AC FFC Tidbit of the Week for March 26, 2023: Have you laughed at work today?

We often include cartoons in our weekly tidbits, and there’s a reason for that—humor helps us get through life! Especially through the tough times. Back in April of 2019, the Atlanta Journal-Constitution published an article by Rose Kennedy on humor in nursing. Here’s an excerpt:

 “Sharon Mawby, MSN, RN, NEA-BC can attest to the power of humor. As the vice president of Patient Care Services and CNO at Emory Decatur, she knows well how fast-paced and stressful the nursing work environment can be. “As a result, nurses, who are often at the very center of care with patients and families, can become overwhelmed and burned out,” she says.

“We know that laughter relieves stress, so when nurses take the time to share stories and laughter with their colleagues, they build a sense of community within their teams. After all, nursing is a team effort.”

Here’s a link to the full article: https://www.ajc.com/lifestyles/medical/how-find-humor-nursing-laughter-the-best-medicine/7OfsNKdVjZbDYsEO2ERFQL/

Another article on humor in nursing (https://www.healthecareers.com/articles/career/humor-can-make-nurses-more-productive-relieve-stress-on-the-job) includes tips from Karyn Buxman, a nurse, writer and speaker who uses her expertise to share how nurses can use humor to relieve stress at work. A few of her suggestions:

• Raise your awareness and start listening, and you’ll likely see humor that you didn’t notice before. For example, she tells the story of a nurse asking a visitor to the unit, “Are you the patient’s closest relative?” The visitor replied, “No, I live 30 miles away.”  And there’s this notation on a patient’s chart: “The patient fell in July and has been going downhill ever since.”
• Put up baby pictures of staff and let people guess who’s who.
• Be sure to include patients in the humor too…tell them why you are laughing so they understand that the laughing isn’t directed at him/her. Be careful to laugh WITH your patients, not AT them.
• Remember that humor can be seen as an important leadership skill to help bring people together.

How do you and your team relieve stress? Do you share humorous stories with each other so you can laugh together? Let us know, and have a great week!

AC FFC Tidbit of the Week for March 19, 2023: Don’t Give up on FFC

Did you miss us last week? You might have noticed that we didn’t send a tidbit —there were a few good reasons why, but nobody likes excuses, right? The thing is, we’re back now and ready to pick up where we left off.

Speaking of picking up and moving forward, when you’re trying to perform Function Focused Care (FFC) with your patients, do you sometimes hit a “bump in the road” where you feel like you haven’t done as much as you could have? Or faced challenges that you weren’t sure how to overcome? It happens to everyone, and it’s not a reason to give up on FFC altogether.

Take moment to reflect on a few opportunities you have missed to encourage a patient to get out of bed and walk or participate more in their morning care. Consider what prevented you from performing FFC, and what you could have done differently. By identifying the barriers you faced and thinking about how you could have overcome them, you’ll more ready to set yourself up for success next time!

AC FFC Tidbit of the Week for March 5, 2023: Are We Having Fun Yet?

We know most people wouldn’t describe a hospital stay as “fun”, but making the most of difficult situations is a talent of nurses! As we talk about getting your patients up and walking, and engaging in function focused care, think about what motivates them. It can be something simple and immediate—especially for patients with dementia who are living in the moment. Playing a favorite song while exercising or walking, or offering a piece of candy once you reach your destination on a walk can help patients view the activity as more fun and less work. If your patient normally lives in a nursing home or assisted living, they are likely used to fun activities going on around them, and this may help their hospital stay feel more familiar.

Also, are you having fun? Your body language, tone of voice and facial expression projects how you feel about an activity, so if you look and sound like you are happy to engage a patient in function focused care or take them on walk to look out the window or visit the nurses station for a piece of candy, the patient may be more likely to participate too.

Have a great week!

AC FFC Tidbit of the Week for February 26, 2023: FFC and PT Go Hand-in-Hand

Having your nursing team perform function focused care with residents can help physical therapists reach their patient goals too. Rather than competing with therapy, function focused care provided by the nursing team complements the specific rehabilitation work that a patient is doing in physical therapy, and both have the shared goals of optimizing the function and mobility of your patients.

Physical therapy (PT) is about determining the root cause of a function deficit, learning what body system is causing the problem, and addressing the specific deficit with rehabilitation therapy. In contrast, mobility is global and involves basic functions like walking, transferring, and performing activities of daily living, which can be encouraged by the nursing team through cuing, role modeling and encouragement.

The Key Point: The nursing team is not derailing the PT intervention with daily Function Focused Care. They may have different approaches, but they share the same goal.

If your nursing team is hesitant to get patients up and moving without the presence or approval of a physical therapist, it may be because they aren’t as confident in their skills to do this and fear the patient may fall. It may also be because they don’t want to “interfere” with a PT’s plan of care. Consider inviting PT to your next staff huddle to talk about their role and provide tips for getting patients up and moving to help your team feel more comfortable doing this. 

AC FFC Tidbit of the Week for February 19, 2023: Simple Sit-to-Stands Can Have Big Rewards

Helping your patients do sit-to-stands each day can help them maintain their ability to transfer, and make your job easier too! Sit-to-stands are simply the action of standing up from a seated position and sitting down in a controlled manner. Patients can use the hallway handrail for balance when standing and sitting if needed. Start by doing a few, then try to do a several more each session. Singing or playing a song while engaging the patient in the sit-to-stand activity (see temptation bundling tidbit from last week!) can help motivate reluctant patients to participate. Also, remind patients that by doing these exercises, this can help them more easily transfer on and off the toilet (nobody likes bedpans) and into and out of bed.

A study from 2015 found that nursing home residents with dementia who performed sit-to-stands daily with the help of nursing aides during day and evening shifts experienced less decline in mobility and functional outcomes. Read more about the study here: https://www.jamda.com/article/S1525-8610(14)00479-4/fulltext

In short—sit-to-stands are a simple, practical, no-cost way to help your patients maintain their strength and ability to transfer, and can therefore help you care for them more easily.

Have a great week!

P.S. Check out past tidbits on our website: https://functionfocusedcare.wordpress.com/tidbit-of-the-week/

AC FFC Tidbit of the Week for February 12, 2023: Temptation Bundling

Have you ever waited to watch your favorite show so you could enjoy it while walking on the treadmill? There’s a term for that—temptation bundling. It means pairing a pleasurable indulgence (favorite TV show) with a behavior that provides delayed rewards (like exercise), thereby by making behaviors with delayed benefits more instantly-gratifying and increasing our likelihood of engaging in those beneficial behaviors. 

As you consider ways to get your patients motivated to move more and engage in function focused care, think about temptation bundling! Instead of simply asking them to go for walk to help maintain their strength (which it does), you can walk to the nurse’s station to get a piece of candy or see a favorite team member. You could also play a patient’s favorite song while she’s washing her face and brushing teeth or walking to the bathroom. This helps make activities more fun and rewarding for both patients and staff!

Can you think of other examples where you can provide immediate rewards to patients when they go for a walk, do sit-to-stand exercises, transfer to a chair, or participate in dressing and washing up, beyond the significant health benefits we already know?

To read on article about a study done on temptation building visit, https://doi.org/10.1016/j.obhdp.2020.09.003

AC FFC Tidbit of the Week for February 5, 2023: Don’t D/C without FFC!

Your patient is ready to be discharged from the hospital and her family members are relieved to finally be getting their loved one back home to a familiar setting, since she has dementia and the hospital stay has been confusing for her. You’ve got the list of medications and follow-up appointments to review with them, but are you missing something?

Your unit has been working on integrating Function Focused Care (FFC) with patients who have dementia, and the nursing staff has done a great job getting this patient walking and encouraging her to participate in her own care, like washing her face, brushing her teeth and even getting dressed. While family members may be focused on other issues like new medications during a discharge meeting, remember that including the need for physical activity and providing function focused care through role modeling and cuing is just as important for the wellbeing of their loved one. If you, as the trusted healthcare provider, take the time to discuss the importance of physical activity and function focused care during your discharge teaching, then caregivers may better perceive this to be a priority and follow through with it. Be specific and use examples in your teaching, and ask family members what activities they feel they can do with their loved one at home.

We’ve attached a simple template for a FFC Care Plan after a hospital stay that you can use during discharge teaching and help family members develop a daily schedule. It includes an example of a daily schedule with activity ideas. Review this with family members during the discharge meeting, and encourage them to add their own thoughts and ideas to the plan with you, addressing concerns they may raise as you go.

post-hospitalplan_revised-8.2.18Download

AC FFC Tidbit of the Week for January 29, 2023: Fall Prevention Buffet–Something for Everyone

Many factors can lead to falls, so it makes sense that multiple approaches be used to prevent them. Research repeatedly shows that fall prevention interventions with a multi-component approach (not including the one you see in the cartoon below!) that include input from all members of the interdisciplinary team are most successful. Examples of these approaches include:

• Educating your team about preventing falls (remember that education alone is not sufficient!)
• Using your facility’s  mobility assessment tool (such as the UMOVE at University of Maryland hospitals)
• Helping patients perform exercises that we know can effectively decrease fall risk (such as those that improve balance and resistance exercises)
• Deprescribing medications that increase fall risk (such as psychotropic medications and opioids)
• Decreasing environmental risks (removing clutter, having appropriate seating in areas where patients may walk, and making sure patients can easily access glasses, hearing aids, walker)
• Addressing pain, sleep, delirium, and sensory changes

A key point is that the approaches used need to be individualized for each patient and focus on their specific risks for falling. This could mean prioritizing deprescribing medications and facilitating exercise for one patient and, for another patient, might include making some changes to their environment and reducing their anxiety.

Just as a salad buffet allows you to pick and choose certain foods to your liking—and who gets just one item at a buffet?—fall prevention requires a variety of individualized interventions. While this requires planning, communication, and teamwork, the end result—a patient who is free of falls and maintains their strength, function and mobility  while in your care—is well worth the effort.

AC FFC Tidbit of the Week for January 22, 2023: Conflicting Goals?

Do you sometimes feel torn between preventing patient falls and getting your patients up and walking? You know that helping patients maintain their strength through mobility can help reduce their risk of falling when they return home. But, having a patient fall while walking is something everyone wants to avoid, especially as it can result in patient injury and a longer hospital stay.

Remember that your hospital has tools that can help you determine what level of mobility your patient can safely engage in. Once you determine this, you can help your patient mobilize to the level that is appropriate for them, while doing your best to keep them as strong as possible during their stay.  The UMOVE assessment is an example of one that is used in the University of Maryland hospital system. You and your team can consistently use this assessment (or a similar one at your hospital) and feel confident that you are safely engaging your patients in mobility.

The two goals of patient mobility and fall prevention do not have to be in conflict—they can both be achieved when the available tools are used, information is communicated, and team members work together!

AC FFC Tidbit of the Week for January 15, 2023: Swap your Sitters for Staff AND…Contest Winner!

Most nursing homes require a patient to be “sitter-free” for 24 hours before admitting them from the hospital. This can be a challenge for acute care hospitals that have patients with dementia, and can hold up patient discharges from these busy units.

One of the teams participating in our FFC study came up with a great solution. Their nursing team takes turns spending 2-hour shifts with patients who are awaiting discharge but have needed a sitter. During their 2-hour turns, the nurses occupy the patients’ time with activities and getting them walking!  The nurses loved it, as it gave them a 2-hour break from other duties, and the patients benefit by having a chance to walk and be mobile rather than sit in bed or be restrained. The extra mobility time helps them prepare to go the nursing home, and can decrease their fall risk once they are there. We encourage you to give this a try!

Also, we are delighted to announce our FFC Self-Feeding Holiday Contest Winner! Congratulations to the 7^th floor at St. Joseph’s Medical Center, and a special shout-out to Rachel Harding, RN, the floor’s FFC champion!!! The team on the 7^th floor used function focused care interventions to optimize self-feeding for more than 30 patients over the past 2 months. Great job, and keep up the terrific work!