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It's All About the Cookies

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Specializes in LTC, Rehab. Has 5 years experience.

It's difficult to summarize - I'm using 'cookies' both literally and as a metaphor for little things making a difference in patient care, and patient contentment, in LTC facilities, but the same argument/principle could be applied in most patient settings.

It's All About the Cookies

I became a nurse in my 50's. I stumbled a bit on my own after passing the NCLEX, unsure of what I wanted to do. A short summation of that time period is that I ended up totally by accident working at a LTC/rehab facility.

On my first day there, I was sitting in the DON's office, doing a tutorial and learning the computer system. The noise of the place kept creeping into my consciousness, and I thought 'Wow, it's not just a place of death - it's full of life!'. And although I've witnessed and heard about many deaths there since then, that initial thought has never totally left me.

I'm too busy to think about these things all of the time, but at least somewhere in my subconscious or conscious is the fact that these people - 'my' residents - actually live there, silly or obvious as that might sound - and that for many of them, this is their 'final destination', with a whole different meaning than the one the flight attendant mentions when your plane is pulling up to the gate. I'm far from perfect, but I think that some of my co-workers forget that sometimes. (And don't we also sometimes forget - just thinking of them as 'Mr. Smith' or 'Ms. Gonzales' - that this is actually someone's mom, dad, grandmother, grandfather, uncle, aunt, etc.?).

So besides trying to provide the best medical care I can, I try to get along with every resident, no matter how cantankerous, angry, frustrated, scared, or confused they are. Sometimes it's impossible, or nearly so, but the vast majority of the time I find a way to connect with them on some level, and just one positive thing (of several) that comes out of that is that I rarely have residents who will refuse their medications, even to the point where sometimes I'm the only, or one of the only, people they'll accept them from. Perhaps a downside of them being cooperative, and sometimes liking their nurse, is that they may try to get a little too close. We do have to maintain some level of professional distance, but at the same time, we don't all have the same definition of just exactly what that is.

This isn't about trying to say how great I am, nor putting down anyone else. Nor was it a plan. But treating patients with respect, your best care, and helping them hold on to whatever dignity they still retain - often in small spaces, and sometimes in adverse situations - can provide better medical care (re: not refusing care and/or meds), and I think they are at least a little more content as well.

One of my long-time and favorite residents once said to me, in her charming but broken English, having just gotten some cookies from the snack cart, something like 'The cookies are important', and then gave me a sly little grin. Yes, she had health problems that made cookies perhaps not the best thing for her to snack on, but small everyday pleasures like that are one of the few things our residents enjoy. Life is short, and as someone said, 'Everything in moderation - even moderation'.

It's a crazy, chaotic job, and I just try to do the best I can every day - and hopefully learn something as often as I can while I'm at it. Little everyday things can often make a difference. Without meaning to sound too treacly, I'll just end with a Mark Vonnegut quote I've always liked. "We're here to get each other through this thing, whatever it is."

In memory of S., my friend.

RN at a transitional rehab facility; I've been working in LTC/rehab facility for almost 4 years. Prior to that I was an IT guy for many years. Got my BSN at 54.

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7 Comment(s)

This is a really nice vignette of how it could be in LTCs where nurses encounter difficulties of cranky residents and have to overcome barriers like refusing meds. What kind of long term care center is this, and how does one spot a good one? I'm thinking from the perspective of an aspiring nurse practitioner, but also as a person who has parents who may eventually want to live in a nice community for their "final destination" as well, who knows. I actually really hope to buy them a rancher in the future where they can have some relaxing days after working so hard their entire lives. But if they want to go into a community with other elderly folks, I would want to find a really nice place and some of the stuff I hear about like not changing dressings, understaffing, outdated facilities, etc, those things are unacceptable. I'll build my own if I have to, but it would be good to know for now what are some model LTC facilities that have set the bar really high.

djh123

Specializes in LTC, Rehab. Has 5 years experience.

The facility I work in certainly isn't a 'model' one (I could go on and on :^)... I just do the best I can with what I've got. To find a great facility, I'd look at online reviews, I'd tour some places, and I'd ask if I could talk to some residents, family member(s)? (not sure if that would be possible), and perhaps staff.

There are excellent places that provide care. 99.9% of the time it isn't about the fancy amenities. . . it is driven by the number of caring staff who work there. It is clear that djh123 is one of the drivers of quality and care in his facility. Kudos to him as he is also role modeling behaviors for the rest of the staff!

Elder care choices are difficult at best. In the most ideal of worlds, working with parents or other older relatives to see what THEY want is the first step. Unless one has strong finances or an extended family network, complete live in home care may not be possible even if it is the hoped for choice. It is always best to have these conversations early. Tour assisted living facilities or senior living communities in your area well ahead of time (alone). Know what is out there, move in costs, and monthly charges and WHAT is covered in the charges. If there are attached SNF or memory care units it is good to know that some options are there instead of an additional move.

My mother was in a local assisted living community with fabulous amenities. To our dismay, after just a few months her personality changed and she was refusing to go down for meals, incurring extra costs for in apt meal delivery, etc. The staff recommended that we consider shifting her to their memory care area where she would see staff all the time etc. It was the hardest thing we ever did. I cried more than mom. Long story short, her sudden memory losses and personality changes were related to a cancer that was discovered by accident a few months later. During that time she acclimated rapidly to her new apartment, made friends, continued our traditions of taking her out for lunch, dinners with our family, church services etc. When I called the administrator to find out if she could continue hospice care there or if I had to move her (again), I cried tears of joy because the response was "this is her home now, of course she comes back". She lived fully for another 9 months.

Bottom line, find out what the facilities provide for options, including those unexpected needs; decide what you can afford if you need to supplement their incomes for in home or community living services well before it is time to need them.

smartassmommy

Has 1 years experience.

A dream LTC to me would be a small scale Kirkbride plan facility, staffed with enough CNAs to give each resident top notch care, enough nurses to give each resident timely assessments, tx, and attention, and to properly supervise the CNAs, activities with plenty of variety that match the needs and values of the residents, and a dietary staff that will prepare delicious meals.

BeenThere2012, ASN, RN

Specializes in PICU, Pediatrics, Trauma.

Yes...Cookies are important. I just started a new position in a new specialty for me...Adolescent psych. It is common for the patients to have trouble sleeping due to any number of causes, but anxiety, fear, worry are most common. One night I asked a patient if she would Like some tea. (She also had a sore throat from a cold coming on). She said yes and the next day she thanked me saying how much it helped her relax. The next day on my shift, I brought in a box of camomile tea. I offered it to a few who had trouble sleeping. They LOVED IT! The next day I also brought in cookies. Within a few days, camomile tea and cookies became the nightly routine with several patients a night requesting some.

What I found, in addition to helping them sleep, was that at each doorway when I handed the cup of tea and cookies to the patients, they opened up to me more. It was an opportunity to wish them "pleasant dreams!". "Hope you sleep well tonight." "Hope you have a better day tomorrow.", and it established a night time routine for them. It has been that little "extra care" that brings comfort, shows care and concern as well as a bit of one to one time that is so hard to do in busy psych hospitals. During the day when I come in for PM shifts, the kids all yell out, " Hi (my name)! Are we getting tea tonight?". "I love that tea.". " You bring the best cookies.". It has helped establish rapport and cooperation at other times as well. It takes a bit of time to do now, and often I am there past my shift completing paperwork etc...off the clock, and please don't even go there about how I shouldn't be working off the clock...This little bit of "extra care" is clearly something these kids need and it makes a world of difference for them in several ways, and my job a lot easier with them as they know I care.

djh123

Specializes in LTC, Rehab. Has 5 years experience.

This little bit of "extra care" is clearly something these kids need and it makes a world of difference for them in several ways, and my job a lot easier with them as they know I care.

Thanks! Enjoyed reading your experience, and I think you've done very well with them.

audreysmagic, RN

Specializes in Psych, Peds, Education, Infection Control. Has 15 years experience.

I know this is a little old, but I loved this article.

I'll never forget when I was on an adolescent psych unit watching a fellow nurse argue with a kid over an extra cookie. She was NOT giving it to this kid - no way, no how. No dietary restrictions, just stubbornness on both sides. This was a tiny hospital and the CEO (who had actually been a floor nurse once upon a time) happened through to see this...and he stops and asks the nurse, "Is this really the hill you want to die on tonight?" Sure, she was annoyed that the kid "won," but at the same time, we had a much better night overall. Every psych nurse I've met has at least one "we almost went to a security code over a cookie" story. I'm all for setting firm limits and enforcing them, of course, but sometimes...just give them the cookie!