Communication

This is a great time to be working in the field of geriatrics, so much is going on in terms of research and available aids for senior citizens. I read about available grants for caregivers to allow them financial aid to return to school so they can get better paying jobs.

When developing a care plan for an individual remember to look into their native language. I spoke with an individual recently that earlier in her life spoke English and Spanish, however, now she pretty much speaks Spanish. Over half of the caregivers speak Spanish, for those who do not, to have available common phrases the individual would recognize and understand would be helpful. The effort put forth would pay double dividends, the resident would feel grateful and the caregivers would feel they were valued that their employer put forth the effort to improve communication so they could do a better job.

Definition of neglect

Wanted to pass along one of the many definitions of neglect. As professional nurses in long term care settings if you assess that a resident needs medical attention then get them to the hospital. Do not allow an administrator or family member to decline the services of an ambulance because they do not want the resident to go to the hospital. As a professional you can be held responsible for neglect when you do not advocate for the resident, especially when the facility's policies direct what action is to be taken. As a professional you are held to the regulations that operate in your state governing the operation of the facility and your nurse practice act including resident rights, and reporting requirements. Not knowing what the requirements are will not excuse you from legal and professional action when allegations of neglect are reported. You also can be held responsible if you fail to provide supervision to caregivers under your leadership and do not provide adequate training. Your best protection is knowing what your job description states, the facilities policies, your nurse practice act, regulations governing the type of facility for which you work and what must be reported to the state board of nursing.

Resident assessments

I wanted to talk about resident assessments. Identifying resident needs also should include an assessment of the skill set of the care staff that will be providing the care and services. Traumatic Brain Injury clients have a different set of needs than dementia or mental health clients. Staff need to receive training specific to the needs of residents with Traumatic Brain Injury. When care staff tell supervisors something is wrong they need to be listened to and the resident assessed. Nurses who complete assessments for residents need to access their resources to gather the necessary information they need. The internet is loaded with various resources from credible sources.

Blood pressure alerts

Monitoring a patient's or a resident's blood pressure is more than just taking the blood pressure recording the result and giving a pill. A facility should have parameters for when a resident's blood pressure reaches a specific parameter and the physician should be notified, including when a standard fax is adequate or when a phone call should be made to alert the doctor.

A person's blood pressure must be evaluated along with any other symptoms that are exhibited. A blood pressure of 77/36 is of grave concern because it the individual's vital organs such as kidneys, brain and lungs may not be getting adequate oxygen. If the resident is responding appropriately, the blood pressure should immediately be rechecked to determine if it is an accurate reading or if it is operator error or mechanical malfunction. If it is indeed an accurate result, the resident maybe exhibiting other symptoms such as non-responsiveness, confusion, dizziness, inability to speak. Medical intervention is necessary, the sooner the better. The resident needs to be evaluated/assessed.

Like wise if the blood pressure is high, the blood pressure needs to be evaluated. If the resident is responding appropriately, the blood pressure should immediately be rechecked to determine if it is an accurate reading. If is is indeed an accurate result, the resident maybe exhibiting other symptoms such as headache, dizziness, nausea, vomiting, slurred speech, inability to raise both arms, smile or other symptoms of stroke. The resident should immediately be transported to the hospital and the physician notified.

It is more helpful if the resident's physician determines the parameters for which he wishes to be notified.

New nurses

I did a visit at a facility today. I shared my concerns with the facility nurse and she responded as if her responsibility was to only send a fax to the doctor and failed to alert him to why he was receiving the fax. I could not determine if she did not have the scope of knowledge to realized that a blood pressure of 77/36 and/or a blood pressure of 211/114 was a serious medical problem. I would like to give her the benefit of the doubt I just don't think she gets it.

Lots of changes happening at the state level. Our state government expanded the definition of financial exploitation of the elderly which was a good start. Training for individuals in the financial institutions, family members and facilities is paramount to preventing the exploitation of our senior citizens. It is very unfortunate when exploitation occurs and the ramifications for the senior involved is wide spread. This past week a news paper had a story where a gentleman was robbed of over 2 million dollars by a woman who promised marriage and companionship. Although the courts said she will pay the money back the reality is that probably will not happen as scamming elderly men was how she made her living. Keeping in contact and having frank discussions about financial matters with loved ones is the most effective means of protection against financial exploitation from crooks.

emergency preparedness

Every facility needs to have an emergency plan because disaster does not schedule their events. We had a facility with a fire in which residents were evacuated. The facility staff were prompt in responding and the facility nurse developed a care plan to address resident needs related to being moved. Some of the issues she addressed included watching the residents for respiratory stress due to potential exposure to smoke, stress of moving from familiar surrounding to a different location, how to provide a calm safe environment and respond to potential behaviors. This professional nurse also included directives on how to deal with questions from family members and the media. Resident were found to be calm and dealing with the changes.