Winning tidbits: suggestions from direct care workers

Hello everyone,

Our friends at nursing home facilities in Pennsylvania have sent us some wonderful tidbits for our tidbit contest. We’ll share a few with you each week.

To start, Kacie Szczech, a CNA at St. Mary’s Villa, has a great idea for residents who wander and like to take other people’s things. She suggests leaving a “treasure box” of miscellaneous items placed in frequented areas for the resident to go through and take some things, such as: towels for folding, empty containers, stuffed animals, and large costume jewelry (if safe). Our research team likes this approach because it does not try to restrict or change the resident’s behavior, but rather supports wandering as an unmet need. Nicely done Kacie!

Janet, another staff member at St. Mary’s Villa, shares her approach to caring for residents with insomnia. She creates and keeps a bedtime routine to signal the resident that it is time to settle down: remove glasses, turn off lights in the room, draw the shades, turn off TV, offer snack prior to lying down, check and change brief. Our team liked this tidbit because it focuses on a common issue for the evening shift staff, and is a simple suggestion that does not require any additional resources to implement.

Have a great week!

Benefits of resident engagement

Hello everyone,

A study published in the Journal of Nursing Scholarship posed the question, “Is an Engaging or Soothing Environment Associated With the Psychological Well-Being of People with Dementia in Long-Term Care?” (https://www.ncbi.nlm.nih.gov/pubmed/27802364)

Well…what do you think the researchers learned? They found that an engaging environment was associated with more positive emotional expressions, and that a soothing environment was associated with neither positive nor negative emotional expressions.

In terms of resident-focused care, this is important to consider as we plan care and activities for those residents with dementia. While a soothing environment may be beneficial during times of agitation, the default should be an engaging environment, which can result in more positive emotions overall.

Have a great week!

Delirium identification and reduction strategies

Hello everyone,

Dementia and old age are the strongest risk factors for delirium, a condition of acute confusion and rapid changes in brain function. It is important to distinguish delirium from behavioral and psychological symptoms of dementia, as delirium is a medical emergency that should be addressed immediately by the healthcare team. Delirium typically involves a vulnerable patient and often occurs after surgery, infection (such as a urinary tract infection), or due to adverse medication effects.

Core features of delirium include acute onset and fluctuating course, inattention, disorganized thinking and a change in level of consciousness (hyper-alert or drowsy). Other possible symptoms include hallucinations, delusions, restlessness, sleep disorder, inappropriate behavior, poor postural control, and a decline or low performance of self-care activities. Keep in mind that while hyperactive delirium is more obvious due to hallucinations or striking out, hypoactive delirium is more subtle, and the person may just seem very sleepy (https://acphospitalist.org/archives/2016/03/delirium-screening.htm).

When you suspect delirium, assess the resident as least once per shift using a brief assessment tool, such as the days of the week backward or months of the year backward. Keep in mind that for a person with dementia, this assessment would not be effective if the person could not do this task anyway. Instead it can be better to determine–sometimes with help of family members–what a person’s baseline cognitive function is and use this to help assess delirium, along with a more complete assessment by medical staff.

The resident with delirium may have poor judgement and difficulty focusing, switching and sustaining attention, so be sure to keep the resident safe from falls and other adverse events, and do not use physical restraints and bed alarms.

According to the Nursing Home Toolkit (http://www.nursinghometoolkit.com/delirium.html), some ways to reduce risk of delirium in nursing home residents include:

  • Keep residents mobile, hydrated and engaged in activities they enjoy
  • Keep eyeglasses and hearing aides in working condition and available to resident at all times to promote sensory input and communication
  • Encourage use of dentures to help ensure adequate nutrition
  • Use consistent assignment of staff and avoid room changes
  • Treat pain with appropriate non-pharmacological and pharmacological interventions
  • Encourage family involvement for re-orientation; use companions as needed
  • Provide non-pharmacological sleep protocol (back rub; decaffeinated tea) and quiet room at night with low level lighting
  • Don’t administer prn (as needed) sedative, antipsychotic, or hypnotic medications to prevent and/or treat delirium without first assessing for, removing and treating the underlying cause of delirium and using nonpharmacologic delirium prevention and treatment approaches.
  • Don’t discharge patients with delirium form post-acute care without and appropriate delirium treatment, care management, and communication plan for transitioning care and ensuring ongoing follow-up

Find more information on this topic at: http://www.nursinghometoolkit.com/delirium.html

 

Have a great week!

Simple solutions to reduce anxiety and improve sleep

Hello everyone,

Dailycaring.com named its number one article from 2017, showing that sometimes even the simplest ideas can have a significant impact. The article is about giving weighted blankets and lap pads to people with dementia to help reduce their anxiety and improve sleep.

According to the article, a 2008 study showed that weighted blankets were a safe and effective non-drug therapy for decreasing anxiety, and the results were confirmed in a 2012 study. How does it work? The heaviness of the blanket provides “deep pressure therapy”. When the body feels the gentle pressure of the blanket, it produces serotonin which improves mood and promotes calm. A typical weighted blanket for adults is about 15 to 30 pounds, but will depend on the person’s weight and physical condition. The standard guideline is that a blanket should be about 10% of the person’s body weight, plus 1 or 2 pounds (but lower if the person is frail). A lap pad is typically 2 to 5 pounds.

The article advises readers to ask a doctor before using a weighted blanket, since people with respiratory, circulatory, or temperature regulation problems, or people recovering from surgery, may not be able to safely use one.

To find out how to make your own weighted lap pad or blanket, or where to buy one, click on the link to the full article:

http://dailycaring.com/weighted-blankets-in-dementia-care-reduce-anxiety-and-improve-sleep/?utm_source=DailyCaring&utm_campaign=fa88c331a8-DC_Email_2018-01-09&utm_medium=email&utm_term=0_57c250b62e-fa88c331a8-123152321

Please let us know if you’ve tried this with any of your residents, and have a great week!

Preventing negative behaviors through resident engagement

Hello everyone,

It’s usually a lot simpler to prevent a problem than it is to deal with an issue once it’s already occurring. Unfortunately, nursing home staff is often so accustomed to “putting out fires” that they feel like they don’t have the time to prevent them from starting in the first place.

Much of what we’ve talked about these past few months is really this…prevention! Engaging residents in activities to keep them from feeling bored, agitated or useless; taking a closer look at the environment and habits of staff to see how it may result in negative behaviors; keeping residents active and taking them outside so they can enjoy the many benefits of physical activity and sunshine…all can lead to reduced negative behaviors related to dementia.

Take a moment to discuss with some staff or think about an incident that occurred recently that could have been prevented had it been handled differently. We’d love to hear some examples from you.

Have a great week!

Spontaneous activities

Hello everyone,

Many nursing homes have dedicated “activity personnel” who coordinate activity programs for residents, which include events such as bingo, trivia hour, musical entertainment and holiday crafts. Formal activities are important because they help residents socialize, get them out of their rooms, and sometimes (though we’d love to see more) encourage physical activity.

 Often though, scheduled activities occur at the same times each day and for some residents, these times don’t work well with their daily routines. Their sleep and energy patterns don’t always sync with what’s planned on the weekly calendar. Or they may not have the cognitive ability to participate in what’s planned. What then? Do they miss out on their only opportunity for activity, meaningful interaction and fun?

Encourage all staff to lead spontaneous activities throughout the day as their time permits and reward them when they do. Just 10 minutes here and there can make a big difference and prevent boredom and agitation in residents with dementia. Look around your environment…are there foam noodles, art supplies, and other things kept nearby that a GNA, nurse or even a family member can grab quickly? Have some music CD’s handy with a CD player in the common areas or near dining rooms. You’d be surprised at how quickly a dance party can start just by turning on some tunes! By providing GNA’s and other staff with these tools, they will have options to turn to when a resident could benefit from distraction and activity.

Have a great week, don’t forget to send us your short tidbits for our tidbit contest, and Happy New Year!

Coping strategies for evening agitation

Hello everyone,

“‘Twas the night before Christmas and all through the house, not a creature was stirring, not even a mouse…” But perhaps, some your residents are?

 People with dementia often struggle with restlessness, agitation, irritability or confusion that can begin or worsen in late afternoon and early evening, and can continue into the night. Commonly called “sundowning”, this phenomenon not only affects the person experiencing it, but can leave staff and other residents feeling frustrated and tired, and impact their mood and ability to function the next day.

 According to the National Institute on Aging (NIA), possible causes for sundowning include confused sleep-wake cycles due to disease-related brain changes, being overly tired, hunger, thirst, depression, pain and boredom. Signs of sundowning may include increased confusion or anxiety and behaviors such as pacing, wandering or yelling. The NIA has some helpful suggestions for coping with and preventing sundowning: https://www.nia.nih.gov/health/tips-coping-sundowningutm_source=20171219_sundowning&utm_medium=email&utm_campaign=ealert

Some of their tips include:

  • Try to determine the cause of the resident’s behavior and address it.
  • If person becomes agitated, listen calmly to his/her concerns and frustrations and try to reassure the person that everything is ok.
  • Reduce noise, clutter, or the number of people in a room.
  • Distract the person with a favorite snack, object or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar and fun TV show (not the news!).
  • Make early evening a quiet time. Play soothing music or encourage a family member or friend to call during this time.
  • Close curtains at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.
  • Go outside (or at least site by a window) since sunlight exposure can help reset a person’s body clock
  • Participate in physical activity every day. This can be a formal exercise class, or simply going for walks and participating in self-care.
  • Keep naps short and not too late in the day.
  • Get enough rest at night.

Sundowning can be exacerbated by serving coffee, cola or other caffeinated drinks late in the day; serving alcoholic drinks, which can add to confusion and anxiety; and too many activities during the day.

Finally, if these approaches don’t help, a medical exam may be needed to rule out pain, a sleep disorder or other illness, or a medication side effect.

We wish you all a happy and healthy holiday, and don’t forget to send us your tidbits for our tidbit contest!!

Holiday tidbit contest

Hello everyone,

In order to get everyone into the holiday spirit, we are excited to announce our Holiday Tidbit Contest! As you celebrate the holidays with residents at your facility, consider person-centered approaches to help decrease behavioral and psychological symptoms of dementia.

 For example, music is a big part of the holidays, so try playing classic holiday songs during care activities or while writing out Christmas cards with residents. Ask visitors to take residents for walks around the facility to look at the holiday decorations. Do you have residents who liked to bake? Host a cookie decorating party for residents and their guests. You can supply the pre-baked cookies, and residents can add the icing and sprinkles. Messy, but fun! Keep in mind that for some residents, the extra “hustle and bustle” around the holidays can be too much stimulation for them, and they may need extra breaks throughout the day for quiet time and rest.

 This article from Daily Caring.com has some great tips and ideas too:

http://dailycaring.com/5-best-alzheimers-holiday-tips-for-an-enjoyable-season/?utm_source=DailyCaring&utm_campaign=e65bccd561-DC_Email_2017-12-11&utm_medium=email&utm_term=0_57c250b62e-e65bccd561-123152321

 Email your tidbit (it only has to be a paragraph!) to Erin Vigne (vigne1@verizon.net) by January 7th. Those who send in the winning tidbits will win a prize for their facility!

Have a great week, and we can’t wait to read YOUR tidbits!

Non-verbal communication techniques

Hello everyone,

DailyCaring.com has a great piece this week about non-verbal communication with people with dementia. Sometimes our words are misunderstood, and body language can say far more. Take a moment to read more (link to article is below) about the 6 nonverbal communication techniques that can make caregiving easier with your residents:

  • Be patient and calm
  • Keep voice, face and body relaxed and positive
  • Be consistent
  • Make eye contact and respect personal space
  • Use gentle touch to reassure
  • Observe their nonverbal reactions

Have a great week!