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THANKS! STEPHANIE JEWETT, RN, MBA

Checklist For Nursing Homes

One of the scariest moments for a daughter, son, niece, nephew, spouse, aunt, etc. is the decision to have to put a loved one or relative into a long-term care facility. As a past Director of Nursing for a skilled nursing facility, it is of the utmost importance that one seeks the information necessary to keep their loved one safe, healthy and happy!

These are some of the most important things to ask in regards to long-term care facilities:
• What did the last State inspection reveal? How many “tags” did they have, and what were they?
• What are the safety measures that are put in place?
• What is the staffing ratio for registered nurses, licensed practical nurses and certified nursing aides to residents?
• Is your facility Medicare and Medicaid certified?
• Who owns the facility?
• Are there any pending lawsuits?
• What is your ratio of urinary tract infections, pneumonia, dehydration, bed sores and/or malnutrition?
• Have there ever been abuse issues, and if so, how long ago? What is the protocol for these incidents?
• What special therapies and activities do you have and how often?
• Do you have a registered dietician that plans the meals?

In addition to these very important questions, look around at the facility. Be sure it is clean and don’t be afraid to talk with other family members and to the residents. Talk with the Administrator, the Director of Nursing, the social worker, the activities coordinator and to the dietician to address any special needs that may an issue, i.e. diabetes.

The decision is not an easy one, and it is certainly in your best interest and the patient’s best interest to get all of your ducks in a row before moving forward. Don’t hurry or be in a rush when checking all of your options. Keeping your loved one in well respected facility that is run with experts can indeed give you peace of mind!

Caregivers - Take A Break!

It is estimated that approximately 25% of the American population is helping a relative with personal cares. By personal cares, I mean companionship, housekeeping, assistance with bathing and grooming, meal planning and preparation, exercises, mobility assistance, monitoring medications, incontinent/toilet care, transportation and errands, child care, etc. That estimate will only continue to rise as today Americans are living longer than ever.

There is no place like home and for the elderly and disabled, living at home provides a better quality of life and it is usually less costly than other alternatives. But what about the caregivers? It can be absolutely exhausting to help a loved one 24/7! As a registered nurse in the field of home-care for several years, I have seen so many caregivers that rarely take a break for themselves. It is imperative that these caregivers take breaks and take care of their own health.

As a nurse, I can understand the wish to help a loved one at all costs. However, you need to have respite time - go out to dinner or to a movie or even take a nap! There are plenty of home-care businesses that will relieve you for even a couple of hours, maybe a whole weekend. There are also friends and other relatives that can give you a break - don't be afraid to ask. Caregivers are so special and I admire all of you, but do yourself a favor and take a break!

5 Ways To Help Keep Memory Alive At Home!

Another field of nursing that I have enjoyed is working with the elderly population. Many times I have encountered seniors in a home setting that display signs and symptoms of dementia, and/or Alzheimer's. There are 5 specific things these patients can do to keep their mind sharp and their memory alive:

• Find something they love to do and keep that favorite thing going everyday, i.e. take a walk in the park, watch their favorite television show or read articles in a magazine. Go to the Internet and learn more about their favorite subject.
• Keep life simple; follow a schedule everyday. Eat at particular times, keep hair appointments to one specific day a week, enjoy a meal out once a week, on the same day.
  
• Get lots of rest - take a nap if one feels tired, but don't sleep the day away. Get up at the same time each day, bathe and then have a nutritious breakfast each and every day!
• Go through scrap books and old pictures, reminding them of family members - their names, ages, etc.
• Get a dog or a cat so that the patient has some responsibility and company in the home. Pet therapy is one of the best methods known to keep a person happy and healthy.

There are many other ways to keep that memory going, but I have found these 5 to be of particular value. These tips are not expensive and they keep the elderly patient with memory problems in check.

CAREGIVING FOR THE ONCOLOGY PATIENT

As a registered nurse with numerous years experience in caring for the oncology patient, one of the most rewarding fields has been preparing the individual, family and friends for the end-of-life process. Unfortunately, however, all too often there are inexperienced nurses that jump into this arena with little or no knowledge of the death and dying stages. According to Elisabeth Kubler-Ross, there are 5 distinct stages, which are outlined in the graft below:

Stage	Interpretation
1 - Denial	Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely.
2 - Anger	Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgmental when experiencing the anger of someone who is very upset.
3 - Bargaining	Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?" when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.
4 - Depression	Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.
5 - Acceptance	Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.

It has been my experience that not all patients follow these stages in exact order. In fact, many skip from stage to stage and the nurse needs to know precisely what stage the patient is in to properly communicate and care for the cancer victim and their loved ones. My prior nursing colleagues were frequently unaware of the consequences that can occur, for example, if a patient is in denial but the caregiver believes they are actually in the bargaining stage. I have found that families and doctors are great references in establishing the proper stage and then adequate consultation with the patient can proceed.

The oncology nursing field is certainly not for all nurses. Some of the most common ingredients for the successful cancer nurse include education on death and dying, great communicators, having empathy versus sympathy, understanding the patient is extremely ill and anger is not to be taken personally, and having a good support system. In addition, most patients are receiving blood, platelets, radiation, chemotherapy and/or mind-altering drugs that can have a huge effect in one’s personality. A caregiver could see a cancer victim go from sleeping peacefully to crying, screaming and being confused.

In summation, the field of oncology can be rewarding, fulfilling, stressful, sad, happy and precise. The goal for the patient is to follow the protocols of patient rights – remain comfortable, clean, emotionally and physically safe in an environment that promotes a strong relationship between the patient and their health care providers, the right to participate in their care, the access to emergent services, to be treated with respect and non-discrimination and the right to privacy and confidentiality of health information. Any nurse that does not have the proper education, training and knowledge in this ever-so-careful and specialized field should not attempt to deal with these delicate patients!

WORKS CITED

"Elizabeth Kubler Ross Grief Cycle model, five stages of grief in death, dying and bereavement." 25 Apr. 2009 .