AC FFC Tidbit of the Week for February 28, 2021: 10 Tips to Reduce Resistance to Care

As you integrate Function Focused Care with your patients with dementia, sometimes you will encounter resistance to care, especially during more intimate activities like bathing, dressing and oral care. This week we’re sharing 10 tips to help you decrease this resistance while encouraging your patient to participate in their own care:

  1. Approach is key! Assume a non-threatening posture: smile & speak in a pleasant tone of voice, keep arms open (not crossed), conduct care at patient’s eye level and from the side. Do not stand over the patient, as they can perceive this as a threat.
  2. Slow down care and ensure you are communicating clearly and explaining the task in a step-by-step process. (We’ll talk more about communicating with people with dementia in a future tidbit!)
  3. Encourage the person to do as much for themselves as they are able. Use role modeling, cueing, and tell them “great job” when they do it.
  4. Put objects needed for the task (e.g. comb, toothbrush, etc.) within their field of vision so they can find them easily.
  5. Remove objects that are unnecessary or distracting (like a TV remote that they can confuse with a hairbrush).
  6. Use your knowledge of a patient’s interests to invoke pleasant thoughts for the resident and build trust with them. Remember that “Get to Know Me” board we talked about a few weeks ago? This is where that comes in handy! The information about a person’s family, career, and hobbies can be nuggets of gold when you need to build trust and decrease resistance to care.
  7. Identify long-standing habits and adjust routines as needed. For example, if the patient does not like going into the bathroom to brush her teeth, bring a basin of water and toothbrush to her bedside instead.
  8. Have they had their pain medication yet? If you think the activity may be uncomfortable or painful, wait until they have had their pain medication before attempting the activity.
  9. Pay attention to the environment. Is it too noisy? Playing calming music of a favorite song of the resident may help. Is the room too dark or too bright? You may need to close the blinds or turn on lights. Is the room cold, especially for bathing? Grab an extra blanket or towels.
  10. Finally…Don’t forget the music! Music can reduce resistance to care behaviors during bath/shower time and meal time, as well as during other activities of daily living.

For a 10-minute overview on strategies to help reduce resistance to care, check out our quick Power Point video using the link below. You’ll be asked for your name and an email address to access the video:

https://register.gotowebinar.com/recording/5945403923400422664

AC FFC Tidbit of the Week for February 21, 2021: 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.

There are many other resources you can share with caregivers to help them integrate physical activity and FFC into daily life with their loved one. For example, the National Institute on Aging has just released a new booklet on exercise: “Get Fit for Life: Exercise & Physical Activity for Healthy Aging.”  This resource is easy to read and full of information about why exercise is important, what kinds of exercises improve health, overcoming barriers to exercise and tips for getting started after an illness or other break. The booklet is free and you can order up to 25 printed copies or download it as a pdf file, which includes links to many other resources and videos too.  Below is a page from the booklet that includes simple tips for helping a person with dementia stay active, which can help them maintain function, a regular sleep and toileting pattern, and improve mood. Remind caregivers that exercise has many benefits for them too, including helping to reduce stress!

Another great resource are the free, short videos on the Function Focused Care website. While these were developed to help show staff at long term care communities how to incorporate FFC into daily care and deal with challenges, the tips and strategies can be used by caregivers at home too.

So, think about your discharge teaching and how you can consistently add physical activity and function focused care to your normal list of items to discuss and review, especially for patients with dementia, as caregivers may not realize the critical role these play in the health and wellbeing of their loved one.

AC FFC Tidbit of the Week for February 14, 2021: Walk the Walk

Getting your patients walking early and often is extremely important and can have a major impact on their recovery and success once they leave the hospital. Once your patients are able to walk (no matter how slowly), it’s time to get moving!

Need some inspiration? Five years ago, nurses at the University of Wisconsin Hospital took part in a study that aimed to motivate nurses get patients walking and give them the tools to do it. It was a success! Here’s a link to a quick article about the study:

One of the quotes from the article that caught our attention was: “And we made a simple system for recording patient movement, and put whiteboards in each room for tracking a goal — three times a day — so that the nurses and patients would see it often,” Steege says. “Eventually, they had patients watching their boards and asking their nurses, ‘It’s getting kind of late, should we get that last walk in?’ ”

Can you imagine your patients asking you that? Talk with your colleagues and think about ways (like using white boards to track walking goals) that you can incorporate consistent walking routines on your unit.

And…walking isn’t just for patients. As you deal with the ongoing stress of COVID-19, remember to take time to walk yourself. Not just down the hospital hall, but outside in nature, if only for a few minutes! This recent article, “Don’t Underestimate the Power of a Walk,” by Deborah Grayson Riegal from Harvard Business Review talks about the many benefits walking offers for mental and emotional wellbeing, including perspective, connection, learning, gratitude and productivity. Read the full article—it’s a quick read and well worth 5 minutes: https://hbr.org/2021/02/dont-underestimate-the-power-of-a-walk?utm_source=pocket-newtab

AC FFC Tidbit of the Week for February 7, 2021: Make Mobility a Priority

This week we’re highlighting an essential reminder shared with us by the Penn State College of Nursing about the dangers of immobility during hospital stays. Even if a patient is unable to walk, there are still things you can do to maximize their mobility and reduce the risk of decreased muscle mass (which can lead to falls once they are back home), pressure sores and contractures. Please talk about this with your staff and encourage them to continue making mobility a priority for patients—it’s a team effort!

AC FFC Tidbit of the Week for January 31, 2021: Exercises to Reduce Swollen Legs & Ankles

Many older adults are affected by swollen legs and ankles (edema), and with decreased ambulation in a hospital setting, this problem can worsen. Edema can decrease mobility, increase fall risk, and simply be uncomfortable for the patient.

DailyCaring.org recently shared a 7 minute video that demonstrates three quick and easy exercises that reduce swelling in legs and ankles by helping the body pump fluids up from the feet and back into the center of the body to eventually by eliminated through the urinary tract. You can teach these to your patients in just a few minutes, and encourage them to do the exercises while watching TV. Keep in mind that once a patient is able to walk, that’s the best thing they can do to reduce swollen legs and ankles!

Exercise 1: Ankle pumps (1:28 in video)
Lie down and elevate feet on pillows. Moving only the feet, point toes up toward the head and then point toes down away from head. Aim for 30 repetitions, 3 times a day. It’s best to do this exercise while lying down, but it can also be done while seated. To make them a little more effective while seated, use a stool to elevate the feet.

An alternative (2:48 in video) is to tap the toes like tapping along to a song. It might even be fun to play some toe-tapping music while doing this!

Exercise 2: Butt squeezes (3:17 min in video)
While sitting or lying down, tighten the glutes, hold for a few seconds, then release and relax for a few seconds, then repeat. Remind the person not to hold their breath while doing the exercise. They should breathe slowly and deeply. Aim for 10 of these squeezes, 3 times a day.

 Exercise 3: Single knee to chest (5:09 min in video)
While lying down, bring one knee up to the chest and then return the leg to the flat position. Keep the other leg either flat or bent with the foot on the bed to take pressure off the back. Aim for 10 repetitions per side, 3 times a day.

Here’s a link to the full article in DailyCaring.org:

Have a great week!

AC FFC Tidbit of the Week for January 24, 2021: Don’t Overlook Hypoactive Delirium

Delirium is common (estimated to be about 50%) among older adults with dementia who are hospitalized, but several risk factors contribute to delirium being under-recognized by nurses and other healthcare professionals in acute care settings: hypoactive (or “quiet”) form of delirium, over age 80, visual impairment, and dementia.

When we picture someone who is experiencing delirium, we often think of the hyperactive form that is characterized by hyper-alertness, restlessness, combativeness, resistance, and rambling. These patients get our attention. The hypoactive form is much different. Patients experiencing hypoactive delirium are more often drowsy, less coordinated, passive and quiet. They are the “easy” or “good” patients and their signs and symptoms can be missed more easily. This is dangerous, since the effects of hypoactive delirium can be far-reaching.

Hypoactive delirium can result in marked functional decline (more than the hyperactive form), higher risk of nosocomial infection, residual cognitive impairment, and a higher risk of death. These patients often have great difficulty when they return home because of a significant decline in function related to a lack of mobility and other physical activity and decreased participation in self-care while at the hospital. By helping to identify patients suffering from hypoactive delirium early on, and helping the patient to maintain their function, you can have a significant impact on their success when they leave the hospital.

Common causes of delirium:

  • Dehydration
  • Electrolyte imbalance
  • Lack of oxygen
  • Injury
  • Rule out psychiatric disorder
  • Infection
  • Urinary retention/unfamiliar environment
  • Medication

Another tip: Preventing delirium is easier than treating it. Things to try:

  • Cognitive stimulation
  • Improve sensory input (make sure they have their dentures, glasses, and hearing aids)
  • Mobilize, mobilize, mobilize!
  • Hydration and nutrition
  • Sleep hygiene
  • Avoid toxic medications

AC FFC Tidbit of the Week for January 17, 2021: What you know about a patient’s preferences can help you!

Since hospital visitors are limited because of COVID-19 surges, you and your colleagues’ faces are among the only ones that patients are seeing. Think about your patients with dementia. You are unfamiliar to them to begin with, and wearing a mask too! Imagine how frightening or confusing this experience must be for them. Fortunately, you likely have a simple tool available that can help you provide function focused care, calm them if they are anxious or scared, and make your job a little easier.

Does your hospital use a “Get to Know Me” or “My Story” board in patients’ rooms? (Click here for an example.) This information-gathering tool helps staff learn more about patients’ preferences during their hospital stays. For patients with dementia and other cognitive impairment, learning about their careers, families, favorite things, and hobbies can be invaluable.

For example, if you know what kind of music or TV shows a patient enjoys, you can talk about these things as you are cueing them brush their teeth or do some stretches. They may miss family members or pets, so knowing about their spouse, grandchildren or dog can help you encourage them to tell you more about them, which can decrease their anxiety and build trust with you. Knowing about their career can also spark conversation, as well as remind you and your colleagues that this person—no matter how cognitively impaired they may be now—had a career with experiences and achievements they are proud of and can share. This can also inspire ideas for activities they may enjoy to keep them occupied. For example, a former accountant might like adding numbers on papers you provide. The “Get to Know Me” board has places to note what causes stress to a patient (e.g. loud noises) and what cheers them up (candy or singing a song!). Knowing this can help you prevent or mitigate stressful situations, and help engage a person if they seem withdrawn or sad.

With many hospitals at or close to full capacity now and staff stretched to its limits, it may help to designate someone on the care team to complete these boards with the patient, or ask family members for answers during a quick check-in call. While it can take 5 to 10 minutes to complete, if can save you much more time in the long run, and help you and your team provide patient-centered care to the most vulnerable.

AC FFC Tidbit for January 10, 2021: Let the Music Move You

Music has enormous power. It can motivate. It can soothe. It can make you smile, and move you to tears. It is more accessible now than ever before, and can be a huge help when taking care of patients with dementia.

We have seen first-hand how simply turning off the television in a patient’s room and turning on some lively music can completely change their mood. Some songs just make you want to move, and having older adults do just that instead of sitting still for hours on end can have a huge impact on their physical and emotional health. Turn on some music for a few minutes when you enter a patient’s room to give medications or perform assessments and encourage them clap, march their legs, or wave their arms!

Music can also be helpful when a resident is anxious and/or resisting care. Try playing soft, calming music while helping a patient with morning care and bathing. Ask their family members to bring in an old smartphone or I-pod that’s loaded with the person’s favorite songs or type of music. If they like to wear headphones, ask family members to provide several inexpensive pairs.

Music can help bring back fond memories and lead to wonderful discussions about them too. You might be surprised at how many people with memory loss can still remember the words of their favorite songs from 40 or 50 years ago. Patriotic songs can be especially moving for people of the “greatest generation”, and popular songs from old movies and show tunes are fun to hear too.

Keep in mind that music can be overstimulating for some people with cognitive impairment, so be mindful of this and observe the reactions of residents when music is playing.

AC FFC Tidbit of the Week for January 3, 2021: Addressing Fears (your and theirs!) about Physical Activity

Hello everyone and Happy New Year!

It’s easy to understand that if a person has fallen before and gotten hurt (this may even be the reason they are in the hospital), that they are often afraid of falling again. Because of this fear, they avoid walking and quickly become weaker, which actually increases their risk of falling again. Sometimes people with arthritis shy away from exercise because they think it will be too painful, when exercise can help relieve arthritis pain. Keep in mind that people with dementia and other cognitive impairment need exercise just like everyone else. Exercise can also help reduce some of the challenging behaviors that can occur with dementia too.

Below are some strategies that you and your colleagues can try to help reduce patients’ fears about physical activity:

  1. Be sure that patients have consistent opportunities to walk safely with a nurse or nursing assistant.
  2. Practice sit-to-stand exercises with a handrail in the hallway and a gait belt if needed to help residents feel secure as they strengthen their lower body and improve balance.
  3. Ask patients about their fears and let them express how they feel; be sure to listen to what they are telling you.
  4. Educate—never stop educating!—your patients about the benefits of walking and regular exercise. Help break the vicious cycle of falling, not walking because of fear of falling again, then getting weak and falling again. What you teach them may stick with them when they leave the hospital. It helps for family members to hear this too, especially when the person has dementia.
  5. Start small. No need to begin with a walk around the unit!  Start by walking a few doors down the hall or to the nurses’ station. Do 3 or 5 sit-to-stands and end with success. Gradually increase the number and frequency.
  6. Offer support and words of encouragement when a patient begins walking more, transferring from bed or wheelchair to a chair, and doing sit-to-stand exercises.

Finally, think about your own fears. Is your fear of a patient falling keeping you from encouraging and assisting them to walk or transfer even though they are physically able to do so? Are you worried that family members will be upset if they think you are asking their loved one to “do too much”? Consider discussing this topic at your next staff meeting and setting some physical activity goals for your unit.

AC Tidbit of the Week for December 20, 2020: Holiday Contest!

The holiday season is in full swing, and we thought it would be fun to put a holiday twist on Function Focused Care as you work with your patients to get them moving! We invite you to please send us either photos of staff (if they’ve given permission) or a brief tidbit (a few sentences emailed to this address will suffice!) describing how you are getting your patients up and moving, and participating in their own care. Maybe you’re singing some Christmas carols together during morning care to help patients relax, or dancing with them to some holiday music as you get them out of bed?

We look forward to seeing your pictures and reading your tidbits! Be creative! Everyone who sends us a photo or tidbit will be put into our holiday bowl for a chance to win a prize!!! Please send us your photos or tidbits by January 4th.

Finally, as you await the arrival of the COVID-19 vaccine, we know that some of your staff may have questions or concerns about the vaccine. We encourage you to share this recording of a webinar held last week by NAHCA (National Association of Health Care Assistants) and AMDA-The Society for Post-Acute and Long-Term Care Medicine. The hour-long webinar includes a panel of long term care physicians who address some of the most common questions about the vaccine, and answer many others from attendees: https://www.youtube.com/watch?v=QJhk71PLRBk&feature=youtu.be

Have a safe, happy and healthy holiday!!!