AC FFC Tidbit of the Week for November 28, 2021: Let the (Holiday) Music Move You!

Hanukkah starts this evening, and Christmas decorations are making their appearance, so let the holidays begin! This season brings fun opportunities to encourage your patients to get up and move! Try playing some holiday music on your unit and ask patients to dance, clap and march (while sitting or standing) to the upbeat tunes (think “Jingle Bell Rock”) and sing along. These songs can bring back happy memories for your patients with dementia. They can also spark conversations about their family traditions and childhoods, which you can have while performing function focused care with them as they participate in getting dressed, washing, brushing teeth and getting out of bed and into a chair for meals.

Share your ideas with us about how you incorporate the holidays into your unit and patient care!

Have a great week!

AC FFC Tidbit of the Week for November 21, 2021: Kids Can Help with Function Focused Care!

With the holidays right around the corner and vaccines allowing families with older adults to see each other again, grandchildren will be able to celebrate with their grandparents this year!

This is a great opportunity to involve kids in function focused care by helping to motivate your older patients to get up and moving so that when they leave the hospital, they will be strong enough to play. While they may not be able to do the moves that this adorable girl is performing to entertain her grandmother, who just had knee replacement surgery, keeping your older patients active and mobile can help them maintain their ability to take walks, play games, cook holiday meals and help with holiday tasks with their grandchildren. If kids aren’t able to visit your unit, encourage family members to do video calls with your patients and have the kids encourage their loved one to keep moving and remind them that there’s lots to look forward to when they go home!

AC FFC Tidbit of the Week for November 14, 2021: Grab a Seat

Look around your patient’s room. Is something missing? We know rooms are small and space is tight, but your patient’s room might be missing a key element that can help them recover and maintain their strength, skin integrity, and more: a chair! Every room should have a chair for the patient to help cue staff to get them out of bed, especially for meals. If you have to hunt down a chair on the unit, or bring one in from a storage closet, you may be less likely to transfer that patient out of bed, where they belong.

Mobility plans are only as good as how well we follow them with action. If a patient’s plan says to have them out of bed and into a chair for all meals, then set yourself up for success and be sure your patients have a chair to sit in.

Have a great week!

AC FFC Tidbit of the Week for October 31, 2021: Tricks for Halloween!

For nurses and other staff who care for older adults (especially those with cognitive impairment) in acute care settings, the prospect of having a patient fall is SCARY! But keeping a patient in bed and discouraging ambulation (for example, by encouraging use of a bedpan or bedside commode instead of helping a patient walk to the bathroom), results in them becoming weaker and increases their risk of falling once they return home. Instead, work with your team to keep your patients moving and as strong as possible so they have better chance of resuming their normal activities safely after discharge.

In addition, for patients with dementia who may want to get up on their own, keeping them in bed may lead them to become frustrated and agitated, and result in challenging behaviors. Try the strategies below…

Tricks of the trade:

  1. Review with staff why people with cognitive decline (who may not be able to communicate their needs verbally) want to get up and walk on their own. Are they bored? Do they hurt from sitting for a long period of time? Do they need to use the bathroom? Do they forget they need help to walk?
  2. A supervised 5-minute walk could be enough to satisfy their need to move for a while, and may help decrease negative behaviors later on due to boredom or discomfort.
  3. Instead of saying, “Sit down, you might fall!”, try to get in the habit of saying something like, “I see you want to walk. Please wait and someone will help you very soon.” Then take the individual for a short walk down the hall, to the nurses station or a window to look outside. Spending those 5 to 10 minutes walking can up end up saving lots of time in the long run. Have staff take turns doing supervised walks.
  4. Perform “sit to stand” exercises using the handrails in the patient’s room or hallway. These help keep leg muscles strong and use up excess energy too.
  5. Spread the love and encourage physical function…..ask the patient, “Could you stand up and give me a hug?” –The reward back is a big hug from you!

Have a Happy Halloween!

AC FFC Tidbit of the Week for October 24, 2021: Up Means Up!

Patients who are dependent for weight shifting (Mobility Level 1 and 2) or Mobility Level 3 patients who need assist should be seated fully upright on a daily basis for no more than 2 hours (less if issues with skin integrity or wounds). OOB to chair = sitting upright. When a patient has an out of bed order, the intention is to have that patient sitting up and upright, not in a chair that is fully reclined, which can result in sacral wounds. If a patient is not ready to be in chair, use a specialty bed first.

Attached is flier from the University of Maryland Medical Center that shows proper positioning for patients in chairs. Please take a few minutes to review and review with unit staff as well.

Have a great week!

AC FFC Tidbit of the Week for October 17, 2021: Team Up for Mobility

We all know that getting patients up and out of bed is vital for lots of reasons, but this can be challenging on a busy unit when patients need extra help or equipment to safely mobilize and staff is short on time.

Try organizing mobility teams, where a physical therapist (PT) or PT assistant and a unit nurse go from room to room to get patients up and out of bed, to the bathroom, or for a walk down the hall if they are able. The “mobility” nurse rotates with other nurses on the unit each shift. When not on the mobility team, the unit nurses handle the mobility nurse’s duties so that nurse can focus on getting patients up and moving.

Not only can this efficient approach help get more patients up and of out bed consistently, working with physical therapy staff can help nursing  staff (especially new nurses!) feel more confident transferring and ambulating with patients. A win-win for sure!

AC FFC Tidbit of the Week for October 10, 2021: Infographic Function Focused Care

One of our study sites asked for an infographic on Function Focused Care (FFC) to help educate their staff about FFC in a quick, visual way. We thought we’d share with everyone what our research interventionist developed because we think it’s great! (She is too—nice job, Irene!)

Attached is a visual you can post on bulletin boards, in patients’ rooms, and share with families that summarizes the key aspects of FFC. Use it during staff huddles and focus on a different aspect of FFC each week:

  • Environment
  • Assessment
  • Activity
  • Toileting and Nutrition
  • Communication
  • Family Caregivers

AC FFC Tidbit of the Week for October 3, 2021: Team Up to Get Patients Moving

Your team has likely learned new and better ways to support, motivate, and communicate with each other during the pandemic. Use these enhanced skills to help make Function Focused Care (FFC) a daily habit for staff and patients. Your FFC champions are leaders and role models, and play a vital role in implementing the strategies we want all staff to use when working with patients to help maintain and even improve their function and physical activity levels. 

Champions not only act as role models, but also cheerleaders, observers, and teachers. Champions can take a few minutes to watch how their team members interact with patients to see if they are using person centered, function focused care approaches during care interactions (e.g., encouraging patients to participate in their own bathing and dressing; walking patients to the bathroom regularly to avoid agitation; or singing a patient’s favorite song during an unpleasant care interaction). Champions can also acknowledge and praise team members when they see them engaging in FFC.  A simple, “Great job getting Ms. Smith out of bed and walking!” can go a long way.

Conversely, when champions witness missteps by staff during patient interactions, such as not encouraging a patient to participate in their morning care, they can turn these into opportunities to teach their colleagues a better way to handle those situations.  Role modeling a better way is one of the best ways to make new learning happen.  For example, when a caregiver tells a patient who is repeatedly getting up and down in an unsafe fashion to “sit down or they might fall” …. And the patient persists and gets more agitated….it may be helpful to step in and show that taking the patient for a short walk or doing a few sit-to-stand exercises with them may decrease the agitation.    

Staying positive and persistent is key to building a strong team of caregivers who provide function focused care at every opportunity.

AC FFC Tidbit of the Week for September 26, 2021: Stand Up to Falls!

Fall is here, and soon we’ll be watching colorful autumn leaves float gracefully to the ground.

But in acute care units, when we hear the word “fall,” a much different scene usually comes to mind and there’s not much graceful about it! Fear of falling is common for older patients—and  their caregivers—but there are things we can do to help reduce the risk of falls, especially for when patients return home after their hospital stays. One of them is to keep patients strong and improve their balance by encouraging them to perform sit-to-stand exercises regularly, and to transfer from beds and wheelchairs to chairs for meals and other activities.

We invite you to “Stand Up Against Falls”! During the months of October and November, we’d like your unit staff to work together to consistently get patients out of bed and moving by going for walks, doing sit-to-stands, and transferring them from beds to chairs.

Here’s a quick video of the sit-to-stand exercise:

And here’s a handout with instructions from the CDC:

AC FFC Tidbit of the Week for September 19, 2021: Bulletin Board Bonanza

Take a look at these great bulletin boards created by one of our research facilitators in Pennsylvania! The bulletin boards present mobility and Function Focused Care information geared towards patients and families. She included multiple copies of chair and bed exercises so that patients can take and keep a copy.  The infographics are from the Johns Hopkins online toolkit and the National Institute on Aging.  

Send us pictures of your FFC Bulletin Boards and we’ll share them in an upcoming tidbit!

Have a great week!