Category: Medication issues
Posted by Dr. El - August 17, 2011 - Communication, Customer service, Medication issues, Psychology Research Translated, Resident care
“Come on now, Vera, honey,” the nurse said in a high-pitched, sing-song voice, “be a good girl and take this nice candy.”
Vera swung her arm and knocked the tiny cups of pills to the floor.
In their 2009 study, Elderspeak Commnunication: Impact on Dementia Care, Kristine N. Williams, RN, PhD, and her colleagues report that resistiveness to care increases nursing home costs by 30%. They examined the way nursing staff speak to residents and its impact on the level of cooperation of residents with dementia. They found that residents became significantly more resistant to care when nursing staff used elements of elderspeak such as:
- simplistic vocabulary or grammar
- shortened sentences
- slowed speech
- elevated pitch or tone
- inappropriately intimate terms of endearment
- collective pronouns (“Are we ready for our bath?”)
- tag questions (“You want to get up now, don’t you?”)
They found that residents with dementia were more cooperative when spoken to in normal adult talk, and suggest the following research-based strategies in working with residents with dementia:
- normal talk
- reorientation
- distraction
- positive feedback
- memory aids
Posted by Dr. El - January 10, 2011 - Communication, Medication issues, Resident care
THE PROBLEM:
Because of their personality styles, some nursing home residents don’t ask for their PRN (as needed, or “per request of the nurse”) pain medication when they need it. The reasons for this vary:
Psychologist, finding the resident in pain: “Why didn’t you tell the nurse?”
Passive: “I didn’t want to bother her.”
Macho: (grimacing) “I can handle pain.”
Forgetful: “I can ask for pain medication?”
THE SOLUTION:
- Counseling the passive or macho types about appropriate use of their pain medication
The forgetful person and those who don’t respond to counseling would fare better with:
- a standing order (medications dispensed at a specific time)
OR
- by having the nurse ask the resident if they’re in pain every time they’re eligible to get pain medication
Posted by Dr. El - March 2, 2010 - Books/media of note, Depression/Mental illness/Substance Abuse, Medication issues
I saw an article yesterday in the Health section of the New York Times describing the difficulty of younger people to imagine what life might be like in later years, particularly in nursing homes. I thought readers would appreciate it.
The old woman had drawn down the shade in her room — hoping, I imagined, to stop the midday Miami sun from penetrating her grief. But the sun still hit the window full force and illuminated the shade like a Chinese lantern.
She sat silently in a wheelchair, her 93-year-old silhouette stooped in the bathing light. I entered, held her hand for a moment and introduced myself. “Sit down, doctor,” she said politely.
Click
HERE to read the entire article.
Posted by Dr. El - September 29, 2009 - Communication, Medication issues, Resident care
I read a post on McKnights.com last week that so distressed me I had to wait a week before I was ready to blog about it. The article, Nurses, Relatives Underestimate Pain in Nursing Home Residents, Study Finds, reports the results of a five-year study in the Netherlands that shows a tendency to underestimate pain, particularly in people with cognitive impairment. What got me as agitated as a dementia resident with undiagnosed pain is that I’ve been reading about these studies since I got into the field over a decade ago.
A quick Google search of “pain management” and “nursing homes” turns up page after page of information about the consistent lack of recognition and treatment of pain. On the first search results page is a 2001
Brown University study noting “woefully inadequate pain management.” Also on the first search results page are numerous studies suggesting ways to alleviate this problem (for example,
tips from the End-of-Life Palliative Information Center and a 2002 National Institute of Health
report).
On April 10, 2009, the Centers for Medicare and Medicaid Services (CMS) issued new quality of care guidelines for pain management. I’m hopeful this will help to change the culture of tolerating pain in the residents under our care.
The next headline I’d like to read is: Treatable Pain Virtually Eliminated Among Nursing Home Residents Worldwide
Posted by Dr. El - December 8, 2008 - Communication, Medication issues, Resident education/Support groups
Talking to a medical doctor is not like talking to a normal person. In a regular conversation, one person says, “Hi. How are you?” The other says, “Fine. And yourself?” And they go from there. If busy Dr. Shah stops by Ms. Crenshaw’s room, inquires how she is, and hears that she’s “Fine,” he’s likely to be on to the next room before Ms. Crenshaw can utter another word. I prefer the Newspaper Headline Approach.
Newspapers grab the attention of readers by revealing the most important and tantalizing details first, so we’re compelled to read on. The same approach, applied to a visit from a physician, would look like this:
Dr. Shah: “Hi. How are you, Ms. Crenshaw?”
Ms. Crenshaw’s headline: “I Have Pain.”
Now she has Dr. Shah’s attention and he will almost certainly ask her where she has pain and other follow up questions.
Another possible headline: “I Have Two Things I Want to Discuss with You.”
This indicates to Dr. Shah that he’s going to need to stick around after the first issue is complete, and it helps him estimate how much time he can spend on each matter. Following the Newspaper Headline Approach, the most important problem is revealed first. This way, if Dr. Shah has to leave, at least Ms. Crenshaw had her most pressing concern addressed, and her doctor is aware there is more to be discussed.
Perhaps all this sounds simple, but it’s surprisingly difficult not to answer the question, “How are you?” with the response, “Fine,” even when we’re not. It takes practice to resist the temptation and tell the physician, from the start, what’s really going on.
