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This is a discussion on Resident Centered Care in Geriatric Nurses / LTC Nursing, part of Nursing Specialties ... We are going thru a "culture change " at the nursing home I work at. I am a manager of a LTC floor....by km7100 Jul 22, '09We are going thru a "culture change " at the nursing home I work at. I am a manager of a LTC floor. Each manager has been given the duty of identifying 1 simple process or aspect of care that the unit can change/enhance to promote person-centered care. We are trying to move to a more home-like environment. Any ideas?
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- Jul 22, '09 by nightmareTheir own pictures and possessions in the room. Coloured bedlinen and even painting the walls different colours in the rooms.
- Jul 22, '09 by VivaLasViejasAllowing residents to eat and sleep according to their own preferred schedules, not facility convenience. Pets. Plants. Carpeting. Their own furniture. Staff in street clothes instead of scrubs. All of which de-medicalize the setting and make it more homelike, which is a lot of what culture change is about. :heartbeat
- Jul 22, '09 by ktwlpnQuote from VivaLasViejasHow does this work? Do have buffets for a few hours at each meal time? We don't even have table linens..Allowing residents to eat and sleep according to their own preferred schedules,:heartbeat
- Jul 22, '09 by husker_rnCheck out info on the Eden Alternative. Worked at a facility that espoused this and I loved it.
- Jul 22, '09 by TrishJKWe started using the Eden Alternative at the LTC where I work.
The staff grew to love it (everyone hates change to start with) so much that it is hard to get them to do shifts in areas which aren't "home" to them. On the plus side, the EA methodology/philosophy - which is totally resident-centred - is brilliant, just superb. Individuals remain individuals for longer and staff grow so fond of the residents in their area that I think the residents receive better care (from the perspectives of emotional commitment from staff; because it is easier to tell if something is wrong/going wrong when you know someone well; and because residents feel happier and have more certitude - sinnce they know exactly what they can expect per shift). I give the method 100%
On the negative (?) side - implementation involves big changes - in practical terms and in the psychology of residents and staff (although, if you have a good corporate culture I imagine it would be FUN). Staffing can become a bit of a problem - you may end up having to get really tough when you're short-staffed, in getting people to swap out of "their" area. Staff cliques can form - whereby some staff start to (maybe even unconsciously) rort the system - they get themselves into such a comfortable place they take short cuts and stop noticing things about their residents that strangers can see (eg a gradual deterioration can be missed); they can also become "uberpowerful" and scary to other staff members who venture into their little kingdoms.
I could go on and on.
- Jul 25, '09 by bluegeegoo2My facility does the resident centered care thing, and it's a far better place to work than the "regular" LTC type facilities for a variety of reasons: There are no "get up" lists for 3rds, so no resident is stuck having to get up at 5 AM every day. Instead, I (3rd shift nurse) have my 2 aides pick 3 people each that are willing to get up early every day, allowing the others to sleep in. Our breakfast time runs from 7-9a, so residents can mosey on down to breakfast when the feel like it. They still have the option of having meals served in their rooms, of course. The aides act as servers, and literally take orders. We have everything from sweet rolls to grits to biscuits and gravy available. Name a drink for breakfast. We have it. Lunch and supper are done a bit differently, more like a hospital where you circle from a group of choices what you want for the next day. Meal time is from 11-1p, and supper is from 4-6p. Anyway, upon admission, one of our (many) papers to fill out is a "resident preference" list, that asks questions like: When do you prefer to get up in the morning? Do you take a nap? When? How long? Do you shower daily? What time? etc. That way, we can tailor our care to what they prefer by adding their preference info on the aides care sheet. Naturally, we can't cater to every whim and fancy, but the residents here seem way more relaxed and happy than at other facilities I've worked for. Good luck with your endeavor. It's worth it in the long run.
- Jul 26, '09 by CapeCodMermaidI understand the theory behind resident centered care...the facility is home...you should have choices about when to get up, when to eat and the like. BUT I have a hard time reconciling this with the sometimes complex medical needs of many of the residents especially on a subacute unit. It's hard to care about what time Mary wants to play BINGO when her room mate Gladys is going into flash CHF or the guy down the hall appears to be throwing a clot. Perhaps segregating residents/patients according to their length of stay (short term vs. long) is the only way this will really work.
- Jul 28, '09 by bluegeegoo2Quote from CapeCodMermaidMy facility does, to a point. We have the "walkie-talkie" rehab unit, 2 assisted living units, and the "not-so-walkie-talkie" long term care/rehab unit. The AL residents do as they please, when they please, and the others are offered opportunities to participate in activities. It's very much like a traditional LTC facility, but the ambience is much more relaxing. One thing I find rather disturbing, however, is when we get a new admit, we have a list of facility diet orders we are to get the MD to sign off on. Simply put, regardless of the diet they are admitted with, we are to get it changed to "regular". Period. Which means the brittle diabetic can have all of the cherry cheesecake she wants. The Na+ restricted resident can have a salt lick if he so fancies. All in the name of "resident centered care". "If the resident wants, the resident gets", is not the very best environment for being a nurse. I try to dissuade the diabetic's away from sweets, and get warned that I'm "violating the residents rights". Hell with it. Here's a tub of Ben & Jerry's. I'll be waiting over here with the Novolog...I understand the theory behind resident centered care...the facility is home...you should have choices about when to get up, when to eat and the like. BUT I have a hard time reconciling this with the sometimes complex medical needs of many of the residents especially on a subacute unit. It's hard to care about what time Mary wants to play BINGO when her room mate Gladys is going into flash CHF or the guy down the hall appears to be throwing a clot. Perhaps segregating residents/patients according to their length of stay (short term vs. long) is the only way this will really work.
- Jul 30, '09 by missyd1991I work in a Eden Alternative home and we have been and are still going through the growing pains but it really does make a difference. You will always have staff that wont buy into what you are tryning to accomplish and others that will use it as a crutch. I am of the mind that there should be a happy medium between medicl model and home model. Our residents are here because they could no longer care for themselves at home or their family's could no longer care for them. I don't think this should be looked at in a bad way. I love longterm care and I'm glad the home I work where I do. We started slowly with fixing up our tubrooms to be more home like, then we went to a buffet on Thursdays that our residents pick the menus, we now have 2 cats and 1 dog. We have several birds and a fish tank. The residents have family pics in room, some who were artists have pics hung in our dining room. It doesn't take much to start change and we were told you will never be finished with change because there will be some other area that can be improved. So embrace the changes and remeber to support one another along your journey and good luck!