Rounds, Falls, and Skin issues

I am a charge nurse in a LTC facility. Just to give you a little history, I am not new at the LTC world. I started as a CNA 21 years ago. After going to LPN school I worked LTC and then went to RN school and find myself back at LTC, so am quite experienced. I am a teacher by nature and volunteer for training and inservices. Recently, I taught an inservice on alzheimer's and special needs. In my research, I found studies that show that with the advances in incontinence products, if your residents are mobile and can reposition themselves in bed, they do not need to be "pottied" every 2 hours. There is no more evidence of skin breakdown when they are pottied and changed every 2 hours than not.

On another note, this same study revealed another "secret." In war days in the concentration camps the prisoners were subjected to various types of torture. Among these was that they were awakened every 2 hours during the night and forced to stay awake for about 10 minutes and then allowed to go back to sleep. This severely disturbed their sleep patterns and thus, made them clumsy and confused during the day due to lack of proper REM sleep. Hmmm, is this what we are doing to our elderly? Is this part of the reason for so many falls and inappropriate behaviors?

And speaking of falls and alzheimer's, did you know that when people have alzheimer's they lose their development in the reverse order of how they gained it? Think of a baby. First they learn to make sounds before they learn to sit up. They learn to walk without shoes before they master walking in shoes, etc. This is why many alzheimer's patient's take off thier shoes. They need to use thier toes to grip the floor which they cannot do with shoes on. When we force them to wear shoes, we are actually causing falls.

How about the whirlpools that are so common in our nursing homes that have been such a necessity for skin issues? Again, studies are proving that bed baths are just as, if not better for the skin than whirlpools. Also, for the confused patient, a whirlpool looks like a pot of boiling water. Would you want to be lowered into that?

The study of alzheimer's disease and long term care issues is really interesting and so in depth. When you dig into it, there is a lot to learn!