication changes.
12. When was the last time the resident had an eye exam?
13. When was the last assesment completed that identified the resident's ability to get up on their own, their balance ability, strength or blood pressure changes?

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Thursday Thirteen Edition #8

Fall Prevention 13 guidelines
1. Safe physical environment
clear walkways of obstruction
stable furniture
easy access to items a person regularly uses
good contrast lighting helps show details and gives cues to anyone moving in the
room, floors in good repair, use footwear that promotes safe walking
2. Address medication side effects - a pharmacy consultant can review and identify
medications with drug to drug interactions that can impact the risk for falls
3. Promote mobility - exercise routinely; research has demonstrated a positive effect of exercise on reducing fall risk and increasing flexibility
4. All wheelchairs and other assistive devices should be periodically evaluated to
check for loose bolts, worn wheels, and is the device still appropriate for the
individual
5. The height of a bed, chair or toilet is crucial to safe standing, the correct
height facilitates rising by requiring less knee extension
6. Utilization of nonskid slipper socks or nonskid mat placed at the side of the bed
and/or toilet can reduce the likelihood of slipping
7. Securely fastened grab bars in the bathroom near the toilet and bathtub/shower
8. Schedule a yearly eye exam
9. Treatment of foot problems can decrease the risk of falling
10. Place a lamp next to the bed that is easy to turn on, have a night-light so you
can see where you're walking
11. Keep emergency numbers in large print near each phone
12. Slow down do not hurry, if the phone rings and they hang up, if it is important
they will call back.
13. Put a non-slip mat or self stick strips on the floor of the tub or shower

Thirteen Resources

1. "Falls in Older People" by Stephen R.Lord, Catherine Sherrington, Hylton Menz
2. e-Newsletter by Liz Taylor e-newsletter
3. "A Nursing Guide to the Prevention and Management of Falls in Geriatric Patients in Long-term Care Settings" by Deanna L.Gray-Miceli DNSc, Elizabeth Capezuti PhD, RN
4. National Institute on Aging
5. Prevent Falls
6. CDC's "What you can do to Prevent Falls" and "Home Safety Checklist" brochures for older adults
7. CDC Falls Prevention page
8. Center of Excellence for Fall Prevention
9. National Institute on Aging, AgePage: Preventing Falls and Fractures
10. The American Geriatrics society Guideline for the Prevention of Falls in Older Persons

11. Center for Healthy Aging Falls Free Electronic News
12. California Blueprint for Falls Prevention
13. National Safety Council

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Fall prevention

I have been gathering and reading articles about fall prevention for the last several weeks. On Thursday Thirteen I will write about resources that are available to prevent falls and things to keep in mind when looking at our homes to make where we live a safe environment. Please visit again on Thursday Thirteen.

Tag you're it.

The rules are: Mention six quirky, yet boring, unspectacular details about yourself. Tag six other bloggers by linking to them. Go to each person’s blog and leave a comment that lets them know they’ve been tagged. If you participate, let the person know who tagged you you’ve posted your quirks!
My six quirky details
1. I like going to bed at 8:30pm and getting up at 6am.
2. When I set the table the knife has to be on the right hand side next to the plate, the spoon next to the knife, the fork has to be on the left side of the plate and I prefer that all the silverware matches.
3. I have to have a table cloth on my dining table.
4. I like to wash my towels and washcloths with bleach.
5. I like my ice tea on the weak side and will add water to the tea at a restaurant (this embarrasses my adult children when they are with me at a restaurant)
6. My favorite snack is sliced fresh strawberries, sliced sharp cheddar cheese stacked on top of Ritz crackers.

Thursday Thirteen Edition #7

Thirteen foods that fight aging
1. Broccoli
2. Cantaloupe
3. Carrots
4. Spinach
5. Sweet Potatoes
6. Brussels sprouts
7. Grapefruit juice
8. Orange juice
9. Papayas
10. Almonds
11. Cabbage
12. Onions
13. Seafood

Congratulations to Jerry & Kandy on the birth of their baby girl this morning!

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Summer fun and safe food handling

Residents enjoy a change of pace. Many facilities will host barbecues for residents and their families. Part of the planning needs to include adequate means to keep food hot and cold food such as potato salad cold, along with hand washing stations. Summer is fun and it is important to be safe when it comes to handling food.

Thursday Thirteen Edition #6 Suggested steps for an investigation by staff in an Assisted Living Center

13 steps suggested for an Investigation for food borne illness

1. Select a number of residents from the total number of residents who became ill; review their records for documentation of when the symptoms started and when they stopped.
2. Determine the time frame to be investigated.
3. Examine the dishwasher. Is the dishwasher cycle reaching 165 degrees for hot water temperature dishwasher? Is the dishwasher chemical dispensing system dispensing adequate amounts of chemical sanitizer to register adequately on the test strips? Check the dishwasher logs for the time frame being investigated.
4. Are the dishes clean after being processed through the dishwasher?
5. Is the dishwasher operating as it should according to the manufacturer’s directions? If staff are having to manually turn on and off the water to the dishwasher something is not operating correctly.
6. Examine the hand wash sink and the supplies staff use to wash their hands. Is the sink functioning properly? Is there adequate soap and paper towels?
7. Observe the food preparation process used by the cook. Is the cook following safe food rules? Changes gloves between different tasks? Was left over hot food cooled with in the parameters of safe food handling?
8. Are staff properly washing their hands the required length of time and using correct technique? Changing gloves when appropriate?
9. Review the meal menus, the actual food that was served to residents during the time frame being investigated. Was the food obtained from an acceptable food vendor?
10. Review food temperature logs for the dates and food that was served to residents during the time being investigated. Was the food cooked to the correct temperature? Check the thermometer being used; that it is functioning according to manufacturer’s specifications.
11. Review staff schedules for staff that worked and were in contact with the residents or the residents’ food in the sample of residents. Were any of the staff sick and if so what were their symptoms? If staff called in sick what were their symptoms and when did they start?
12. Review the facility’s policies for infection control. Did staff follow the policy? Does the policy/procedure need to be updated?
13. Analysis your collected data and determine follow up action based on the data.

Factors that may affect a resident interview

At first glance interviewing a resident or patient about an event would seem simple and straight forward. Interviewing an individual about an event that may have traumatized them, needs to be handled with patience and sensitivity which requires more than simply getting answers to multiple questions. Some things to keep in mind.
1. The individual may be experiencing anger at what happened to them.
2. The individual may feel victimized.
3. The individual may feel embarrassed or ashamed that they allowed this to happen.
4. The individual may be in a state of shock and hasn't realized what happened.
5. The individual may feel the need to protect whoever the perpetrator is.
6. The individual may fear retaliation if they tell someone what happened.
7. The individual may deny the event or blame themselves.
8. The individual may distrust anyone who tries to talk with them about the event.
9. The individual may be confused due to the effect of what happened.
10. The individual may be in pain, physical or emotional.
11. The individual may be experiencing grief over the event, maybe tearful.
12. The individual may be withdrawn.
13. The individual may be unable to relate accurately the facts of the event.

Because of all the above possible factors it is extremely important to write down exactly what the resident/patient/individual states. If you do not understand what the individual says request that they repeat their statement. Do not guess at what they said. Interviewing is a skill and takes practice.

Thursday Thirteen Edition #5

Thirteen suggestions to investigating falls or incidents involving residents
1. Ask the resident involved what happened - write down verbatim what they say.
2. Inquire if anyone in the area witnessed the incident or heard anything. Write down who you talked to and what was said with the date and time.
3. Survey the environment where the incident happened.
4. Make a list of possible contributing factors, such as time of day, lighting, temperature, activity prior to incident etc.
5. Review resident's diagnoses and allergies.
6. Review resident's medications. Are there any new medications causing interactions? side effects?
7. Interview family members. They could know a piece of the puzzle and not realize it.
8. Interview the person that completed the report.
9. What was the mental/emotional status of the resident? Were they upset prior to the incident, are they experiencing confusion?
10. Was the resident doing something out of the ordinary? If so why?
11. Evaluate the data. Can you answer WHO, WHAT, WHERE, WHEN, WHY.
12. Was the incident caused by lack of knowledge or skill of the caregiver?
13. Develop preventative strategies based on the evaluation and data of the investigation.
This is just a starting point of suggestions. Doing an in depth investigation requires time and experience.

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Thursday Thirteen Edition #4

Thirteen ideas to help an older person
1. Offer to spend time with them even if it is for only 20 minutes.
2. Ask the older person to talk about places they have been.
3. If the person is vision impaired offer to read something to them they would enjoy.
4. Assist them to get connected with services for the blind, such as books on tape.
5. Offer to do a task that is now difficult for them to do, such as dusting.
6. Ask the person to share what their life was like growing up.
7. Ask them what they did for fun as teenagers.
8. Ask them who their favorite actor or actress is.
9. Ask them about who they think was the best president and why.
10. Ask them about hobbies they use to do.
11. Offer to drive them somewhere they need to go or drive them to church.
12. Offer to run an errand for them.
13. Remember to always thank them for their time and shake their hand or give a hug if appropriate.

Photo Contest!

Please visit more Photo contest Members at Five minutes for Mom! This photo contest is sponcered by Skinny Dippers!
I chose this picture of my granddaughter because she looks so spontaneous and dancing with wild abandonment. Seeing her so happy warms my heart.

Thursday Thirteen Edition #3

13 suggestions for residents to address concerns in an Assisted Living

1. Report the concern to the administrator verbally and in writing. Keep a copy of what you submit
2. If the issue is not of a private personal matter share the issue at the resident council meeting. Maybe there are others with a similar concern
3. Tell your family member or legal representative.
4. Call the Ombudsman with your concerns. Their number should be posted in the facility.
5. Submit a suggestion to the suggestion box for resolution of the issue.
6. Call the Corporate 1-800 number, often times a corporation will have a number for complaints.
7. Report the concern to the State Complaint Hot Line. Number should be posted in the facility.
8. Report your concern to your case manager, if you have one.
9. Share your concerns with the facility's licensed nurse.
10. Share your concerns with your minister.
11. Share your concerns with your doctor or therapist.
12. Document the date the problem started, the date you told someone about the issue, and the name of the person you told.
13. Check back in a reasonable amount of time with the individual you shared the concern with, to see what action has been taken.

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Thursday Thirteen

Care Giver Training

This past week I was privileged to observe a training in a facility that the nurse was presenting to caregivers. Training was on resident rights. The question being discussed was how to balance resident rights with resident safety. A resident had a recliner lift chair and wished to have use of the controller. The staff were concerned she would accidentally flip herself out of the chair. One caregiver stated she had placed the controller beside the resident's leg and requested she call for assistance when she wanted to get out of the chair. Another caregiver stated that perhaps they could check on her hourly. Another caregiver volunteered and said "we need to include this on the service plan". Another caregiver suggested "lets ask the resident what she would like". By the end of the training almost everyone present had contributed something about the care for this resident.

Observing interaction between care giving staff and trainers is a another means to evaluate a facility and how they provide for residents. When the caregivers are engaged in the decisions about the care they provide and feel they are being listened to then it is a good probability you will see the care givers listening to what residents are saying.

Thirteen Thursday #2 Issues of dignity

My 13 idea of respecting another's dignity when living in an assisted living center.
1. Address an older individual by their title Mr. Mrs. Miss, Mame, or only if given permission, by their first name.
2. Refrain from addressing an older person as "honey, sweetie, sweetheart or any other term that denotes an intimate relationship. You wouldn't address an employer with these terms.
3. Be considerate of the individual's personal space.
4. Knock before entering an individual's quarters.
5. Wait, after knocking, for an invitation to enter or at least wait an appropriate amount of time before entering to allow the individual to respond.
6. Request to speak to an individual quietly in private. Do not holler across a dining room the individual's name. No one else needs to know the resident's business or that you need to talk to them. Demonstrate that respect.
7. Do not holler across a dining room and ask the resident how their meal is, that is demonstrating a lack of respect. Go over to the individual and address them in a respectful manner to inquire if their meal is satisfactory.
8. Go about your duties in the dining room in a quiet manner. Meal time is one of socialization for residents. Be respectful of their environment it should not remind one of a junior high cafeteria. There should not be banging of dishes, wait staff hollering across the dining room shouting orders or staff visiting with one another. This is time for the residents and should be a pleasant experience; for some this is the highlight of their day.
9. If a resident needs assistance to the bathroom do not announce it to the whole dining room how embarrassing! If you need to let a coworker know you are leaving the area because a resident needs assistance to the bathroom develop specific statements such as "Mrs. Brown requires assistance" meaning its a bathroom run and may take a while or "Mr. Moon requests assistance" meaning you will be taking him back to his room to change cloths because of an accident or whatever might work for your situation. Remember the residents were once fully functioning adults with pride and dignity. They have lost so much independence, control over bodily functions, ability to care for themselves as they once did; we need to make the effort to preserve their dignity and demonstrate respect.
10. When providing personal care for residents make the environment as private as possible. Provide adequate covering. Do not allow coworkers to walk in and carry on a conversation while you are providing care.
11. Try to carry on polite conversation while providing intimate personal care to decrease embarrassment for the individual. Provide the resident modesty whenever possible.
12. Explain what you wish to do before you execute and ask the resident's preference and permission.
13. Refrain from discussing resident information in public areas such as the dining room, elevators, common bathrooms (it is amazing how voices carry out of a bathroom), hallways or any where the information could be overheard.
For more Thursday 13 Please click below!

Resident Rights Source

Resident Rights published on the Thirteen Thursday (#1) came from the RCW (Revised Code of Washington) Chapter 70.129. The 70.129.005 RCW states ...the intent of the legislature includes that long-term care facility residents have the opportunity to exercise reasonable control over life decisions. The legislature finds that choice, participation, privacy, and the opportunity to engage in religious, political, civic, recreational, and other social activities foster a sense of self-worth and enhance the quality of life for long-term care residents.
The first resident right identified was the right to a dignified existence. Fellow bloggers would you share with me? What would a dignified existence be for you? What would be a dignified existence for your parents?

Thirteen Thursday

Thirteen Resident Rights
1. A resident has the right to a dignified existence, self-determination and communication.
2. A resident has the right to exercise his or her rights as a resident of a facility, as a citizen or resident of the United States and the state of Washington.
3. A resident has the right to be free of interference, coercion, discrimination and reprisal in exercising his or her rights.
4. A resident has the right to manage his or her financial affairs.
5. A resident has the right to personal privacy and confidentiality of his or her personal and clinical records.
6. A resident has the right to voice grievances.
7. A resident has the right to prompt efforts by a facility to resolve grievances.
8. A resident has the right to examine the results of the most recent survey or inspection of a facility conducted by federal or state surveyors.
9. A resident has the right to privacy in communications, including sending and prompt receiving of mail that is unopened.
10. A resident has the right to have reasonable access to the use of a telephone where calls can be made without being overheard.
11. A resident has the right to retain and use personal possessions.
12. A resident has the right to be free from physical restraint or chemical restraint.
13. A resident has the right to be free from verbal, sexual, or physical abuse including corporal punishment or involuntary seclusion.
Please visit other 13 Thursday posts.

Why Elders are tagets for abuse

Because July is Washington State Adult Abuse Prevention month I wanted to include posts with information relating to abuse. Elders are targeted because they are more trusting, often live alone, are lonely, less likely to report a crime due to embarrassment or fear, many keep cash and/or valuables in the home and physical limitations.

Exercise should be fun

What a Saturday! We purchased a table tennis set a while back, so today my brother and I played table tennis for two hours. I'm sure I will pay for it tomorrow but what fun. If a person can find an activity they enjoy the exercise is bonus. Losing extra weight and toning up the muscles does a great deal for maintaining balance and keeps the old brain juices flowing.

Fourth of July

My family and I want to wish all of you a happy Fourth of July.  Have fun and be safe.

Meetings the story of my life

Thank goodness for weekends. By the end of last week, I felt like I had been running nonstop all five days. I usually do pretty well at pacing my work load however there are those times when others re-prioritize the agenda. Meeting seem to have taken over everything we do. I counted four impromptu committee meetings last week, lasting anywhere from 30 minutes to 21/2 hours and that translated into additional work and altered schedule. I guess I need to quite bellyaching and be glad I have a job that I enjoy, find challenging and rates high on the satisfaction scale.

Intimidation

Abuse can be so subtle. Intimidation is another form of abuse of the elderly. If a resident is told that if they do something they could be discharged, that could be intimidation. The Washington State regulations are very specific in regards to circumstances for which a resident may be discharged. So if you have a loved one who has been told they could be discharged for some behavior, request to see the Washington Administrative Code that states the specific reason a facility may discharge a resident. Also speaking with the state ombudsman, they may be of assistance in such matters.

Today was a good day!

Today was interesting. I was able to visit the lady I had mentioned in an earlier post who doesn't remember talking to me. However today was a good day because she did remember talking to me on the phone and was very delighted I had time to visit with her in person. She talked for an hour and fifty minutes. The power went out for about ten minutes in the facility, just after I arrived to my friend's apartment and staff quickly came around to check on each resident. My friend did not seem surprised that the young girl came to check on her so apparently this is a routine; when the power goes out at anytime residents are checked on. During my visit, three different staff stopped by and my friend knew them all by name. Yes, today was a good day.

Lock it or lose it!

In keeping with the theme of prevention of abuse something that families can do to curb financial exploitation of a resident being moved to an assisted living center is to purchase and install a lockable cabinet for valuables and money before they move in. Most assisted living centers do not have lockable storage in the apartments. The container needs to be bolted to a drawer in a dresser or to a cabinet. There should be two keys, one for the resident and one for a family member. Keep a record of items and dates when things are put in and taken out of the locked valuables box. I have numerous examples where money, jewelry, and valuables have been taken from residents. Seldom are the valuables recovered. Most facilities reveal in their resident handbook or facility rules book that they are not responsible for valuables that disappear. The best plan is to prevent theft before it happens. The turnover as a whole is high in assisted living centers and boarding homes. Although facilities are required to complete background checks on all persons having unsupervised access to residents, this does not prevent theft. If theft does occur report it immediately to the administrator of the building, not anyone else. The administrator is responsible to conduct an investigation and put policies in place to see that theft does not occur. Also, for the state of Washington the Complaint Resolution Unit (CRU) is supposed to receive a report about the allegation of theft from the facility.

On the front page of our town newspaper was an article about a gentleman being evicted from his home at an assisted living center. It is beyond my ability to understand how a corporation can take money from an individual for 3 years or more, tell them "not to worry they will be taken care of," get the business up and running, pay for the building and then after they take all the resident's money then up and say we don't take anymore state assisted clients you have to move. The lobbyists for the Assisted Living are so strong in the capital that whatever laws get passed they have worked them around so the Assisted Living contingent can get what they want and the residents are the ones that suffer. We've seen this happen all over Washington State. Moving is so traumatic often times the move literally kills the resident.

July Adult Abuse Prevention

July is Washington State Adult Abuse Prevention Month and I would like to share some bits of information with you. Did you know that

* a person turns 60 every 7.5 seconds,

* Statistics show that only 1 in 5 cases of abuse of a vulnerable adult are reported to authorities;

* Studies show that 90% of individuals with a developmental disability experience abuse at some point in their lives;

* Abusers are usually those closest to the vulnerable adult such as a caregiver a spouse or an adult child or grandchild;You can go to the Washington State website at www.adsa.dshs.wa.gov for more information.

Examples of abuse

The last entry defined the vulnerable adult and listed types of abuse. Some types of abuse can be overlooked if one is not a tuned to a situation. For example an elderly mother living with her son and daughter-in-law in the same townhouse was infested with mice. The son and daughter-in-law failed to make getting rid of the mice a priority, even though they were living in the same townhouse. The son and daughter-in-law were negligent in providing an adequate environment for the mother, who was paying rent to live with them, because she was no longer able to live alone due to dementia. Another example is a situation in which a niece says to her aunt "If you don't give me money for gas I can't come and see you". This same niece was coercing her aunt into giving her money for a professional license when the niece had not worked in that profession for the last 5 years. The niece was financially exploiting the aunt. It is difficult to say to family members of individuals who are being taken advantage of that what they are doing is abuse. However if someone does not speak up the situations can escalate.

Happy Fathers Day!

Many times when I have interviewed a geriatric client they have reminded me of my father or grandfather. I know my father and grandfather would be pleased to know they are remembered everyday. If you have parents still alive cherish the time you have with them because they will not always be with you. My father and grandfather were taken from me within six weeks of one another in 1984. That was one of the darkest years I ever experienced. I try to remember things they shared with me. My grandfather said more than once "You can't put a young head on old shoulders" and my Dad always said "Live within your means". Enjoy this Father's day and celebrate the special people in your life.

Always a Nurse

An interesting occurrence happened this evening about 5 pm a car stopped in front of our driveway and the passenger door opened. An elderly lady leaned her head over and proceeded to be sick. When I realized what was happening I picked up a towel damped it and took the towel out to her. I asked if she was having any chest pain and she replied no, she was just sick to her stomach. She said she had eaten some ice cream and thought that is what had made her sick. The driver appeared to be middle aged, maybe her daughter. After the lady seemed to be back in control she took the towel, wiped her face and thanked me for my kindness. I felt concerned for her. The contents on the drive appeared to have more than just ice cream and I was concerned she had gotten a hold of some contaminated tomatoes. However I didn't think to ask her if she had eaten any tomatoes. I hope she will be ok.

Incompatible Medications

This week in reviewing resident charts discovered a problem with elevated INR results due to coumadin for three of the residents we were reviewing. Modern pharmaceuticals are phenomenal however they also bring risks. To keep a resident safe it is everyone’s responsibility to be vigilant to the potential untoward effects. The residents INRs were above therapeutic ranges measuring from 2.3 up to 9. In researching possible causes learned that simivastatin can increase results of an INR. Two of the three clients were taking simivastatin. When developing a care plan there should be directions for teaching the resident what signs to watch for and report to the nurse, directions should include indications for which caregivers should be alert and when the resident should be seen by the doctor or sent to the hospital.

Memory loss

Geriatric nursing can be so delightful and full of surprises. Each senior is different and has a story to tell. I had a pleasant elderly lady call me this week. If fact she has called me at least three times. She never remembers my name or that she has called me. She was concerned about the government being charged for protective undergarments when her insurance is paying for the supplies. I explained that this type of issue is handled by the Medicaid Fraud Unit and often takes an extended amount of time to complete an investigation. She continued on with her story and listed people she has talked to, she couldn't remember their names but knew they worked in the government. I continued to visit with her and asked her how I could help her. She wanted to know when she would be receiving a report about what was found out. I replied I was sorry, but that I do not work at the Medicaid Fraud Unit so do not know that information. I asked her if she was getting the supplies she needed and she said yes. I asked her if anyone was mistreating her she said oh no, of course not, she was just wondering about what had been done about the government being charged for the protective undergarments. We visited a little more. I thanked her for calling and said if I could be of assistance please call back. She thanked my for my time and for listening. I suppose I will get another call next month and my friend and I will visit again.

Vulnerable Adult?

Who is defined as a vulnerable adult?An adult who:

*is 60 years or older who cannot take care of him or herself and/or

* has a developmental disability and/or* has a legal guardian and/or

* lives in a facility (adult family home, boarding home, nursing home, or soldier's home) and/or

* receives services from a licensed health, hospice or home care agency and/or

* receives personal care or health services from an individual who is paid for providing the service.

What is abuse?Abuse is an action (that is not an accident) that injures, intimidates, punishes or unreasonably confines a vulnerable adult. Abuse can be physical, mental, sexual, or coercive. Types of abuse include abandonment, neglect, self-neglect, and financial exploitation. Some professions are automatically mandated reporters such as nurses, teachers, psychologists, and employees of any adult family home, boarding home or nursing home. I'm sure there are others that I have missed.

Light verses Sunlight@

read an interesting article this week titled "Brighter lighting Improves Symptoms in Patients with Dementia". The study is published in the June 11 issue of the Journal of the American Medical Association. Researchers were studying the effects of light and melatonin in elderly patients. Light exposure was manipulated by installation of large number of ceiling-mounted fixtures with glass diffusers in the common living rooms of group-care facilities increasing the residents exposure to brighter light. The results of the study showed that light therapy attenuated cognitive deficits and reduced symptoms of depression. In combination with bright light, melatonin also improved sleep efficiency, reduced nocturnal restlessness, and reduced the average duration of brief nocturnal awakenings.
In assessing a patient's environment I try to determine if there is adequate light. I've interpreted this to be is there enough light in which to read. After reading this article perhaps adequate light should be redefined.

Share Experience

Geriatrics can be so delightful. Some of the clients I have the privilege to interview are so engaging, witty and surprising. I spent an hour today with a young lady of 87 years that was so charming I was sad to leave. One of her opening statements was so profound "I grew old too fast and smart too late". We shared thoughts about children, the bible, sad state of affairs of the country and her worry that she will outlive her money and have to accept state assistance. She said she was a writer and had stories she would like to write before she dies. I hope she gets that chance.

Depression

Today I was reminded how fragile life is when a colleague phoned to tell me one of our seniors in our community had jumped from a building committing suicide. My friend was devastated. According to the National Institute of Mental Health, in the year 2000, 5,306 persons aged 65 and older died by suicide. There is great concern about the alarming numbers of older adults who suffer from depression and thoughts of suicide, and -because they are too often undiagnosed and untreated- may go on to take their own lives. The years I worked in the psychiatric hospital gave me an appreciation for the seriousness of the situation when an individual makes a statement or exhibits behavior indicating they are considering taking their life. If you encounter an individual who you think my be thinking about suicide, take that next step and ask the tough question "Are you thinking about harming yourself, are you thinking about suicide?" Asking the question is not planting the idea of suicide, the idea was already there. If the individual admits to thoughts of suicide, get help. Call the mental health services in your area, they would be listed in the yellow pages under mental health, do not delay.

Sincerity

Sometimes when I have a geriatric client that I'm interviewing and they seem cautious or hesitant, I will talk for a little while about something I saw in the news or if I notice something in their home that is important to them I will ask them if they would tell me about the item. If they continue to be cautious or hesitant I will ask them what they had for breakfast and then follow the question with how are you feeling today? Geriatric patients respond to sincerity and sometimes it is a little bit before they can make the determination that you are sincere.

Interview

Once a rapport is developed with the individual, begin the questioning with inquiries that are the less intrusive, less threatening. Have a process by which you methodically interview so that you obtain all the pieces of information. Your process will be structured according to the goal of the interview. For example in the operating room as a circulating nurse I needed to verify, the patient's name with his name band. This was accomplished by introducing myself, then the patient would respond by telling me who he was. I needed to know if the patient had eaten anything in the previous 12 hours, so I would ask when did you last eat or drink? This would be followed up with when did you last have water? That question would be followed up with do you smoke, chew tobacco or chew gum? You get the idea, very direct questions for specific pieces of information. When interviewing a geriatric patient the questioning needs to go at a slower pace for two reasons. Sometimes the patient takes more time to process what you are asking or they may need more time to formulate an answer or you as the interviewer may need additional time to listen for clues in the response to determine what the next question needs to be. The skilled interviewer learns through experience when to stick with the interview plan and when to venture to secure additional information.

Most Misunderstood Theory

The nursing process is perhaps one of the most misunderstood nursing theories, and yet one of the most effective as well as practical. It takes time for students and new nurses to understand this process, and many fight it every step of the way, until one day a light bulb begins to burn brightly.
When performing the assessment part of the nursing process for a geriatric patient it is appropriate that the nurse is purposefully respectful. Many times elderly patients are not treated with respect, are dismissed, ignored or assumed to not be in control of their mental faculties. Addressing the client as Mr. or Mrs., until you establish or gain permission to address them differently, is the first step in establishing rapport that is so important in order to establish a trusting professional relationship. Many times an elderly client is able to respond to some questions but not others. One should not assume that because there is a deficit one presentation of an elderly individual that all areas are not functioning. Even the client residing on a specialty dementia unit, often is able to convey during an interview that they feel safe, they are treated with dignity and have choices when they are unable to remember the date, name of their home or the name of the town in which they live.

Protecting those who cannot protect themselves!

More and more we are hearing in the news abuse cases of vulnerable adults. How is vulnerable adult defined? A vulnerable adult is anyone who is limited in their ability to protect, provide or speak on their own behalf. An individual who is dependent on another person to provide the necessities of living. For the month of July we have been encouraged to wear purple ribbons to increase awareness for the prevention of abuse of vulnerable adults. If you know of abuse that is happening please call Adult Protective Services in your area. Sometimes to improve living conditions for another all it takes is that call.

Introduction

I am a professional registered nurse of 34 years. I have worked in many settings including hospital setting as a float nurse, in-service director, operating room circulating/scrub nurse, doctor’s office, psychiatric hospital, home health nurse, assistant director of nursing in a nursing home and as a nurse consultant for long term care. I knew from the time I was fifteen I wanted to be a nurse and have never regretted my choice of professions. I hope to share with readers some of my experiences, trials, successes, failures, and lessons.