Re: LTC and Complacency

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: 8/2/99 : Patti, : You bring up a very good point and this is why NAs must be in care plan meetings - because you do see these changes. : Some info must be brought to attention of a nurse immediately. But other info that is vital to the ongoing well being of the resident is better shared when a number of people are together so you can discuss what the problems is, what is to be observed and what you will do to monitor or remedy the problem. : Others should be doing assessments as well, so it is not entirely up to the NA to spot decline. Care planning committees, care review committees, team conf, shift report - all of these are forms of communication about the status of the resident. This is why NAs must be on these committes. NAs also must how to ask the right questions and offer suggestions to get the job done in a non-threatening and professional manner. : This is the purpose of the Leadership Program - to enable you to do just this - how to speak up for your self and your residents/clients in a way that people will listen. Watch for more info about the Leadership Training Program on this web site. : Thanks for sharing your wisdom. I will also flag your memo for Lorrene - a NA on the National Committee. : Keep in touch. We need you good thinking. : Genevieve Gipson RN MEd RNC : Career Nurse Assistants Programs, Inc : National Network of Career Nursing Assistants : 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

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