How friendly are nurses?

How friendly are nurses? I would generally say nurses are very friendly however we frequently see articles in nursing journals of bullying in the workplace.

I pondered this while attending the Global Speakers Summit in Auckland recently.  I was over-whelmed by the friendliness of the speakers there, many of whom are very well known internationally. It was a level of friendliness I haven’t observed at the many nursing conferences I’ve attended and certainly gives an opportunity to reflect and see how this can be improved.

I asked a nursing colleague about this and asked her for her opinion. Her response was ‘that’s why speakers are successful and nurses struggle. The lack of genuine connection and sharing.’  She went on to say ‘nurses have been eating their young for years‘. She added that nurses would do well to build each other up and celebrate success not labour struggles.

At the Speakers Summit, I don’t recall a single time when a person walked in my direction without a smile and stopping to exchange pleasantries. Some of these people I knew or had met previously but many were first time encounters. Their responses went beyond pleasantries and extended to engage in a conversation that created connection and sharing and a sense of belonging. A pleasant change and one I hope we can do more to foster in nursing. Surely our patients and their families would benefit hugely if we can all be a little more compassionate and patient, and show genuine interest in each other.

A colleague offered the following explanation as to why nurses rush and lack apparent friendliness at times. ‘Nurses jobs have become about the task and the paperwork , with fewer nurses looking after more patients. And whilst there are still some who manage to make time to connect with those in their care, there are many more who are on a treadmill running from task to task.  Many of these nurses are then given students to look after and they do their best to make it a great experience in difficult circumstances. That rushing and being task focused doesn’t do the best job of mentoring and teaching and doesn’t support the best possible care which otherwise might be achieved. Perhaps if the health care system had more nurses and less management you would see a lot more friendly nurses.’

How do we as a collective ponder and plan for change to improve not only the outcomes of what we’re trying to achieve as nurses, but provide a much more enjoyable workplace for all those in it? Remembering that in residential care, the workplace of nurses and care-giving staff is also the home of residents needing support.

Aged Care Managers and Nurses Study Days

April 12th and 13th, 2018 – Christchurch

Presenters: 

 

Gillian Robinson – Bachelor of Nursing, Registered Nurse, Lead Auditor, Management Consultant, Author
Liz Beaglehole – New Zealand Registered Dietitian, with a Post-graduate Diploma in Dietetics (with distinction), Canterbury Dietitians.
Ben HarrisMedical Laboratory Scientist, Honorary Lecturer for the University of Otago

Incorporating clinical and management topics, these study days are designed to provide the opportunity to learn together and gain a greater understanding of each others roles and aged care industry expectations. Gain your professional development hours by joining your colleagues for two fun days of learning.

Topics include:

Day One – Thursday 12th April – 9.00am to 4.30pm

  • Age-related Residential Care (ARRC) – understanding the DHB funding service specifications
  • Quality and Risk Management – striving and achieving excellence
  • Clinical Leadership – how to lead the clinical team effectively
  • Clinical Documentation – What, when, how and why to document
  • Clinical Assessment and Care Planning – bringing it all together for better resident outcomes
  • Microbiome – why understanding this is so important
  • Multi-Drug Resistant Organisms (MDROs) – the current and pending impact

Day two – Friday 13th April (9.00am start, finish approximately 1.00pm) 

  • Urinary Tract Infections – to dip or not?!
  • Norovirus and Influenza – latest updates
  • Food Safety – Food Safety and Nutrition
  • Question and Answer session

Attendees will supply their own lunch.  Morning and afternoon tea will be provided.

Venue: Chapel Street Centre, Cnr Harewood Road and Chapel Street, Papanui, Christchurch.   (Easy access from the airport)

Numbers will be limited so register today.

To register – email gill@agedcarecompliance.com and supply the names and designations of each staff member attending, and confirmation if they will be attending day one or day two or both days?

 

The attendance fee for this content filled education is $155 (plus GST per attendee to cover both days), $85.00 plus GST per attendee to cover either day one or day  two.

We will respond with confirmation of registrations. Certificates of attendance will be provided.

Moving  and Handling People – Good Practice Guidelines – December 2017

The Draft Moving and Handling guidelines are currently being finalised with the view to be implemented from December 2017.  Developed by Worksafe, they cover Health and Safety at Work Act 2015 (HSWA) duties and risk management for PCBUs in the health care industry and supersede the 2012 guidelines.  There are a range of factors noted in these which need to be taken into consideration for those building new facilities or doing refurbishment of existing facilities. There is also a raft of information on Bariatric Care which is an increasing part of the services being provided in residential care.

The draft guidelines include the following:

Please note that there is not a complete consensus on the criteria for classifying a person as bariatric based on weight or Body Mass Index (BMI). However some examples include those people:

– with a body weight greater than 140 kilograms.

– with a BMI greater than 40 (severely obese), or a BMI greater than 35 (obese) with co‑morbidities.

– with restricted mobility, or is immobile, owing to their size in terms of height and girth.

– whose weight exceeds, or appears to exceed, the identified safe working loads (SWLs).

Health risks for bariatric clients

People who have been bariatric for a considerable time face chronic and serious health conditions, many of which should be considered before moving or handling them. Health conditions to take into account include:

– skin excoriation

– rashes or ulcers in the deep tissue folds of the perineum, breast, legs and abdominal areas

– fungal infection

– bodily congestion, including causing the leaking of fluid from pores throughout the body, a state called diaphoresis, which makes the skin even more vulnerable to infections and tearing

– diabetes

– respiratory problems

– added stress to the joints, which may result in osteoarthritis.

Planning for bariatric clients:

The planning process for bariatric clients in order to reduce moving and handling risks should include:

– admission planning

– client assessment

– communication

– room preparation

– mobilisation plan

– equipment needs

– space and facility design considerations

– planning for discharge.

Facility and equipment needs for bariatric clients

Health care and other facilities providing care for bariatric clients need to provide adequate spaces for these clients. Some considerations could include:

– ramps and handrails at entrances

– bariatric wheelchairs

– that the facility’s main entrance has sufficient clearance

– adequate door clearance and weight capacity in lifts

It must be remembered that the above comes from a draft but as drafts often end up being very close to the finished document, I felt it timely to share this information. To read more on Health and Safety in the Workplace go here

Understanding the Change Process

When undertaking a change management process in care facilities, I’ve identified 5 distinct phases of reaction from managers and staff.  These have often occurred after I’ve been appointed to perform the role of statutory (temporary) manager by a DHB. This is generally after risk to residents has been identified following an audit or a serious complaint.

As a temporary manager, often there is a facility manager in place however for a range of reasons doesn’t have the resources or knowledge to meet the needs of the residents to a standard that satisfies audit outcomes.

Phase 1 is on first arriving and there is relief on the part of the staff and manager (if there is one) on the basis they have the view that I’m there to ‘save the day’, make things right and then they can get on with running things.  Comments such as “you should have been called in a long time ago” are common.

Phase 2 is where the staff and in place management start to realise that I’m not going to do all the work for them and my role is that of mentor and coach. Further to that the role includes assistance with obtaining necessary resources to support clinical and operational practices. This is where push-back and resistance starts to show as people resist change and try to hold stead-fast to those practices that have got them to the point they’re at.  As pressure increases for change to occur, resistance increases and at times sabotage of the new way of doing things starts to appear.  As one provider put it recently “they’re ever so nice to your face and will stab you in the back”. The denial phase plays out and the anger phase starts.

Phase 3 is a time when divisions start between those who want to embrace change knowing it’s intended to improve and make the workplace safer for staff and more so, safer for residents; and those who don’t have insight to recognise the need for change.  The need for people to remain in their comfort circle doing what’s known and predictable is incredibly strong for a large number of people. This slows momentum and the temporary manager starts to get the blame for things being wrong.  Such comments as ‘it was all fine before the DHB stepped in, they just need to back off and let us get on with it’ are also commonplace in this phase. Sometimes senior staff at the facility will contact their DHB and say the temporary manager is unreasonable, not doing anything and needs to be removed. All as an attempt to get rid of the person they see as pushing them outside their comfort circle and affecting maintaining of the status quot. The bargaining phase can continue for quite some time but this often depends on how direct and steadfast the response is to the bargaining strategies.

Phase 4 occurs when there is the start of the depression phase and realising that solid work, participation by all and a willingness to take on new ideas and learn new ways of doing things needs to occur. The real work has started by the willing few in the early phase and continues and now the collective change can start to be evident.

Phase 5 is acceptance that the temporary management or change management process was necessary. Staff start to commend the new way and embrace new ideas recognising that things are actually better now than they’ve been before.  As people always have choice about coming on board with change or leaving, invariably there are some staff and sometimes managers or even members of Governance who continue to resist seeing a new way is needed and those few will leave the organisation or continue to resist.

I’m able to observe which phase an organisation is operating in by the response of those working there and was intrigued to read of exactly this same set of steps in a book titled ‘Expert Secrets’ written by Russell Brunson. Some of you who are familiar with the work of Elisabeth Kübler-Ross will also recognise these phases as reflecting her stages of grief.

Acceptance is hard as people take the need for change as a criticism when in my view, people don’t fail; systems do!!

Clinical online tools for Aged Residential Care

HCSL are pleased to announce that from January 2018, you will be able to access clinical online tools for:

  • Initial assessment and initial care plan.
  • Short term care plans (and evaluations)
  • Long term care planning (and evaluations)
  • Progress notes
  • Restraint/ Enabler restraint management (and evaluations)

All mobile device compatible so you can be with your residents rather than stuck in the office!

HCSL bringing cost effective, specifically designed tools for the New Zealand residential care sector.  The Corporates have their tools, why shouldn’t you have the same advantage?!

 

To find out more and get a no obligation free quote for use contact us here.

 

Testimonial from Tainui Village – New Plymouth

Upon reading one policy everything fell neatly into place. I found her documentation to be outstanding.  It is very reassuring to know that every policy and procedure is the most up to date and designed to meet audit requirements.  All her forms are easily accessible and very user friendly.   We can instantly benchmark against others.  At the click of a button we can analyse falls, infections and adverse events.   Creating graphs and other information for Board reports takes minutes rather than hours.

Having come from a background of many years in QA, HSE and Electronic Document Management in the Oil and Gas Industry, when I entered the aged care sector, it was a huge “eye opener”.  After sitting through several handovers and meetings and listening to discussions on medications etc I felt as if I was listening to a foreign language.  Oh my goodness I thought and then Gillian’s documentation arrived together with a visit from her shortly after.

Gillian’s enthusiasm and commitment for both the aged care sector and her documentation is contagious.  I feel I can now discuss, with the knowledge I have acquired in a few short months, aspects of aged care I never knew existed.  Gillian is only a phone call or email away and all queries are always answered promptly, no matter how minor.

 

Thank you very much Gillian.

Lois Lash – Quality Assurance

Tainui Village –  October 2017

 

Testimonial from Shoal Bay Villa Dementia Care

Dear Gillian

As noted previously, I have sold my business.  Thanks so much for your fabulous support and encouragement and especially the ‘find me’ conversations we had; so without much ado, I will say ‘cherrio’ and depart quietly.

I wish you the very best going forward with all your ventures and I am sure you have something new on the go as you never seem to sit still….

Warmest regards

Nadene Elrick

Owner – Shoal Bay Villa (Northcote, Auckland)

HCSL Mobile app for Internal Audits

Mobile app now available for conducting your residential care ARRC specific internal audits.

There are a full range of internal audits pre-loaded ready for use. Collectively, these audits reflect the criteria Certification auditors will be checking.

 

This process gives you the opportunity to be sure you’re on track with achieving compliance. The findings auto-populate into corrective action tables which prompt timely addressing of these corrective actions. This system syncs with your main computer system and makes reporting to management and Governance boards very easy.

 

The Certification auditors (after given specific access authority with your permission) are also able to access the results of the internal audits you’ve completed.

To view a brief video on the use of this system, click here.

Attendee Testimonial for Aged Care Education Study Day – July 2017

Topics included: Quality & Risk Management, Clinical Leadership, Clinical Documentation, EPoA, ARRC, Communication and Difficult Conversations

 

I am writing this endorsement on behalf of my colleague and myself, in relation to our attendance at the study day you hosted 5 July 2017.

The topics you presented were most relevant to our Registered Nurse role within the aged care sector, and between us both provided new learning opportunities, as well as refreshing the current knowledge we already held.

You addressed each session in a professional and engaging manner that held our attention, complemented by comprehensive written material as well as PowerPoint presentations, along with plenty of opportunity for questions and comments from the floor.

Gillian you are one of very few speakers that is able to hold my attention for more than one session let alone a whole study day, a perfect balance between speech and conversational styles!

We were also most impressed by the quality of the complementary gift bag that was given to each attendee containing not only goodies to help us through the day, but with something to take back to the workplace, I acknowledge both Cubro and Ebos for their support with this.

The venue was great with easy access and good parking, and it was clean and refreshing providing plenty of comfort and personal space for those attending. I will be recommending my associates to make a note in their diary for next time. Thank you Gillian

Kind regards

Lyn Black

Bloomfield Court Retirement Home – Canterbury

Dysphagia Diets – Are we all understanding each other?

Dysphagia diets and a lack of understanding of how to implement them consistently, is increasing risk to residents in aged residential care services.

Texture modified diets are commonly used in aged care facilities to manage the risk of aspiration pneumonia and choking with eating and drinking.  Residents with dysphagia may be placed on a texture modified diet following assessment with a speech and language therapist.  However there are often a range of terms used for texture modified diets, and differing opinions on exactly how the diets should be prepared.

 

Confusion with terms, and the types of foods and fluids offered leads to increased risk of harm for the resident.  This is particularly obvious when transferring from one facility to another.  Information on texture modified diets is passed to the new facility who may use different terms.  For example a site may report ‘this resident requires a soft diet’ and the interpretation of this diet at the new facility is to puree all food.

 

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a framework to standardise terminology and offer simple testing methods to check that the preparation of the diets are correct. Dietitians New Zealand and Speech Language Therapists of New Zealand have endorsed in principle the IDDSI framework.

The goal is to reduce the risk of harm for our patients and residents due to miscommunication and poorly prepared texture modified diets.  It is important to note that the framework relates to dysphagia diets only.  Residents may be on a modified diet due to other factors not related to dysphagia.  For example a resident with no teeth may need softer foods but can actually manage sandwiches.

The good news is that for many sites, there is very little change needed as they are already using the correct terms.  The diagram above shows the new terminology and the minimal change in wording;
  • ‘Smooth puree’ becomes pureed (which is also extremely thick fluids)
  • ‘Minced and moist’ remains unchanged
  • ‘Soft diet’ becomes ‘soft & bite sized’
  • Moderately thick and mildly thick remain unchanged for thickened fluids
The IDDSI framework assigns standard colours and numbers to assist with easily identifying texture modified foods and fluids.  Some manufactures of texture modified foods and fluids are looking at ways to incorporate the terms, colours and numbers onto their food packaging.

 

Food and Fluid Preparation and Testing

The IDDSI framework offers simple tests to check that the thickness of the fluids or the size of the particles for modified foods are correct.  The tests use forks, spoons, fingers or syringes – equipment that is readily available at sites.

With training and education on how to do these tests, kitchen staff and managers will be able to easily check their texture modified diets and thickened fluids are prepared correctly.

 

IDDSI App and Website

The IDDSI framework have developed many resources and videos to assist with the standardisation process.

Download the app https://play.google.com/store/apps/details?id=com.appdataroom.iddsi&hl=en

or go to www.IDDSI.org

or ask your dietitian and speech language therapist for more information.

 

Where to From Here?

Here are some small steps to help implement the IDDSI framework at your site:

  1. Stop using any terms that are not on the framework. The term ‘mouli’ is not recognised and should not be used to describe a texture modified diet.
  2. Download the app or look at the IDDSI website to familiarise yourself with the framework.
  3. Try testing one of the textures you currently prepare. Does the ‘puree diet’ your site produce pass the spoon tilt test?  Does the size of the minced food for ‘minced & moist diets’ fit between the prongs of a fork?  Is the size of meat offered for residents on the ‘soft & bite size diet’ the size of your thumb nail?
  4. Ask your dietitian or SLT for further training on the correct testing and preparation of dysphagia diets.

This article was contributed by Liz Beaglehole NZRD (Canterbury Dietitians) and Anna Miles PhD, Speech-language Therapist, Senior Lecturer, Speech Science, School of Psychology. The University of Auckland.

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