AC FFC Tidbit of the Week for August 7, 2022: Potty Talk

We’ll start with Number Two: One of the biggest factors related to behavioral issues in nursing homes (and may therefore be the case in acute care settings with your patients who have dementia) is constipation. Since it can be very difficult to use a bedpan for bowel movements on the best of days, helping a patient walk and transfer to the toilet can help prevent constipation, and in turn prevent some of the behaviors that can result from the pain and discomfort of being constipated.

For Number One (and Number Two):  Use “proactive toileting.” For patients with dementia, nursing staff can prompt patients to use the bathroom regularly and assist them to the toilet if needed.  It can help to use a consistent schedule. If a patient is restless in bed, they may need to use the bathroom and cannot verbalize that, so take a walk to the toilet with them and see if they need to go.

Have a great week!

AC FFC Tidbit of the Week for July 31, 2022: White Board Wisdom

When it comes to maintaining (or improving!) function and mobility in your patients with dementia, knowing what they were able to do prior to coming to the hospital is crucial. You may be able to find this information in the patient’s electronic record, but how often do you search it out and how easy is it to find?

One of our recent study participants had a great idea. They have a white board in each patient’s room that lists what the patient could do prior to their hospital admission, so the healthcare team can quickly determine the person’s baseline function and mobility, and set daily goals to help the person maintain or even increase them. The board also notes if the person wears glasses, hearing aids, uses a cane, etc., which is important to know when communicating with them and encouraging them to move.

If your unit doesn’t already use “White Board Wisdom”, consider trying this simple, practical way to remind staff, patients and their families what the person can do and work together to keep them doing it!

AC FFC Tidbit of the Week for July 24, 2022: Are your patients equipped to move?

You know by now that a big part of Function Focused Care is getting your patients to move and ambulate as much as they are able. Often, they need to use a cane or walker, and a gait belt can help you walk safely with patients. Are these handy when it’s time to go for a walk, or do you have to spend precious time searching for these items instead of spending time walking with your patient?

Consider keeping these items behind the door so staff can find them easily and get moving! Wall hooks (Command Strips or a similar product can come in handy here) can hold a cane and/or a gait belt, making them easy to store and find, and less likely to get lost or tripped over. Give it a try and have a great week!

AC FFC Tidbit of the Week for July 17, 2022: Sit to Stand Exercise–Simple But Effective

Our friends at the Penn State College of Nursing shared these great Function Focused Care reminders with us, and we are paying it forward and passing them on to you.

Remember that an exercise as simple as “sit-to-stand” can go a long way towards helping your patients with dementia maintain their ability to transfer to a chair or toilet and keep legs strong. Check out the other tips below and share them with your staff too!

AC FFC Tidbit of the Week for June 10, 2022: White Board Wisdom

When it comes to maintaining (or improving!) function and mobility in your patients with dementia, knowing what they were able to do prior to coming to the hospital is crucial. You may be able to find this information in the patient’s electronic record, but how often do you search it out and how easy is it to find?

One of our research study participants has a great idea. They have a white board in each patient’s room that lists what the patient could do prior to their hospital admission, so the healthcare team can quickly determine the person’s baseline function and mobility, and set daily goals to help the person maintain or even increase them. The board also notes if the person wears glasses, hearing aids, uses a cane, etc., which is important to know when communicating with them and encouraging them to move.

If your unit doesn’t already use “White Board Wisdom”, consider trying this simple, practical way to remind staff, patients and their families what the person can do and work together to keep them doing it!

AC FFC Tidbit of the Week for July 3, 2022: Happy 4th of July!

We hope you are enjoying the summer and have a chance to celebrate the 4^th of July this weekend!

Fireworks injuries are common this time of year, but we know falls is an ever-present concern in healthcare settings, especially when patients are frail or cognitively impaired older adults. A key to addressing and limiting falls is paying attention to WHEN they occur—the end of evening shift? During a change of shift? Once this is identified, you can begin to develop strategies for minimizing fall risk during those times of vulnerability.

During a huddle this week, talk with your team about when they see the most falls, or near falls. Then discuss why they think falls are happening more frequently at that time. For example, is staff distracted with getting ready for the new shift? Have patients been waiting long to get up to use the toilet and try to go without assistance? Are patients getting up during the night because they can’t sleep? Finally, brainstorm some strategies for proactively addressing falls before they happen. Last week we talked about purposeful hourly rounds, which could help, or perhaps rethinking who can check on patients during shift changes, if that’s a common time for falls. You may be surprised by what you learn, and what ideas your team comes up with!

AC FFC Tidbit of the Week for June 26, 2022: Purposeful Rounds Benefit Patients AND Staff

The goal of “purposeful hourly rounding” is to avoid what’s happening in the cartoon below, and instead be present with patients while getting ahead of potential problems before they occur (thereby decreasing call lights!). For example, purposeful rounding can help your team better communicate with patients and plan for toileting by setting up times where you will assist him/her to the bathroom to avoid last-minute urgency or potential falls.

This brief article describes how one Texas hospital successfully implemented purposeful hourly rounds and the benefits that followed:

https://www.theberylinstitute.org/blogpost/947424/322785/The-Benefit-of-Purposeful-Hourly-Rounding

The authors highlight 6 key Ps of Purposeful Hourly Rounds:

• Potty
• Pain
• Position
• Possessions (personal effects within reach)
• Peaceful environment
• Pick up (pick up trash near the patient’s bed or bedside tray)
• Bonus “P”: Presence of nursing staff. “Before our nurses enter a room, they are told to pause to take a minute to clear their mind and focus their attention solely on the patient. This allows them to use their time with their patients more effectively and the patients receive full attention. The art of presence enhances the nurse-patient interaction and draws on a model of true patient-centered caring (Sutterfield & Stern, 2002).”

In what ways can you and your team improve upon your hourly rounds with patients to help decrease call lights and nurse fatigue while improving patient care?

Have a great week!

AC FFC Tidbit of the Week for June 19, 2022: Times for Tough Love

Happy Juneteenth! And Happy Father’s Day to all the dads out there too!

For some of you, your dad may have been the parent who doled out the tough love. Sometimes as nurses, we must show tough love with our patients too. For example, do you have a patient who keeps saying “no” to getting out of bed? How do you respond? You know that getting them out of bed (or at least moving in some way) is critical for a successful recovery, strength maintenance and transition back to home, but it can be difficult if you constantly face “NO—I’ll do it tomorrow” as a response. Certainly, learning what motivates a patient is the best way to start, such as if they want to get strong enough to attend a special family event, or be able to enjoy a hobby they love doing. But other times, a stern voice and a “we’re going to do this whether you want to or not” attitude can be the last remaining option.

It helps to educate family about the importance of getting their loved one up and moving. By gaining their support, everyone is on board and sending the same message to your patient—”We’re doing this! You’re getting up!” You may be surprised how often, once someone is finally up and out of bed, that they are glad they did it and it was fear or anticipatory anxiety that was really keeping them from trying. After they do it once, even though there may have been some yelling and upset, they may be more likely to do it again since they are over that initial hurdle and know that you will keep them safe.

AC FFC Tidbit of the Week for June 12, 2022: Collaborate with Colleagues for Mobility and More

Do your nurses and nursing assistants huddle together to plan their day? Taking a few minutes at the start of a shift to create a plan for the day can make it easier to get patients up and moving.

Huddle agenda suggestions (things to review, discuss and decide):

• How much assistance does each patient need to get out of bed for meals, walk to the bathroom, or walk down the hall?
• Who will assist with mobility on this shift? If this will be a shared responsibility, who will take the lead with each patient?
• Does each patient have the equipment they need to ambulate, such as walker, already available in their rooms to save time getting these later?
• Can we schedule times to get patients out of bed so we’re not trying to get everyone up at once when all the meals arrive?
• For those patients who cannot get out of bed, what exercises can we do with them while in the room and who will lead this today?
• What else would be helpful to plan together???

AC FFC Tidbit of the Week for June 5, 2022: Talk Mobility During Bedside Reports

Bedside reports are a great opportunity to update a patient’s mobility score for the day and communicate it to the healthcare team, including nurses coming on shift. If a person’s mobility score indicates that they should be up and transferring to a chair or walking, this gives the team a chance to discuss the score with the patient and make plans for their physical activity for the day.

While you hopefully won’t approach it the way the doctor is in the cartoon below, having a team consistently discuss mobility goals together with the patient may help increase a reluctant patient’s willingness to engage in physical activity that they are capable of doing. Give it a try!