Archive for June, 2010

Posted on June 12, 2010 - by Nurse Virginia

CONFESSIONS OF A NURSING HOME NURSE, WHAT WERE WE THINKING?

(Part II)
When I look back twenty, twenty-five years ago at routine nursing practice then, my first thought is “What were we thinking?”  Thinking we were reorienting a confused person, looking for their mother, by saying “You are old, how old would your mother be? Your mother is dead.” We would physically tape elderly confused people to their side rails, to keep them in place, so we could do their wound treatments. Our practices certainly weren’t kind, why did we do it?

We thought we were there for our patients, in fact would have been very offended at any other suggestion. But the truth is we were there for the task. We were so task oriented, we talked about the jobs to be done and seldom talked about the person we were taking care of.

Routine wound treatment for bed sores -then:
Swabbing the open wound area with a betadine solution or some other solution to “dry” the area, which made the skin tough as leather – causing hard edges around the wounds that took long periods of time to heal.
Having the wound “open to air.” Which meant if the open wound was on your butt, (which it most likely was because we had you sit in the same position for long periods of time in a wet incontinent product) to have the area open to air every shift meant that you were laying in bed on your side with your bottom exposed for long periods of time.
If the elder had a deep open area – they routinely had an order for a “20 minute, heat lamp treatment every day.” This meant not only was your bottom exposed, we now highlighted that area by illuminating it, in case anyone passing your room walking down the hall missed what was going on in that room.  Privacy – no, no one has the time to sit with you and we need to check on you, so that door was staying open.
If you were confused or wouldn’t stay in place for your “treatment” we had an answer for that too – we just taped you to the side rail. Yes, we turned the elderly person on their side, bottom exposed, and propped them there with pillows. Then as extra insurance to get that job done, taped them on their bare skin, with long strips of paper tape to the side rail of the bed they were facing.
What were we thinking?

What if you had Alzheimer’s disease and woke up early every day looking for your Mother? The thinking of the time was to re-orientate the confused elder to the reality of the situation. So that elderly confused woman, was greeted each and every morning when looking for her mother, with the good news, “You are old, your mothers dead, how old do you think your mother would be if she were still living?” If the elder was insistent about looking for her mother, the kind caregiver would take the insistent elder to a mirror, to show her how old she was, and prove her point.  What were we thinking?

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.plesegettoknowme.com

Posted on June 10, 2010 - by Nurse Virginia

CONFESSIONS OF A NURSING HOME NURSE, WHAT WERE WE THINKING?

(Part I)

I fondly remember a wonderful nurse, some 25 years ago. She was the day shift supervisor, in a large facility, that was part of a well known chain. She “rallied the troops” every morning by going unit to unit saying “We’re in the trenches, everybody has to pitch in.” This might have been motivational, of a sort, for the staff. But with the benefit of time and a different perspective, it sure makes a person uncomfortable. I don’t know think what those nursing home residents must have thought.

Why the battle cry? Why was taking care of these elderly people thought to be a fight? Who really was the enemy?  If I ran into that nurse today I would embrace her as the good nurse and friend she was. She wasn’t a bad person; she was a nurse that came from a military background, as so many did then. And she really felt the need to rally the troops everyday.

I remember being uncomfortable so many times in those days, for so many things that didn’t seem right, so many years ago.

25 YEARS AGO – HIPPA – YOU MUST BE KIDDING
Private, personal information? We lined all the residents in rows around the nurse’s station, wheelchairs sometimes three deep, facing the nurses. Then we gave “report” on everyone, with loud voices and the nursing assistants in attendance. Everybody got the low down on themselves and everyone else. If no one had the courtesy to tell a resident the results of their lab test, you can be sure the results would be read loud and clear right in the middle of the nurse’s station, during the next shift change.

Someone died during the night? All the details were everyone’s business the next time the shift changed. Was it expected or unexpected, was the family there, did they donate the elder’s belongings, we knew it all and it all was shared.

I especially remember a wonderful woman in her early eighties who always sat “front and center” in that row of residents. Her name was Gertrude and she was a retired nurse. I always wanted the retired nurses close to us, because they so loved the nurse’s station. But, Gertrude didn’t let anything go by her. When she was unhappy with the “report” she would take off her shoe and with amazing accuracy throw it over the nurse’s station and hit the offending nurse with her shoe. No one seemed to notice, that I would then ask a nursing assistant to “help Gertrude put her shoe back on.”  The Gertrude’s in nursing homes still need to be heard.

Many things have changed in our society over the last twenty-five years, some for the better, and some not so much. But, life in the nursing home? There we are at least going in the right direction.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know You – Aging with Dignity and Relevance
www.pleasegettoknowme.com

Posted on June 5, 2010 - by Nurse Virginia

COMMUNITY LIVING – LOVED BY THE YOUNG, DREADED BY THE ELDERLY

(Part II)

When young people move into the academic community, it’s time for the family to step back; however, it’s the reverse when the elder moves into the nursing home. During entrance into the nursing community elders need the family to step forward. The typical picture of elders in the nursing community is one of hopelessness and helplessness. Often the family feels much the same way.

Through a lifetime of experience, many times elders have gone through the grieving process. The way in which they handled grief in the past can support them through this time of further loss and grieving. During times of grief and loss, the last thing they want is something new, and yet new seems to be all they have.

Many become angry or resentful. These are normal reactions to grief. Along with that is the need to find someone or organization to blame. It’s usually safe to blame family members as they express their anger, resentment, and frustration. Elders are wise enough to realize that if they express their frustration toward the nursing staff they may be perceived as being difficult.

Families can help new residents avoid being labeled as difficult. They can do that most effectively by taking an active role in the nursing community team.

Book excerpt: Please Get To Know Me – Aging with Dignity and Relevance
_________________________________________________________

I wrote this book because of the strong feelings people have towards nursing homes. Because of the many families I have seen, so uncomfortable visiting. The families, who don’t know what to say anymore to their Mom, except to quiz her on what she had for lunch. The families, who feel quilt about Mom being in a nursing home and so find fault with the staff.
Learn how to become an effective part of the team caring for your loved one in the nursing home.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com

Posted on June 2, 2010 - by Nurse Virginia

COMMUNITY LIVING – LOVED BY THE YOUNG AND DREADED BY THE ELDERLY

(Part I)

Sometimes in our lives, most of us encounter the necessity of community living. We may look on those times with anticipation, excitement, joy, gratitude, and pride. It’s much like an eighteen-year-old leaving for college after she has earned her place through academic achievement and parental financial sacrifice.

However, entry into the nursing-home community is rarely met with excitement or happy anticipation. Elders seldom do it voluntarily.

Unlike the young college freshman, elders rarely anticipate the people they might meet, or relationships they’ll form, or value the learning opportunities before them.

The big difference is that elders don’t move on to the next upward step in their careers. They don’t see community living as preparation for the next step in life or as a desirable stage of life. For elders, this is the final step. Just the idea of the final step can be depressing and disheartening. Or, it can be an invigorating climax to a well-lived life.

Like college students, the elder may have roommates, their own share of personal space, and get used to community shower rooms. They eat many times in cafeteria style off a tray at a table with strangers. They can also make new friends and enjoy rich experiences.

Family members need to help the elders focus positively on such transition. Elders tend to see their entry into such communities as the end of a long line of experienced losses. They have lost homes and possessions accumulated over a lifetime. They’ve lost relationships and companionship through death, disability and frailty, and they no longer have the challenge of learning and growing.

Book Excerpt: Please Get To Know Me – Aging with Dignity and Relevance
____________________________________________________

One day many years ago, I was the nurse for an elderly woman who had just moved into the nursing home. Every night when I went in to check on her she was wide awake. I asked her why she couldn’t sleep. She then shared with me that at night, while in bed, in her mind, she went through her house. She mentally walked the rooms, opened closets looked at her clothes, opened drawers, and she could still picture where everything was. The elderly moving into a nursing home have suffered so many losses; we often forget the loss of their “things.” Tomorrow Part II of Community Living.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois

Posted on June 1, 2010 - by Nurse Virginia

GOOD SKIN CARE FOR ELDERLY- BEST WAY TO PREVENT CELLULITES

Bob ran into a bush while on his riding mower and a large branch hit him in the shin. His skin wasn’t broken, and he said later he had hardly felt it and” just kept going.”  Problem was Bob is 67, had a knee replacement in that leg and experiences decreased circulation in his lower extremities due to heart disease.

At first, it was a lump that just appeared on his shin the size of a small egg. The next day, it was painful and because of his knee replacement his wife insisted he go to the doctor.

Now, three days later and on an oral antibiotic, his leg is twice the size of the other and hot to the touch. His knee area is bright red and the leg is various shades of red and blue down to his ankle. Bob now has to go on a second antibiotic and if not successful, it will mean IV antibiotics in the hospital.

Signs and symptom of cellulites: (inflammation of the cells)

• Skin warm or hot to the touch
• Redness
• Pain
• Swelling
• Possible fever

Cellulites can occur anywhere on your body from your face to your toes. However there are certain areas much more susceptible. Lower legs are the most likely, especially for anyone with compromised circulation. Any break in the skin is an opportunity for bacteria to enter and start an infection. Be it insect bite, wound, ulcer, dermatitis, athlete’s foot or any opening in the skin that is an opportunity for infection.

Sometimes you don’t find an opening in the skin at all, as in the case of Bob. Just the trauma to the tissue was all he needed with his history of bad circulation to start a cellulites.

Skin is always the first line of defense against infection and keeping the skin in the best of condition requires diligence.  In 1859 a young chemist noticed that the men working on an oil rig in Pennsylvania were using a by product of the oil on their skin. It was a thick substance that formed a water barrier on their hands and aided in healing cuts. The young man took some of this substance and studied it, then named it Vaseline. Vaseline products continue to be one of the best ways to maintain soft skin. Keeping a jar of this old remedy in your medicine cabinet, might not be a bad idea, I do.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com