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!

Describing behaviors- The first part of DICE, a tool to assess and manage behaviors

First off, congratulations to Future Care Irvington, who sent in the winning tidbit for our contest!!! We asked you to send us tips for how you get your more challenging residents to bathe. A nursing assistant at Future Care Irvington said she gives verbal cues to her resident, one step at time, and talks to the resident about her interests while bathing. Great job, Natalie, and keep up the good work!

Today we are going tackle the first part of DICE, a tool you can use to assess and manage behavior change in people with dementia. DICE stands for:

  • Describe the behavior
  • Investigate the influence of things like cognitive status, environment, caregiver approach, physical/medical disorders, and psychiatric symptoms
  • Create a plan
  • Evaluate if it works
  • (Kales, Gitlin, Lyketsos, 2014, JAGS)

It helps to approach this process as a detective would approach an unsolved mystery. Just like detectives, GNAs and nurses often receive vague and incomplete information, they manage multiple responsibilities, they have developed a good intuition based on experience and familiarity, and may have to prove their case to others in order to move forward with an intervention.

The first step, effectively describing a person’s behavior, is critical as it sets the foundation for the investigation. A detailed description of a resident’s behavior should include:

  • Frequency (every week, day, hour, 10 minutes?)
  • Duration (Does the behavior go on for an afternoon? An hour? A few minutes? When does it stop?)
  • Setting (In common area? Shower room? Bedroom?)
  • Who is involved? (Specific caregivers? Other residents? Other staff?)
  • What was happening right before the behavior began?
  • Be specific…just saying someone is “often agitated” is not enough. Instead, “Resident repeatedly hits call bell before each meal every day, and when GNA arrives, just mumbles and complains about the food” is far more helpful information. You can probably come up with a few theories of what the problem could be just based on those few details!

We’d like you to spend some time this week discussing with staff how they describe behaviors of residents that need to be addressed. How does being more specific offer additional clues as to the cause of the behavior?

Next week we’ll focus on the second step of DICE, Investigation.