#person centered

[stigmasticksandstones-blog]

Stop saying prison works!

Stop saying prison works!

  Stop saying prison works! It doesn’t work!   For a while I have wanted to write a blog which solely focuses on if custodial sentences are effective. The question ‘does prison work?’ has always been a topic of discussion but has been pushed to the top of the agenda recently due to the documentary which aired last week on STV in which Ross Kemp entered HMP Barlinnie in Glasgow for 10 days as an…

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[perks-of-being-a-nurse]

little wins

there’s a lady on my unit, she’s not my patient, she’s not in the section i’m working in, but i’ve seen her before and i’ve talked to her and i know a bit of her history, let’s call her Nancy*. she’s been identified as violence risk. she yells, she get’s worked up easily, she can be really mean, she swears at people, she’s resistant to car, and she’s been know to hit staff members. she isn’t oriented; i’ve never seen her on a day where she’s been oriented. sometimes she knows she’s in hospital, sometimes she thinks the hospital is her home, and sometimes she doesn’t know where she is but she knows it’s not right. she often thinks that all the staff are her children and she has to take care of them. “you don’t need to ask me, i just want to know where you’re going and that you’re safe,” was something that she said to me once. she has dementia.

she’s aap. aap stands for “assessed awaiting placement”. usually these patients are waiting for a spot in long term care, but they could be waiting for assisted living, supportive housing, rehab, etc. Nancy has been on our unit for months. there’s not spot in long term care for her. because of her behaviour there aren’t many facilities that can give her he one-on-one care that is sometimes needed to manage her behaviour. the main reason she’s still in hospital is because we need to get her behaviour under control.

before she came into hospital she lived at home with her son, but her behaviour was difficult at home as well and her family didn’t know how to handle her. she would wander away from home, she was violent, sometimes with her grandchildren, she would yell, and her kids would yell back. it wasn’t good for anyone for her to be at home any more

in clinical recently, i happened to walk past her door. she was sitting in a chair with a tray on it, presumably so she couldn’t leave her room and bother other patients, which she has in the past. her hair doesn’t have foot rests. she’s not a big lady, and when she sits in the chair her feet don’t touch the ground. she found this uncomfortable.

i went into her room, chatted with her for a bit, and figured out what was bothering her. she asked me to comb her hair, and i did, which she was really happy about. she told me about how recently she had seen herself in the mirror recently and cried because she didn’t like how she looked. we talked a bit more, and then i went and got her a foot stool which she was really happy about.

i say with her and talked for a while, and while i was sitting there with her an ecg tech walked into the room. i knew this would be a challenge. Nancy is often resistant to care. the ecg tech came in and the three of us started talking. the ecg tech explained why she was there, that she wanted to put the leads on so the doctor would could take a look at Nancy’s heart. “he knows what’s going on with it he has the whole time i’ve been in here!” she would say.

they wanted to do a 24 hour holter. i think the ecg tech knew that the leads probably wouldn’t stay on for a whole day. “just try it,” we said, “you can take it off if you real don’t like it, but it would help the doctor to know what your heart is doing.” it took about four tries for her to put the leads on, and probably took a little under half an hour. we had four separate conversations and i’m not really sure what happened in any of them.

after we got the leads on her, her son arrived. having her family around always grounds her. it makes her so happy. her son is probably her favourite person in the world. he got her up, and took her to get a coffee and she was in a great mood.

the leads might actually stay on today.

*names and identifying details have been changed to maintain patient confidentiality

[this-is-me19]

I don’t understand this world we live in.

I don’t understand how giving a little bit of respect is hard, how giving a little bit of kindness is hard.

Being a caregiver means caring about the people you’re taking care of, not view them as nothing but a means to an end—“just another job”.

I don’t understand this selfishness.

Our charges, our individuals are supposed to trust us, initial strangers to essentially “paid” friends, but if we disrespect them and don’t care about them, how can they know nothing but abuse? We are to show them care and support.

Why are they being put upon in this manner?

They are people, some adults and some children. They need this assistance to function and have a good quality of life. That’s our job in this instance.

I just don’t understand how we have a right to treat them harshly when they have limitations to their understanding or ability to communicate.

You’re there to care. That means treating them as human, as a friend and get to know them, let them into your heart.

One day, maybe, unconditional love.

I just don’t understand this world.

[tndda]

Person Centered Practice Update

The Person Centered Practice “It’s My Life” campaign ends August 31, and the winner will be announced next month!  Get those “It’s My Life” wristbands out in one last push before the campaign ends!

Our Person Centered Organizations are now listed on the DIDD website, under the Person Centered Practice tab at this link.  In July 2018, we will begin listing “active” or “inactive” status on all PCOs depending on their ongoing progress with PCO expectations.  Please reach out to the Person Centered Practice department with questions.  Applications for new Person Centered Organizations will be going out at the end of the month.  Look for an email from Person Centered Practice and an announcement in Open Line.

We are still requesting magazine donations, especially men’s, lifestyle, and nature magazines, to use in our People Planning Together workshops. Contact your regional office to schedule donations.

Upcoming People Planning Together Workshops:

West: September 26th and 27th at Support Solutions in Memphis. Please contact Janice Williams ([email protected]) to schedule West regional classes.

Middle: Please contact Kate Adams ([email protected]) to schedule Middle regional classes.

East: Please contact Caira Garcia ([email protected]) to schedule East regional classes.

[perks-of-being-a-nurse]

the thing that i wrote for the publication that the facility we’ve been in does

so, this is the piece that i wrote for a publication that the facility we've been at does every year. it's kind of based off a bunch of stuff that I said in this post, as well as some other thoughts. it’s written in a more formal way, so that’s a thing. i have edited it to remove identifying details.

In coming  __Up North__ to do my first practicum, I didn’t really know what to expect. Having my clinical at __The Facility__ has greatly exceeded all of my expectations. The staff here at __The Facility__ have been so welcoming and helpful. I have met so many amazing people that are so encouraging, and are happy to answer questions and facilitate our learning. I have also met a lot of great residents, and had the privilege to speak with them and hear some of their stories.

I think a lot of facilities try to practice person-centered care, but they aren’t succeeding to the fullest extent that they about be. I believe that __The Facility__ really embodies the principles of person centered care. A good definition for person-centered care that I found is “a way of thinking and doing things that sees the people using the health and social services as equal partners in planning, developing, and monitoring care to make sure it meets their needs” (link to the article this definition comes from here: http://www.hin-southlondon.org/system/ckeditor_assets/ attachments/41/what_is_person-centred_care_and_why_is_it_important.pdf ). In school we have called it patient-centered care, but they’re all just different names for the same thing.

Something another student said was that a lot of facilities seem to practice more “provider-centered care” than person- or patient-centered care, and I think that this is true to some extent. Daily tasks are done in a way that is perceived to be easiest for healthcare providers, but is not necessarily the highest quality of care that we can give our clients. Even though this may be the goal, I don’t think it’s really the case. Both staff and residents at __The Facility__ seem more relaxed and less rushed than in other facilities I have seen. I can definitely say that based on my limited experience, it is a much less stressful working environment. I’m not helping an HCA who has to get eight residents up, do all their care, and get them dressed before breakfast in the dining room by 08:15.

Person-centered care seems to me to permeate every aspect of the facility, down to the way the building was designed. Residents can wake up when they want, get up when they want, and eat what they want. There is evidence that letting people with dementia sleep until they naturally wake up can decrease confusion, agitation, and aggression, so it’s really in the best interest of clients and caregivers.

All the discussions around person centered care remind me of an article that I read, that I now can’t find anywhere, about adults with developmental disabilities. They asked adults with Down syndrome what one thing they would change that they thought would improve their quality of life the most, and the most common answer was that they got back was that they wanted to choose their own bedtime. What adult doesn’t get to choose their own bed time? Adults that live in facilities or are under the care of others; others who want to make their own lives easier by telling the people that they’re caring for when they should go to bed. One think a bunch of the staff at __The Facility__ talked about, especially on __the units__ where I was first, was that all the residents are retired, why should we tell them they can’t sleep in?

The past four weeks at __The Facility__ have a great learning experience. It is such a privilege to be able to work in such an awesome facility in the beautiful setting of __The North__. I will carry the teaching and insights into nursing practice that the staff have given me into the rest of my career. Coming __Up North__ for my practicum was definitely the right choice for me, and it wouldn’t have been the amazing experience that it was if it weren’t for __The Facility__.

[perks-of-being-a-nurse]

person-centered care

the clinical rotation i am doing right now is in long term care; here Up North they call it "continuing care", and at home back in BC they call it "complex care". all different names for the same thing. in the region where we are, continuing care (and I'm assuming the rest of the health care system here) is really big into person-centered care, also sometimes called patient-centered care. one reason that they don’t use the term patient centered care here in continuing care is that the people we work with aren’t really patients, they residents if they live in a facility, or clients if they receive home care help. 

person-centered care is a term I think that has been floating around for the last little while, and it has definitely been talked about in my BSN classes. a quick google search defines person-centered care as “a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs”. I think this is really great. that article also looks pretty interesting, although i didn’t read it all.

i believe that a lot of facilities try to practice person-centered care, but they aren’t succeeding to the fullest extent that they could be. something that another student said that i think is pretty true is that a lot of facilities practice more provider-centered care, that is that daily tasks are done in such a way that it’s easier for healthcare providers, but not necessarily the highest quality of care for clients. although, i think that this is not always the case. both the staff and the residents at facility where i am seem less stressed than at other facilities where i have been; everything is WAY less rushed. 

person-centered care seems to me to me in every aspect of this facility, even the design. the facility has four units that are each split into two sides each with 12 or 14 beds. each of these sides has a common sitting area, a dining room, and a small kitchen. all the meals are served here, and this is where the residents spend most of their time. each resident room has a bathroom with a shower. also on the units there is a shared bathroom, the chart room, report room, med room, dishwashing room, and a storage room. the unit i was working on was a locked dementia unit, so it was laid out slightly differently.

other than the layout of the units, the care is also delivered in a way that is very personalized to the residents. the residents are not woken up in the morning unless they really need to be for some medical reason. some residents are woken up briefly if they need some medications or to have their blood sugar checked, and then they go back to sleep. there was one resident that got up between 04:00 and 06:00, and other residents that would sleep in to 13:30. there is evidence that not waking up people with dementia can decrease agitation and confusion and actually leads to everyone having a better day (which i have seen be true). residents can choose what they have for breakfast, or choose not to have breakfast (unless they need to like if their blood sugar is low or something). they can choose if they want to eat their meals in the dining room or in their rooms, if they want meals later, it’s all good. they can also have coffee, tea, and snacks basically whenever they want unless there’s a medical reason for them not to. they can watch movies, listen to music, read books, hang out in their rooms; there isn’t really a set schedule. for bathing and personal care as well, they can refuse and that’s okay, unless there’s a health reason that they really need it like skin breakdown or infection control. they can also go to bed whenever they want, which means residents go to bed between 19:00 and 2:00.

i really like it there. 99% of the time, the vibe there is so relaxed, and i love it. it reminds me of an article i read on time (and now can’t find for the life of me which i HATE) that was about adults with down’s syndrome. the researchers had asked the question of all of these adults with down’s syndrome what was the one thing that they thought would improve their quality of life most, and the most common answer was that they wanted to choose their own bedtime. this killed me. what adult doesn’t get to choose their own bedtime? i love with my parents when i’m at home and my parents haven’t made me go to bed for two years, and i wasn’t even legally an adult in my province. one thing that a bunch of the staff at the facility kept saying that i thought was great was that they’re all retired, why should we tell them they can’t seep in?

i don’t know if this is the way things are done everywhere else and complex care is just really crappy where i’m from, but this place is great. 

[tndda]

Person Centered Practice Success Story

Sandra is 52 years of age. She has been receiving waiver services since 1992 with support from a corporate conservator.  Sandra is bright, funny and very much in control of her life, and her conservator respects her decision making abilities.  Her conservator only makes decisions when absolutely needed. In the past 15 years, Sandra’s cerebral palsy has progressively taken away her mobility and verbal communication. She has chronic pain due to her muscle contractions.   A few years ago it was determined that an iPad would help to reopen her world of communication and bring back a quality of life, as Sandra was somewhat socially isolated, by her inability to communicate.  She is able to read and spell and previously used an alphabet card for very tedious communication.  Having an iPad with voice output meant that she now could have real conversations.  

After receiving her iPad, Sandra began emailing and looking for friends. Most importantly, she told everyone that she wanted to go to college and get a degree.  Although she said that she received a regular high school diploma from another state, it could not be located.  She then decided that she would get a GED so that she could attend college as a degree seeking student.  Some people were skeptical but with her CoS on board, she began to make her dream come true.   Sandra quickly surprised everyone, passing her tests and earning her GED.  Together with a supportive CoS, she applied to Walters State in Morristown, Tennessee and was accepted.  Sandra wanted to study criminal justice, but when the time came, she surprised everyone by choosing to work towards an associate degree in business which would make her more employable.  There is a satellite campus close to Sandra's home that some felt would meet her needs.  Sandra, however, wanted a college experience and insisted on attending the main campus 25 miles away.  Sandra registered for her classes and set up her appointments with the disability office to determine reasonable accommodations that she would need to be successful.  Sandra is now a student at the main campus of Walters State, with a scribe to assist her in classes.  She has already successfully completed several essays and tests.  A professor has complimented her determined ability and work ethic.  Sandra has had substantial changes in her life especially socially.  She is on her way to making friends at school, and she is always on the go.  

For Sandra, the iPad has enriched her life.  Without it, Sandra may not have been able to achieve her goal of attending college.  Each time there was a barrier, Sandra and her CoS worked through it together and made things happen.  Sandra is a sincere and focused self-advocate.