Friday, July 29, 2011

Patient Violence Against Healthcare Staff (Research, Video 2:46)

The first time I saw a female nursing home resident with dementia attack a female nursing assistant (CNA), I really wasn’t surprised. Violence has become so embedded in our society that it’s expected, even in healthcare facilities. I was a hospice volunteer in an urban nursing home. The incident happened so quickly, I almost missed the facial punch that struck the CNA so hard I thought she would fall to the floor. What followed the punch is what impressed me most. There was a brief pause while the CNA steadied herself and walked away. Another CNA immediately interceded and calmed the resident who may have forgotten what she did later.

Long-tern care staff members are at high risk for experiencing aggression from residents. They need ongoing safety information to prepare themselves. Reported in the Journal of Clinical Nursing, results of a focus group study involving the interviewing of 30 nursing home staff caregivers revealed these three caregiver themes regarding patient aggression:

1)   Caregiver explanations regarding the occurrence of aggressive behavior and contributions of residents and caregivers
2)   Measures for handling the aggression of residents
3)   Caregiver self protection and coping with aggression

While staff caregivers use many interventions to reduce aggression, too often they ignore their own practical knowledge about connections between aggressive behavior, pain, and other physiological issues that may cause aggression. More education and emphasis on a systematic approach, including factors leading to aggression, is needed to help staff caregivers better manage resident aggression and their own coping strategies.

This video reminds us that violence against healthcare workers impacts everyone:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Friday, July 22, 2011

Hospice Chaplains: Who Wants Them? (Research, Video 1:11)

Being diagnosed as terminally ill can trigger many thoughts in a person’s mind. Considerations may include if or how their lives matter, what they can do to make their final journey more productive, what happens after death. For those who are inclined toward beliefs in religious or spiritual truths, the hospice chaplain is someone they may want to counsel them with answers.

What do patients expect to receive from hospice chaplain visitation? Who are the people who request this support? Why are these visits important to them? These are questions that the Department of Chaplain Services at the Mayo Clinic in Minnesota researched with 4500 eligible medical and hospital patients in Minnesota, Arizona, and Florida. About one-third of the mostly male, married, over age 55 Protestants and Catholics responded from each site with these results:

1)   Nearly 70% of patients reported wanting chaplain visitation.
2)   Chaplains visited 43%.
3)   Indicating that visitation by a chaplain was important were 81% of patients.
4)   The strongest predictor of wanting chaplain visitation was denomination vs. no indicated religious affiliation.
5)   The most important reason for patients wanting chaplain visitation was that chaplains served as reminders of God's care and presence.

Being religiously affiliated is a very strong predictor of wanting chaplain visitation. In this video, Sig Jaeger, chaplain of Hospice Palm Beach County in Florida, and a patient share their mutually beneficial visitation experiences together:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Thursday, July 14, 2011

Nursebot Pearl, a Robotic Assistant for Older Adults (Video 5:21)

Meet Nursebot Pearl, a robot that will make you rethink your vision of how a caregiver can look and interact with you. Whenever I mention the use of robots for improving the quality of life of older adults, someone feels compelled to remind me that robots can’t replace people. I totally agree. But the reality is that people are living longer, and the population of older adults with ongoing health concerns continues to increase. Those living at home with chronic disorders are particularly in need of support that robotic technology can provide.

Several years ago, researchers from the University of Pittsburgh and Carnegie ‎Mellon University started the Personal Robotic Assistants for the Elderly project, an inter-‎disciplinary multi-university research initiative focused on robotic technology for the ‎elderly. The project goal is to develop mobile, personal-service robots that assist older adults suffering from chronic disorders in their everyday lives. Pearl continues to be researched and improved. The National Science Foundation funds her development.

A talking robot, Pearl’s face has interchangeable parts that display various emotions. Among many tasks, she can help seniors maintain their independence by reminding them about hygiene, medications, doctor’s visits, and other important information they might forget. She can send information remotely to caregivers and provide needed strength for manipulating objects. A major benefit for older adults living alone is the social interaction they can enjoy in her company.

Frances Shani Parker, Author

Friday, July 1, 2011

Dolls and Other Dementia Therapy (Research, Video 2:32)

 “What’s your baby’s name?” I asked while exploring my hospice dementia patient’s reality. Susan and her doll stared at each other, grinning as if they knew secrets from ancient times. And maybe they did. She looked at me, pointed to her doll and said, “She’ll tell you her name when you come back with cookies.”  (excerpt from my book Becoming Dead Right)

Patients with dementia find various stimuli engaging, some more than others. It’s important for caregivers to know which approaches are more likely to be successful when working with patients. The Research Institute on Aging of Charles E. Smith Life Communities in Maryland did research to determine stimulus engagement with193 residents of seven Maryland nursing homes. These results were reported in the American Journal of Geriatric Psychiatry:

1)      One-on-one socializing with a research assistant, a real baby, personalized stimuli based on the person's self-identity, a lifelike doll, a respite video, and envelopes to stamp were the most engaging stimuli.

2)      Refusal of stimuli was higher among those with higher levels of cognitive function and related to the stimulus' social appropriateness.

3)      Women showed more attention and had more positive attitudes for live social stimuli, simulated social stimuli, and artistic tasks than did men.

4)      Persons with comparatively higher levels of cognitive functioning were more likely to be engaged in manipulative and work tasks, whereas those with low levels of cognitive functioning spent relatively more time responding to social stimuli.

5)      The most effective stimuli did not differ for those most likely to be engaged and those least likely to be engaged.
Caregivers, particularly those in long-term care facilities, can use these dementia therapy research results when planning engagement stimuli and one-on-one socialization schedules for residents with dementia. This will help caregivers maximize benefits for patients.

As a hospice volunteer in Detroit nursing homes, I observed how easily many patients with dementia enjoyed their close relationships with dolls and stuffed animals. In this video, a daughter does doll therapy with her mother, who is past middle stage dementia. I found this video particularly interesting because, unlike many patients I have observed, this mother freely admits she knows her doll is not a real baby. But she still enjoys nurturing the doll and pretending it is real. The daughter wonders if the doll therapy is truly age appropriate for her mother. This video shares the mother’s response.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.