Wednesday, December 17, 2008
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
To read more Thursday Thirteen
Wednesday, December 10, 2008
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.
Wednesday, December 3, 2008
Thursday, November 20, 2008
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!
Please visit more Thursday Thirteen!
Tuesday, November 18, 2008
Sunday, November 2, 2008
Wednesday, September 24, 2008
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.
To read more Thursday Thirteen
Saturday, September 20, 2008
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.
Wednesday, September 17, 2008
1. History of falling
2. Cognition, mental status
4. Vision (eye site elevated to target rather than looking at feet)
5. Ambulation ability
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.
To read more Thursday Thirteen
Wednesday, September 10, 2008
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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Wednesday, September 3, 2008
1. Safe physical environment
clear walkways of obstruction
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
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
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
To read more Thursday Thirteen
Friday, August 29, 2008
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.
Wednesday, August 27, 2008
5. Sweet Potatoes
6. Brussels sprouts
7. Grapefruit juice
8. Orange juice
Congratulations to Jerry & Kandy on the birth of their baby girl this morning!
To read more Thursday Thirteen
Monday, August 25, 2008
Wednesday, August 20, 2008
Thursday Thirteen Edition #6 Suggested steps for an investigation by staff in an Assisted Living Center
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.
Monday, August 18, 2008
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.
Wednesday, August 13, 2008
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.
To read more Thursday Thirteen
Wednesday, August 6, 2008
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.
Monday, August 4, 2008
I chose this picture of my granddaughter because she looks so spontaneous and dancing with wild abandonment. Seeing her so happy warms my heart.
Wednesday, July 30, 2008
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.
To read more Thursday Thirteen click on
Monday, July 28, 2008
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.
Wednesday, July 23, 2008
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!
Sunday, July 13, 2008
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?
Wednesday, July 9, 2008
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.
Tuesday, July 8, 2008
Saturday, July 5, 2008
Thursday, July 3, 2008
Sunday, June 29, 2008
Saturday, June 28, 2008
Thursday, June 26, 2008
Tuesday, June 24, 2008
Monday, June 23, 2008
Thursday, June 19, 2008
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.
Wednesday, June 18, 2008
Tuesday, June 17, 2008
Sunday, June 8, 2008
Wednesday, May 28, 2008
Monday, May 12, 2008
Wednesday, May 7, 2008
Monday, April 14, 2008
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.
Tuesday, April 1, 2008
Sunday, March 23, 2008
Tuesday, March 18, 2008
Sunday, March 9, 2008
Friday, February 29, 2008
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.