Posted by Patti on August 02, 1999 at 09:34:04:
LTC has it's faults- some of which lead to detrimental
outcomes to our residents. We can blame no one but ourselves.
Have you ever experienced having your child grow up- and it is such a gradual process that parents don't notice the day
to day changes- or week to week changes- in ht., wt., growth? All the sudden Aunt Matilda from Timbucktoo shows up and says-
"OH my, look how much little Suzy has grown!" Parents look, but don't see the same thing Aunty sees. Because Suzy lives with
us day in and day out we don't see the big change that Matilda sees...
It is the same thing with Nursing Home residents. A pt. is admitted and we do an assessment- sort of I guess- and we get to
know Mrs. Jones. We work with her every day- feeding, bathing, giving meds and treatments. After a while we stop seeing the
changes that Mrs. Jones may be going through. We don't see that she isn't eating as much as when she first came; we don't see
that she isn't voiding as much/or more; we don't see her ROM getting tighter. Gradually, she goes from eating 100% of her meals
to 90%, then 80%, and so on. Because we see her everyday we don't see things that are slowly happening.
So when Mrs. Jone's niece shows up- who hasn't seen her in years- and freaks out because Mrs. Jones looks horrible- we wonder
why?
What can we do to change this complacent way of caring? How can we force ourselves to look at these changes that we can't see?
If we do a proper admission assessment- and get info for what is typical of our new admits, maybe this is a good place to start.
Gathering food & liquid intake records for a couple weeks is a good idea if we use the info to help us see change. Getting voiding
data is good also, as long as we follow up with the data. Having a PT assess ROM from day one is also another way to check
progress or degress.
An example I can give of seeing change is strong and vivid:
A couple years ago we had several kids move to another unit at the same time. One of the kids- a 15 yr. old girl- had a certain degree
of ROM in her wrists that we all knew was normal and had actually gotten better since admission. This girl moved on. About three
months later the unit the she moved to was very short staffed and I went over to help them out. As I was working with the girl I
became shocked at her now rigid wrist. There was no ROM in it at all! I noticed this big time, but her staff had not. Their reasons
were that they didn't see the gradual lessening of the ROM- to the point that no one even mentioned it to the nurses or to the
OT.
The lesson learned from this was: Always look at the data from admission. Ask- is this the same? If not, why? What can we do to
bring it back?
I guess we can expect a certain amount of change- but it should be for the better, not the decline.
CNA's are the ones who see the most. We deliver most the care; we do almost all direct care. If we can keep in the backs of our
minds what is "normal" and what isn't, and we report the changes on a daily basis, then maybe things can be corrected before
they get out of hand. Nurses only see bits and pcs. of the pt- they don't know what is going on from the daily care standpoint.
I make a practice of looking at each pt. from a view of what they looked like at admit, to now. I do this each week. And I share this
info/observations with the nurses. There may be some wisdom to working in other units for a month or so; going back one can see
so much more!
Any thoughts about this? I do think this is a serious thing, and we can make or break a lot with our own eyes