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 at 0800. Then the rest tend to stagger across the morning, with all resident's up for lunch by 1200 on most days.
I feel that this has worked well for the most part. We have been doing this since a few days before Thanksgiving. For the morning shift, it is calmer, and we have had fewer fights and behaviors. We do have a few residents that will stay in their pajamas most of the morning or all day, which is fine, as our unit is very warm. They are decent pajamas, not hospital gowns.
The PM shift isn't happy because of the few that do stay in pajamas, and then we do have a few that just don't eat breakfast after arising.
Yesterday, we had one resident stay in bed all day. This is a resident that has a habit of not getting out of bed until Noon most days as it is. However, yesterday, while allowing the CNA to change them, they didn't want to get up, not even to eat. That said, they missed breakfast, lunch and dinner. The resident is a diabetic, however, we do not do any accu-checks on, because of continuous refusal, or they would allow the accu-check, then refuse the insulin. I have never seen them run below 100, and tends to go high anyways. The morning Novolog is almost always held, r/t not eating breakfast, and when they allow it, the split Lantus is given at lunch with the MD Novolog and the rest of the AM meds. In addition, I had another resident get up at 1030, have a bowl of cereal (She usually just eats the cereal and toast at breakfast anyways), ate only her dessert at lunch, then go back to bed. She had a rough day the day before with insomnia and increased agitation and exit seeking, wanting to go home and see her family. Her VS were fine, this is behavior that we see on occasion with her.
Today, I had a resident sleep soundly until about 1330 or 1345 r/t them not going to bed until 0400 this am. We just let her sleep, didn't wake her for breakfast or lunch, didn't get her up for her shower, just let her sleep. The PM nurse was upset because we didn't get her up for lunch or her shower. This resident has been starting to flip her day/night schedule for awhile, and usually doesn't get up until 1100 as well. She sleeps in her recliner in the dayroom/dining room, so it isn't like she is isolated.
We don't have an open kitchen yet, however, have continental breakfast available to us in the morning, usually the kitchen is able to make soup and a sandwich after lunch, if we haven't pulled and saved the trays. They get plenty of fluids and snacks through the shift, especially the late risers.
I know that we are having weight issues, and have been having weight loss issues before the two weeks that this new schedule started. I have several that are on supplements, and the most worrying ones are on weekly weights. I understand that this is something that I need to be concerned with. However, for the most part, other than the ones that don't eat well to begin with, we are having increased intake at meals because they aren't sleeping at the table during the meals.
I apologize for this being too long, but I would really appreciate any constructive criticism to make this transition better for everyone involved. My DON has implemented this at her old facility but didn't have this specific type of population, either. I am still a fairly new nurse, having only been at this one facility, and working for just eight months.
I want what is best for my residents, and to decrease the amount of unnecessary anti-psychotics/anxiolytics that are being used for behaviors.
