Touch Base: The Role of Registered Nurses at Elite Care
At Elite Care Oatfield Estates Milwaukie and Fanno Creek Tigard we set out To Fundamentally change the way housing and health care is delivered to the elderly. To do this we had to understand the architecture, culture and environment. It is important to understand the Register Nurse position and how they deal with our residents.
The role of the RN in dealing with a frail population weather they have dementia, Alzheimer, memory care and other ailments that come with old age.
Why touch base is important and how is it one of the major spokes in our wheel.
We are a relationship based organization. Relationships are formed and reinforced through the junction of time and space. This is true of all ages, when we consistently meet the same person in the same place at the same time we normally develop friendships with that person.
We are pro active not reactive this takes a set routine in which we observe and record functioning levels looking for changes. We then try to act on those changes. The recording of observations in a controlled environment that is consistent and routine gives us the best environment to notice real changes not changes that might be related to environment or other outside forces. This means same time same day same script.
We talk about the residents being in control to be in control you need to know with a certainty that something is going to happen. This allows you to make the decision to be there or not, to prepare or not, to be nasty or nice. When things are random, our options are eliminated through our anxiety of not knowing when something will happen or how it will happen. The power comes from understanding what and how something is going to happen and being able to make the decision on how you are going to respond.
This gives us a forum to explain to the resident how important they are from a professional member of the community. Nurses have a high level of respect, so if they are reinforcing out residents BIP Belonging (How grateful we are they are part of the community) Influence (how important their feedback is at these sessions) and Purpose (taken care of themselves and how that allows us to attend to the more sick residents). Every time we get the opportunity to reinforce BIP, especially with people in authority we elevate the well being of our residents. If we present ourselves as people in authority then what we say will have a much greater impact, they will listen obey and follow our directions.
White Coat effect. When you set up a prescribed meeting and you do it consistently it becomes one of your weekly mile stones. Elders need very few weekly mile stones to be able to orient themselves to the week. If one of those mile stones deals with keeping them healthy and safe, then they will get a comfortable feeling that they are getting good health care. If we send the results to their gate keeper or physician then they will feel like their parent is getting good medical care. If you feel like you are getting good medical care you are getting good medical care. If you are getting good medical care then you are healthier and stay healthier. It is a natural placebo effect.
When customers feel heard and attended to they give you the benefit of the doubt when something happens.
Teaching families and residents not to be incontinent. If we give the residents and family members a forum to hold their questions for and a prescribed time and place to ask those questions they will wait most of the time. If there is not a prescribed time they will interrupt us and just ask whenever it comes to their mind. By having a routine set up allows for these questions to be asked in a safe and consistent environment, not only will the questions come when we are ready for them, but we will get questions that they might not otherwise feel comfortable asking. This is their time to talk about their issues with a person of authority.
At this point we are thinking our residents have dementia and do not know if the meetings are consistent, have no ability to remember and ask questions, and in general are not able to have legitimate feelings, that they are being well taken care of in a medical way. Yes this is the industries normal reaction. They also lock up the residents and over medicate them, because they are so hard to get along with. If we expect the residents to act normally we have to assume that they are normal the results will amaze us. If we do not honor our schedule appointments with our residents we will be telegraphing to them that they are indeed marginal and that is how they will act.
Third level of effect
Gives us a consistent and effective way to reassure both family members and residents that they are getting superior health care.
Gives us a reason to communicate with families and or professionals on a routine and important issue. Allows for family members to give observational feedback, history and help in triaging any potential problems.
Gives us vital sign and anecdotal information that the residents should take with them to all professional visits. This will greatly increase our standing in the community and will allow all of the contacts to give us the benefit of the doubt if something does happen. Law suits do not occur because of bad outcomes they occur because of bad communication.
When we are in this constant communication with the prescribed family member, physician or case worker then, we can use the opt unties to promote our culture, needs, or vacancies. Out of sight out of mind, we want the clients (the families) to be thinking about us to volunteer with us and to spend time with their family members.
We will be able to trend the decline or stabilization of our residents from the direct observational (touch base) with sensor information to see if there are early indicators of potential problems that we can then program for.
Let’s now look at the real time it is taking up
If we have 36 residents we are doing this for, it takes up 18 hours. This is figuring 24 minutes of face time and 6 minutes of travel time.
Of those 18 hours at least 50% would have to be spent observing and recording the residents that are having problems anyway.
This leaves 18 residents that are taking up valuable time when they do not need immediate help or observations. They will consume 9 hours of time. If we are able to intercede in a coming problem then we will eliminate the intensive help that comes with an incident and the disruption of the flow we should more than save the 9 hours in future work.
What additional benefits are there?
Ability to have a consistent understanding of the residents so when incidents occur or sp reviews happen most of the information will be stored in memory speeding up both processes and saving considerable amount of time.
Consistent schedule review of resident’s documentation and quality of work that the RSC and PA are doing. This will allow for early detection of errant or misconceptions.
Quality control function for managing the houses. Housekeeping, food, activities and residents emotional well being. This goes to the out of sight out of mind or allowing a quiet resident to be neglected while we attend to the sweeky wheels.
By having a fix schedule of when we are going to see a resident the residents, the family members and the staff can save up questions or comments about that resident and ask the nurse at the proper time. If I see something wrong with a resident and I know that the nurse is going to see them a specific time I will comment at the appropriate time.
If the professional and leaders of the house find they are too important to have a fix schedule how we expect the rest of the staff to find a temporal organization important.
It is the rituals that we set up that will move our culture and environment in a positive direction.
It is the creation of opportunities to communicate our beliefs and culture to all stakeholders that will allow our culture to flourish.
Lack of contempt=rejecting or excluding someone from the community.
Part of the goal is to hone the RNs ability to MBWA. When we ask them to fill out questions on a resident that does not have the verbal skills or emotional wear with all to answer the questions directly they have to be aware of person as they are going about their everyday routines and remember their observations. Thus if I ask if a resident is being treated with respect my assumption is that they have observed the resident in their environment and the interaction of other people with that resident. To understand if a person is being should be a blink to a train professional. To understand if a resident has purpose should be evident in their actions do they get up in morning are they trying to take care of themselves are they washed do they have a twinkle in their eye???