Culture Change in a Secured Dementia Unit - page 2

How have you implemented this? We have recently gone from waking everyone up when shift starts at 0600, to letting them wake naturally. For the most part, we have about 6 to 8 (out of 22) that are wake and come for breakfast... Read More

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    It's a great idea. I've worked at places where people are dragged out of bed at 6.30 am and back in bed by 1.30 pm so the evening shift wouldn't get mad. I can see it becoming a problem if someone does shift their pattern, sleeps all day and is awake all night. It happened with a Jewish holocaust survivor we had on my unit - he slept through the day because he felt safe and his wife was usually around but at night he got scared and continually cried out for someone to be with him.
    Last edit by Vinniesguy on Dec 19, '12 : Reason: Spelling - not my strong point!
    MichelleRN34 likes this.

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    I have done this too and my first thoughts when reading your post before you said it were: If your not careful you are going to have weight loss...first....next comes Pressure Ulcers.....Contractures and then Depression....
    I would opt more for a Walk to Dine program. Form a small committee lead by an aide who volunteers for it. Next pick out those who need to walk. Have them meet in an area(livingroom) then have the rest of the aides walk them together to the dining room and get a new group and do the same. After they eat they meet back at the Living Room for a special dessert or Smoothies.
    You will see your weight loss go way down....your falls go down(people are getting stronger) your depression rate go down(people are socializing) your constipation issues improve.....the list goes on and on....less Pressure Ulcers.....(blood flow)
    It's one of the best programs I have ever instituted.
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    I work in a cert alz. long term care. We do have scheduled meal times and staff does encourage the residents to get up before breakfast but the ones who do not want to or who might start having behaviors are aloud to stay in bed and we just keep trying to get them to come eat. Make sure the careplan reflects the changes and there is nothing wrong with residents eating at 3 am. We let them eat when they are hungry. Offer foods they like. Maybe the setting is the problem. Sitting situations may need to change. Definately offer supplements. We do have one resident who sleeps through breakfast and takes 3 hours getting ready for lunch so she doesn't arrive until 1-2 pm. we order her something from the kitchen. Her family is aware. Her doctor is aware and her careplan is up to date. At home they may have slept in till all hours and they are supposed to be in their home environment.
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    This all sounded so so familiar to me.....I instituted the Homestead Model that Genesis puts out....I loved it however....the weight loss will be your issue......push smoothies and choc milk. Dementia residents love the sweet taste and will get their calories here.
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    Sorry I haven't been able to update. It's been really busy at work.

    I hate to say this, but we ended having to go back to the "old" way. As my DON likes to tell me, it's baby steps. Sometimes, you just have to take a step back. It would be nice to have a good model to follow, however it seems, that we just kind of fly by the seat of our pants as we go along right now.

    I still think if it had been given time, and support from everyone, it would have worked. Unfortunately, it also takes a want and desire to change for the better, and because that was lacking, from varied people, the change made wasn't for the better.

    Oh well, baby steps. It may be a mute point at this time, as I am getting ready to move into a new position as the Restorative Nurse. Again, a brand new program, building it from the bottom up. I don't know what I am doing, however I am looking forward to the challenge. I just hope a failure of trying to move my secured unit to culture change doesn't forbode me in the position of Restorative Nurse.

    I will miss my special residents, though.
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    I have worked this model and it was one of my best experiences ever! Be careful of weight loss, PU's,contractures and social isolation though. While I think it is the way to go....unless you invest tons of time teaching staff and getting them to buy into the program it won't work! My experience was these aides turned out to be some of the best I have ever worked with. They "learned" the residents so well they anticipated and met needs with very little encouragement from me which allowed me to continue to implement, teach and evaluate.
    I loved it!


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