Readers of the Journal of Gerontological Nursing responded to the following question:
What are your best sources of help for resident tare problems?
For a nurse who works mainly on assessments and care planning, I find I have varied sources all of which are pieces of a puzzle to be solved. Resources start with the resident and his family and continue through "expert" consultation. But the best will always be the resident. He/she has the key.
Mary F. Dobbins, RN
Resident Care Coordinator
Evergreen Health Care Center
Stafford Springs, Connecticut
Other experienced nursing staff (RNs, MDs, CRNPs) and nursing magazines.
Pead Been, ADN, RN
St. John Specialty Care Center
Journai of Gerontological Nursing, J Toward Healthy Aging, American journal of Nursing, Generations, Journal of the American Geriatrics Society, The Nurse Practitioner and The Gerontologist.
Sheila Flodberg, MS, MEd, BSN, RN
Geriatric Nurse Practitioner/Director of Nursing
Religious of the Sacred Heart/Oakwooa1
The comprehensive team care planning approach
Deborah N. Dunham
Elderlink - Fairfax County AAA
When I have a problem with resident care, I talk with the Director of Nursing. In most instances I am satisfied with the interaction and changes are made. In very rare instances, I need to use the administrator. However, I believe that the Director of Nursing has ultimate responsibility for the resident's care and should be the best source. It behooves Directors of Nursing to take that responsibility and be the "change agent."
Andrea dayman, MSN, RN
Geriatric Nurse Practitioner
Baton Rouge, Louisiana
Periodicals such as this one. I also have a support network with other Directors of Nursing.
Irene L Fanning, RN
Director of Nursing
Life Care Center of Evergreen
As long-term care strives to deliver more individualized and resident-focused service the number of resident care problems identified and the resources required to resolve them increases.
The best source for help with care issues is a well-educated staff. We accomplish this by integrating and understanding emerging knowledge and innovative approaches noted in journals, texts, and conferences. As staff becomes educated in the causes of care problems their repertoire of solutions and adaptations grows. Education also assists staff in becoming sensitive to the aging process and the difficulties which may accompany it.
Another source for help with resident care problems is the comprehensive assessment. This often includes information from the family. Of particular value is data concerning lifelong patterns, habits, values, moods, attitudes and communication style. As part of the assessment quantitatively and objectively mapping and monitoring behaviors assists in detennining the cause of the care problem. We have found a modified version of CohenMansfield's Agitation Instrument and A Behavior Monitor Log from the University of Pennsylvania School of Nursing useful.
A third valuable source of help with resident care problems is the interdisciplinary team care conference. Here, the expertise of different professions combine with direct care staff to contribute ideas and brainstorm solutions. The presence of the family and the resident can provide insight into a problem and interventions effecting a solution.
When physical and chemical restraints are removed, when care is individualized and focused on quality of life, "resident care problems" do emerge and must be resolved. Taking time to compassionately see life from the perspective of the older adult experiencing the care problem combined with ever-emerging knowledge of how to best meet the needs of this population will help long-term care s-t-r-e-t-c-h into the next millennium.
Mary Ann Anichini, RN, MS, CS
Geriatric Nurse Practitioner
St. Benedicts Home for the Aged
Research based journal articles, physicians, discussion with other nurses and other disciplines. There is not enough research in geriatric nursing. In the MSN program I am in, rarely do I meet a geriatric nurse who can discuss with me the needs of this population.
Elizabeth A. Cameron, RN, BSN
Marywood Nursing Care Center
My peers and colleagues; NADONA meetings, publications such as this one.
Betty A. Dale, RN, CDONA
Director of Nursing
Life Care Center of Vista
Literature such as magazines on gerontology and references books.
* Seminars such as behavior management in the elderly.
* Health care professionals such as physicians, therapists, psychiatrists and mental health specialists.
* Reference manuals/books that are most current maintain a knowledge base on current standards of practice.
* State agencies such as the Department of Licensure and Certification.
Kim Lovoy, RNC, NHA
Director of Quality Assurance
Long Term Care Corporate Office
This question was submitted by Editorial Board Member Gerì Richards Hall, MA, RN, CS, of the Mayo Clinic Scottsdaie, Scottsdale, Arizona. Dr. Hall responds.
The problem resident remains with us: posing significant and complex challenges. Prior to the last decade, nurses employed in longterm care settings often felt isolated when faced with challenging residents. Few had received formal training in long-term care settings or in meeting the special needs of people over age 75. Surprisingly few journal articles dealt with problems and issues of the long-term care resident. Associations for long-term care facilities existed, but primarily for administrative education and legislative concerns. In the past, many nurses were socialized to believe that asking for help indicated a lack of nursing skills.
Over the past 15 years the longterm industry has blossomed into a comprehensive health care delivery system with services limited only by the imaginations of providers. Yet one factor continues to contribute more to the antacid consumption of the nursing staff than most others: the difficult or challenging resident.
The answers provided on helpseeking reflect growing sophistication among long-term care nurses. Using the resident and family, interdisciplinary team members, and comprehensive assessments to individualize care suggests the increasing emphasis on aging education. Using expert resources including psychiatrists and care specialists helps to relieve the burden of having to "know it all."
Consultation with other nursing colleagues, attendance at educational meetings, obtaining materials from journals, research, and other print resources reflect the increasingly scholarly approach required to provide well-informed care. Awareness of political realities is demonstrated by the suggestion of consultation with the State Department of Licensing and Certification. Networking with colleagues and professional long-term care nursing organizations has become acceptable and desirable. Integrating information from multiple sources provides a comprehensive and balanced approach to the care of challenging elders.
Having been trained in the era of "Good Nurse" or "Bad Nurse" - having all the answers or just less than all the answers - it is rewarding to see the emergence of the "Professional Gerontological Nurse." By helping our colleagues utilize the vast richness of resources now available to us, we are in an excellent position to move gerontological nursing into the new millennium. There will always to difficult or problem residents, but with collaboration, the challenges will become fewer in nature and the interventions more effective.