nursinmama921 1,806 Views
Joined Jun 22, '11.
Posts: 4 (25% Liked)
I am a memory care coordinator for a dementia unit and I deal with this all day! Purpose is the biggest thing! I made several activity kits that can be done with one or 2 residents. I put them in shoebox sized rubbermaid containers and label the front with what they are so that the CNAs can easily identify what they are supposed to do. I have a lot of info on this and would be happy to email it to anyone that wants it. THe biggest thing that works well for men is to give them a block of wood and a piece of sandpaper and ask them to sand it down for you. They will work on it for HOURS!!! We havev to remember that the activity staff cannot reach every resident at every minute. We have to support them. Be low is a list of some of the boxes I have made. PM me if you need more suggestions or an explanantion of some of the boxes.
1. Shape Sorting Board
2. Flower Box
3. Beads and Pattern Cards
4. Sensory Soother
5. Sewing Cards
6. Sorting Colors and Letters
7. Sock Sorting and Folding Box
8. Pat Mats
9. Sewing Cards
10. Beach Balls
11. Music Trivia Ball
12. Name 3 Ball
13. Simple Puzzles
14. Yarn Box
15. Activity Aprons
18. Sing a long/Music Time
19. Ribbon Box
20. PVC Pipes Box
21. Play-Doh Box
23. Short Stories
24. Watering Plants
25. Patio Time
26. Group Walk
27. Spa Box
28. Current Events
29. Baby Doll box
30. Fill up the bird feeders
31. Looking at magazines
32. Sanding Blocks box
I've been a floor nurse, an RCM, and a DON, and I can tell you there is rarely, if ever, a need to volunteer information that a state surveyor's going to jump on. Simply document what you saw and what you did to fix it---never suppose or assume anything that didn't occur in your presence. For example, in the case of the pt. with a new pressure ulcer, you'll want to save the "air mattress was deflated" for the incident report, which is an internal document that's not really supposed to be fodder for surveyors (although they can, and often will, ask for it when they come across an issue). In the chart, simply note that a new pressure ulcer was found on pt's___________ that measures __________cm and has ________ drainage etc., describe what you did to treat it and that the MD and family were notified.
The same goes for nearly every patient situation you'll come across in your career. You want your documentation to be complete and thorough, but there's a fine line between defensive charting and that which will hang you and your facility. It takes a while to learn, but eventually you'll understand the nuances and be able to tailor your documentation to frame each incident in the best possible light without being dishonest or omitting details that are truly germane to the issue. Don't hand the State the weapon they'll use to beat you over the head.......if they want the information, it's best to make 'em work for it a little.
Bless your heart. I have been in your shoes. I have been on my own since April and my preceptor was less than ideal, I expected more instruction, less negativity. For what it is worth, the experience has made me a better nurse and I grow stronger as a nurse every day. Hugs to you. And may you never forget this experience, because one day you will be a preceptor and you will do outstanding because you know what not to do now.
Dear preceptor.. I came to you smiling, full of energy and ready to tackle the last leg of my orientation journey, with your guidance of course. I haven't really gotten any inclination on where that guidance is at. You tell me what patients to take, and I take them. Then when I am at the bedside, communicating with the family (you know that rapport thing?), you decide that it is a great time to tell me *not to touch the patient*, or the machines for that matter unless you are there. What? I did not fall off of the nursing school wagon yesterday. I am new to your facility, but not a new grad. I did get a smug sense of satisfaction when the family told you it was fine and I was handling things.
I see that you do not have any intention of assessing my skill level or evaluating areas in which I need assistance. In your eyes, I have no skill level or even brain stem function because every action on my part is met by you with some sort of resistance or interrogation. You cant wait for me to come out of the bathroom before you call the doc... making me look like some sort of fool that cant call the doctor. Lo and behold the toilet flushes and I am greeted with 75 orders, all of which you *write* but make me *do*. Although I am a critical care nurse, and am comfortable with bedside procedures, it is *imperative * on your part to ensure that I am educated on sterile fields and how to open packages. That makes me feel so great, especially with the doc at the bedside.
Precepting with you has given me a great opportunity to practice dealing with "the cold shoulder, being aloof and unapproachable." I *know* that you aren't any of those things, just preparing me for when I run into someone who is. Thanks! I am now well versed in forced conversation, fake enthusiasm, and being lonely but not alone.
I have been practicing my mental, telepathic and psychic abilities... seeing as how there isn't any verbal interaction between us, its time to take it up a notch. *places fingertips to temples* Can you hear me now?
Here is an interesting thought. You breeze in, tell me how the lights have to be like this, and these lines need to be like this and so on. I am respectful of those requests. I like things a certain way too.. try to be mindful of that. The road goes both ways here. The same goes for documentation. Maybe you could ask me why I wrote a certain thing before you scratch it out and write error... although all the extra embellishments make my flow sheet look freakin fantastic, right?
When I ask you about something, especially when its a policy and the rationale for not following it... I just love when you get mean and flash those *knowing* looks to all your friends at the desk.
Precepting with you has been quite the experience, and as life goes, all things must come to an end. Now that our journey is finished, know that I will *never* forget you.
Love, your preceptee
All of our residents have cork boards in their rooms above the bed. Recently we put little cards up on their boards. We drew stick people or put a P for Pal, H for Hoyer. Now when I go into a room I know if I can help that person or if I need to go get help. My CNA's know that I will help whenever I am available and they have no problem asking me to help with a lift. If I have the time and not on my way to do something important I will stop and help. When you have a few extra minutes and you see an aid going into a room ask them if you can go with them and help. They will appreciate the extra hands and after a while they will see that you really want to be a helping hand and they will appriciate the help that you can give.
When I was a CNA in LTC, our facility had each resident's care plan posted on the inside of their closet door. In this way, any staff member could easily refer to the care plan. If you know where to find the residents' care plans, you can simply check and see if they are a stand-by assist, one-person, two person, etc. and if they are a SBA or assist x1, you can go ahead and potty them yourself, for example. The only consideration would be if you have the time. I know that for myself, the fifteen plus minutes it takes to potty the average LOL, get her tucked back in, all her pillows adjusted to her satisfaction, etc., is fifteen plus minutes I don't have.
Ask them to show you, they will love to teach you, let them know that they are valued as your eyes and ears to the residents as they are with them most of the time and that you want to know more about what they do and how they do it so you can pitch in when you have time. I have had wonderful CNA's who loved to show "the nurse" what they did and how and many who were so helpful when I was new to a unit. Showing me where things were and telling me about the residents... They are some of the hardest working people I know... being a CNA is one of the toughest jobs I know of.... Now go Ask!
you can go to www.med-pass.com ......scroll down to forms and click on infection control log ......you can change it to suit your needs...hope this helps....this is similar to the one I use in our hospital
I agree, hospice is underutilized more so than abused! I think we live in a society that places too much emphasis on fighting death rather than embracing it as the natural process that it is. If I were a LOL agitated due to my advanced dementia, I would want that addressed. An agitated person is NOT a happy person. An agitated person is a scared, angry, frustrated, lonely person. The risks of sedation, in my opinion, are far outweighed by the benefits of feeling safe and calm. When I am that LOL, bring on the benzos!!!
The first time I passed meds was in a nursing home lunchroom. I sent some med flying across the room trying to push it through the backing. I learned after that to be very careful opening meds!
As far as the "pricking too hard" some patients are just fussy, and by telling your instructor it sounds like they might just have been trying to cause a little trouble, or for some odd reason thought they were helping teach you something. Perhaps they weren't excited about having a student, or what have you. The only thing you might want to try and change is letting the finger dry a little longer, perhaps he got a little alcohol or what have you in it and it made it sting more. Also the lancets at the hospital are bigger and people get very used to the finer needles they use at home and make a fuss no matter what.
Don't let these incidences break down your confidence, they aren't worth it.
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The absolute first place you need to go is www.apic.org, which is the Association of Practitioners of Infection Control. They, along with government agencies set the standards of infection control care. From there, I would check out the Joint Commission's website as well as your state Dept. of Health's epidemiology web site. Good luck to you!
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