The key to working successfully with the aging is -** not efficiency (important as that is) but a life giving element spirit, and this element is love. Without love, work with the aging resident, in particular, becomes meaningless.
Achievement of the highest quality of care for geriatric residents requires the highest quality of professional leadership. Not every nurse is qualified to direct the care of these residents but if all staff members are imbued with a true love for the aging and are taught the necessary basic skills, the maximum level of care can be reached.
How Needs Are Met in Nursing Service
Total care demands that every geriatric resident be treated with complete understanding of the importance of all needs: spiritual, psychological, and social as well as physical. Every employee, every procedure, every piece of equipment used in resident care must be designed to contribute to the well-being of the residents.
Total needs can be met only when staff members on all levels are personally motivated to persuade residents that they really want to achieve the goals set for them by the doctors, nurses, and professional therapists, and encourage them to make the best possible use of every faculty they still possess to prevent regression and increasing infirmity.
Optimum levels of activity vary among individuals and according to the degree of physical deterioration. Obviously, excessive or stress-producing activities can do more harm than good, and the selection of the most beneficial kinds and levels of activities prescribed for each resident is more a matter of the art of perception than it is of science.
Fatigue, like stress, is a many-faceted experience- one for which no precise or adequate definition has ever been evolved. Fatigue refers to the condition of a body that has been weakened by prolonged stress. This may set the stage for various physical symptoms, the majority of which affect the circulation, the digestive tract, and the central nervous system. When a resident ¿5 enthusiastic, the fatigue disappears. Weariness and boredom in older persons may be engendered by lack of motivation.
It is the nurse's duty to make sure nothing happens that will be detrimental to the resident and to ascertain each individual's strengths and limitations. Possibly the greatest challenge in the field of aging is dealing with the mentally infirm. Whenever there is brain damage the possibilities for recovery are necessarily limited. One can, however, help reduce irritability and mood swings through an interpersonal relationship of understanding with these patients and the ability to convey this understanding.
Selection and Training of the Staff
The administrator and personnel director must have a very clear idea of exactly the type of person they require to achieve the maximum level of resident care, and the selection of each individual must be based on one's ability to perform the duties that will be assigned. The staff members selected must be willing to continue to learn by attending inservice education programs and applying the techniques they have learned to the care of residents. Also, they must understand themselves so they will not create problems when they work with the residents. We all need to have a deep understanding of ourselves before we can truly understand others.
While implementation of the program of resident-centered care is the focus of the nursing service director's attention, this preoccupation must not be to the exclusion of a high degree of sensitivity to the employees' own needs-for a sense of worth and dignity and a feeling of satisfaction in contributing to the overall goals of the nursing service. The director of nursing service also has a duty to keep abreast of trends in nursing education and the public's growing sophistication about health care, which, in turn, influences changes in nursing education at various levels.
In addition to possessing a genuine love for the aging, staff members of the home-on all levels and in all departments-need to have a feeling of awareness and concern for all residents, not just those for whom they are directly responsible. They must master (and accept the importance of) such techniques as recognition of a resident as an individual, constant encouragment of residents in their efforts to improve, persuasion of those who are reluctant to try to help themselves, and the uses of challenge, competition, and reassurance in building or restoring the residents' morale.
Professional staff members working in a home setting where residents are trying hard to reach a higher goal of independence need to recognize the tremendous contribution that is made by the LPNs, orderlies, aides, and other workers who give wholeheartedly of them selves to the residents. Often they develop a rapport that is essential when one is working day after day with persons whose physical and mental health are waning This applies to not only nurse's aides but also to foo(i service aides, recreational aides, and occupational therapy aides-indeed every person who comes close to the resident in the course of a day. Often they are closer than the professional staff for they are the ones who most directly affect the lives of residents.
Certainly, the physicians, nurses, physical therapists ministers, and other professional persons do have art influence on the residents, but much of their special techniques and abilities are relayed to those less-skilled individuals who nevertheless are the ones who convey to residents and family the thinking, the attitude and philosophy of the professional group.
To carry out an effective program that will meet the needs of all residents the nursing service director must work closely with the recreational director, physical therapist, occupational therapist, social service director, and the beautician. Even though the results of the ministrations of each of these services may not immediately visible each one has a very importanl contribution to make to the well-being of the residents;
In addition to the nursing director's meeting with the staff involved in direct resident care, there should be a daily department head meeting where total staff effort can be coordinated by the administrator. An atmos phere of freedom and permissiveness should prevail so all persons involved will express their true reactions and feelings and will be ready to listen to others and to share experiences. Thus, a common bond resulting in coordinated efforts is formed and renewed daily through these department head meetings.
To ensure that every employee understands the necessity for teamwork, the leadership must originate with administration. Administration needs to be totally informed of every facet of resident care, for only then can it effectively instill the proper spirit in the department heads. It does take time to develop a program that will be truly beneficial to the aging. The immediate leadership goal must be to achieve a proper attitude in every individual in an organization, starting with the department heads and the supervisory personnel. Those who need to change their ways, but are unable to change or who cannot be convinced of the importance of change, need to be guided to a different type of work-something that will be more compatible with their natures. Some personalities just aren't the type for working with older persons.
Employees need to be revitalized each day to meet the challenge that their duties entail. Working with residents in a long-term care facility is an intense and often exhausting job. It is up to those who care for the aging to gradually instill into the residents' hearts and minds a wholesome attitude toward the end of life. Unless an individual employee possesses the virtues of sympathy, charity, patience, generosity, kindness, understanding and forbearance, the employee's efforts will be shallow, haphazard, and soul-less.
To the degree that an employee is spurred on by love of God, as shown by a love for an elderly neighbor, will the success of the home be made manifest. A buoyant spirit can be maintained until the end of life, provided the will is there. The capacity for love, for work, for intellectual enjoyment, for play, for a thousand other joys can endure if there are understanding and love to support the aging in the hearts of those who care for them. We want to realize and give life to the knowledge that the physical and mental aspects of patient care can never be separated from the spiritual if proper and wholesome care is to be given to the aging. Nothing can be accomplished without spirit. When we think of spiritual life, we think of that vibrant, forceful something that gives to the individual a thirst for living. Spirit is necessary in every phase of life and in all that we do.
Effective Staff Communication
A successful ongoing organization is not possible of achievement without an effective system of communications that reaches out from the administration to all departments and back to the administration from the departments.
Many nursing homes and other long-term care facilities have benefited from issuing a daily report on the accomplishments of the previous day and the plans for each new day. Such reports are helpful in keeping all departments aware of what is going on in all areas of the home. This daily morning report includes all the department heads, such as occupational therapy, physical therapy, recreational therapy, social service, and nursing service. One of the reasons for relating the happenings of the previous day is in order that the staff can comment to residents-recognizing their efforts and encouraging them to further accomplishments. Plans for the coming day are set forth so individual residents can be motivated by the personnel to complete any projects they have been working on or to start new ones.
Once a week an activities meeting should be scheduled at which the total personality needs of several residents are reviewed and the course of action to be followed is outlined. Each department head comments on the role the department has played in meeting the needs of each resident discussed. An evaluation is helpful in revealing whether the goals have or have not been reached. It also helps in formulating new approaches to encouraging the residents to continue their therapy program.
Speaking to residents about coming events, showing interest when they are participating, complimenting them after they have accomplished a task, and relating with residents after a_n event such as an art show or a special program is over is within the power of every staff member and should be an integral part of one's duties. Reports, discussion and evaluation of residents' responses iind progress are extremely important in a home inasmuch as every employee must be interested in every resident.
The resident's energy must not be over-taxed and sufficient time needs to be given to the nursing care functions that help meet the physical and emotional needs of all residents. One excellent means for coordinating the work of all departments in a home is the Master Chart which provides an overview of the resident care plan at a glance. In addition, a daily report on each resident should be turned in by the orderlies, aides or nurses to the nursing service director and the head nurse on each floor (Fig. 1).
Activities and Motivation
Activity and interest mean living purposefully to the end of one's days, while inactivity means death-if not for the body at least for those qualities of mind and spirit that make life an adventure to the end. When one is happy and content and looking forward to each new day, one's spiritual life is bound to grow. This, of course, is one's first concern. If people have an "I dpn't care" attitude, there is usually a carry-over into their spiritual life. Helping to fill residents' days with joy and contentment, then, is a real challenge.
Various activities are helpful to the aging. The value of an activity for the individual is not measured so much by the end product but by what the activity does for the individual as the product is being created. Many residents take personal pride in what they are doing. This is apparent as one sees residents working to perfect a craft to the best of their ability, in spite of their infirmity. The aging need to have visible proof thar they still can do something creative. This is, in effect, a natural reassurance of their self-worth.
Occupational therapy programs should concentrate mainly on the residents who are incapable of doing something without help. It is within this group, whose avenues of accomplishment are limited, that con- centrated efforts need to be placed. We do not want the disabled or infirm to be without the consolation on creating something. While it is true that peace and happiness cannot be sought outside of oneself, we realize that opportunity and circumstances can help or hinder one in efforts to achieve peace and happiness.
The director of the program and the occupational therapy aide need to visit the mentally infirm who are in need of further assistance, with special attention given to those who are also paralytic, arthritic, or physically infirm. Every effort needs to be made to tailor activities to meet the needs of each individual.
Motivation needs to come from within the individua person. Residents of a home must want to do something for some specific reason. Helping them to set a goal is important. The goal-or goals-should not be set too high; they must be within the reach of the person's physical and mental capabilities. If a resident can accomplish some activity undertaken, that person gradually will increase in self-confidence and self- reliance. Self-confidence born of certainty is a natural result after repeated successes. When a resident is confident, that person will tend to be less dependent and regain some self-respect that may have been lost following physical or psychological damage caused by illness. J
We recognize that in group living it is difficult to meet all the needs of each person. The natural setting is not generally conducive to independence. Giving a handicapped person opportunities for self-expression is one of the best ways to increase independence, but it is one of the hardest to accomplish when one is afflicted with a disability or handicap. Solving this problem requires the exercise of real ingenuity on the part of every staff member.
Stimulating self-motivation in residents cannot be accomplished by one person working alone. It needs to be understood and fostered by every staff member volunteer, relative or friend of the resident. Recog- nizing the good and the potential of a resident is the first step; then a resident needs to be helped to self- motivation in order to use ability to its full capacity. This is the challenge that staff, volunteers, and relatives need to accomplish as a team.
In each person's life there needs to be a goal. This is true for all of us-not only a final goal but also a proximate goal. Why do we undertake a project or perform a certain work? Time has proved in working with the aging that if residents work toward an Immediate goal, there is greater enthusiasm and zeal, Nursing home staff members have noted this as the residents unite to help toward building funds, mis- sions, community projects, and giving to the poor and the needy. Many older people have given much to others during their lives. Many desire to keep on giving, This desire should have avenues for expression in our nursing homes. Projects such as fixing toys for poor children or making and fixing clothing for the needy are ways that residents can give expression to their desire to help others. Residents in some homes hold regular get-togethers and call them "salvaging bees." Anyone, includingwheelchair residents, can contribute by lending a hand by repairing, sewing, mending, ironing, sorting, preparing and making ready items to be sent to those in need. We have seen the stimulating effect of one resident upon another. Seeing the results of another resident's efforts in the therapy program has stirred other residents to produce a worthwhile project. Employees can do much by discussing the program with enthusiasm and zeal. Relatives, too, have a very important part to play.
If all the residents in a home realize that it is a home and that everyone is interested in their welfare, appearance and accomplishments, they are going to want to do more and meet the challenges of living life to its fullest.
Evaluating Results of Programs
Evaluating the results of the employees' united efforts for the residents' welfare is important for every staff member, and especially for the nursing service director and other department heads. Every minute step toward progress or advancement by a resident is an added joy for every member of the staff. If a resident shows even a little interest in life or a brighter gleam in one's eye, the staff is rewarded for its concentrated efforts for the resident's benefit. They then reap the fruit of their labors because they have set another person on the road to truer self-fulfillment, greater self- confidence, honest pride, noticeable self-confidence and enhanced self-respect-even though a resident still has the handicap of an unmended disability.
This, then, is the opportunity, the challenge and the privilege for all who work with the aging in a long-term care facility.